John Charnley
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Sir John Charnley, (29 August 1911 – 5 August 1982) was an English
orthopaedic surgeon Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
. He pioneered the
hip replacement Hip replacement is a surgery, surgical procedure in which the hip joint is replaced by a prosthetic implant (medicine), implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) repl ...
operation, which is now one of the most common operations both in the UK and elsewhere in the world, and created the "Wrightington centre for hip surgery". He also demonstrated the fundamental importance of bony compression in operations to arthrodese (fuse) joints, in particular the knee, ankle and shoulder. Charnley also influenced generations of orthopaedic surgeons through his textbook on conservative fracture treatment which was first published in 1950.


Early life

John Charnley was born in Bury, in
Lancashire Lancashire ( , ; abbreviated ''Lancs'') is a ceremonial county in North West England. It is bordered by Cumbria to the north, North Yorkshire and West Yorkshire to the east, Greater Manchester and Merseyside to the south, and the Irish Sea to ...
, on 29 August 1911. His father, Arthur Walker Charnley, was a chemist and had a chemist's shop at 25 Princess Street; his mother, Lily, had trained as a nurse at
Crumpsall Hospital North Manchester General Hospital (NMGH) is a large NHS hospital in Crumpsall, North Manchester, England. It is operated by Manchester University NHS Foundation Trust. There is an accident and emergency unit, together with a maternity unit, high ...
. He also had a younger sister, Mary Clare. John went to the Bury Grammar Junior School in 1919, moving on to the
Senior school A secondary school, high school, or senior school, is an institution that provides secondary education. Some secondary schools provide both ''lower secondary education'' (ages 11 to 14) and ''upper secondary education'' (ages 14 to 18), i.e., b ...
in 1922. He had a scientific aptitude and was encouraged to study chemistry and physics. In the autumn of 1929 he gained admission to the
Medical School A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...
of the
Victoria University of Manchester The Victoria University of Manchester, usually referred to as simply the University of Manchester, was a university in Manchester, England. It was founded in 1851 as Owens College. In 1880, the college joined the federal Victoria University. A ...
, from where he graduated with a
Bachelor of Medicine A Bachelor of Medicine, Bachelor of Surgery (; MBBS, also abbreviated as BM BS, MB ChB, MB BCh, or MB BChir) is a medical degree granted by medical schools or universities in countries that adhere to the United Kingdom's higher education tradi ...
,
Bachelor of Surgery A Bachelor of Medicine, Bachelor of Surgery (; MBBS, also abbreviated as BM BS, MB ChB, MB BCh, or MB BChir) is a medical degree granted by medical schools or universities in countries that adhere to the United Kingdom's higher education tradi ...
and
Bachelor of Science A Bachelor of Science (BS, BSc, B.S., B.Sc., SB, or ScB; from the Latin ') is a bachelor's degree that is awarded for programs that generally last three to five years. The first university to admit a student to the degree of Bachelor of Scienc ...
(Anatomy and Physiology) in 1935.


First surgery and war service

From 15 August 1935, Charnley was appointed a House Surgeon at the Central Branch of
Manchester Royal Infirmary Manchester Royal Infirmary (MRI) is a large NHS teaching hospital in Chorlton-on-Medlock, Manchester, England. Founded by Charles White in 1752 as part of the voluntary hospital movement of the 18th century, it is now a major regional and nati ...
in Roby Street, and after three months he went to the main Infirmary where he completed his year as House Surgeon. As his friend David Lloyd Griffiths remembers, Charnley considered the possibility of becoming involved with
cancer Cancer is a group of diseases involving Cell growth#Disorders, abnormal cell growth with the potential to Invasion (cancer), invade or Metastasis, spread to other parts of the body. These contrast with benign tumors, which do not spread. Po ...
research, but most of his professors thought it was a waste of time and dissuaded him. He planned to achieve the status of
Fellow of the Royal College of Surgeons Fellowship of the Royal Colleges of Surgeons (FRCS) is a professional certification, professional qualification to practise as a senior surgeon in Republic of Ireland, Ireland or the United Kingdom. It is bestowed on an wikt:intercollegiate, ...
as soon as possible and, after having attended the fellowship course at
Guy's Hospital Guy's Hospital is an NHS hospital founded by philanthropist Thomas Guy in 1721, located in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the Kin ...
in
London London is the Capital city, capital and List of urban areas in the United Kingdom, largest city of both England and the United Kingdom, with a population of in . London metropolitan area, Its wider metropolitan area is the largest in Wester ...
, he passed the final examination on 10 December 1936. He obtained the post of Resident Surgical Officer at Salford Royal Hospital on 1 January 1937, and after 21 months he unsuccessfully applied for the similar post at Manchester Royal Infirmary. He then realised the career opportunities presented by research work and was appointed as a demonstrator in physiology at
King's College London King's College London (informally King's or KCL) is a public university, public research university in London, England. King's was established by royal charter in 1829 under the patronage of George IV of the United Kingdom, King George IV ...
in October 1938. The opportunity to return to Manchester came when he was appointed a Resident Casualty Officer (RCO) in April 1939. This work put him in contact with many orthopaedic specialists, since he was responsible for cases presenting at the daily morning fracture clinics. During the afternoons and nights, he acted as the Resident Surgical Officer, operating on general emergencies. By the end of 1939, Charnley's projects had been stymied by the outbreak of
World War II World War II or the Second World War (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...
. He joined the troops as a volunteer in the
Royal Army Medical Corps The Royal Army Medical Corps (RAMC) was a specialist corps in the British Army which provided medical services to all Army personnel and their families, in war and in peace. On 15 November 2024, the corps was amalgamated with the Royal Army De ...
on 1 May 1940 and, after a training period, he was posted to
Dover Dover ( ) is a town and major ferry port in Kent, southeast England. It faces France across the Strait of Dover, the narrowest part of the English Channel at from Cap Gris Nez in France. It lies southeast of Canterbury and east of Maidstone. ...
as a Regimental Medical Officer. He participated in the British
evacuation of Dunkirk The Dunkirk evacuation, codenamed Operation Dynamo and also known as the Miracle of Dunkirk, or just Dunkirk, was the evacuation of more than 338,000 Allied soldiers during the Second World War from the beaches and harbour of Dunkirk, in the ...
and, subsequently, he was sent to 31st General Hospital at
Hellingly Hellingly ( ) is a village, and can also refer to a civil parish, and to a district ward, in the Wealden District of East Sussex, England. Geography Hellingly contains the confluence of the River Cuckmere and one of its tributaries, the Bull ...
,
East Sussex East Sussex is a Ceremonial counties of England, ceremonial county in South East England. It is bordered by Kent to the north-east, West Sussex to the west, Surrey to the north-west, and the English Channel to the south. The largest settlement ...
. He then moved to Davyhulme Park Hospital and later to the General Hospital at Garrioch. Finally, he was sent to
Cairo Cairo ( ; , ) is the Capital city, capital and largest city of Egypt and the Cairo Governorate, being home to more than 10 million people. It is also part of the List of urban agglomerations in Africa, largest urban agglomeration in Africa, L ...
; there he spent most of his military service under the supervision of orthopaedic surgeon Dudley Buxton. Buxton had a high opinion of Charnley and gave him more responsibilities by sending him to the 2nd Orthopaedic Centre and putting him in charge of the new orthopaedic workshop. That experience probably encouraged him to apply for the orthopaedic school in 1942, with the support of his senior colleagues. He was promoted to the rank of
Acting Major Major is a senior military officer rank used in many countries. When used unhyphenated and in conjunction with no other indicators, major is one rank above captain in armies and air forces, and one rank below lieutenant colonel. It is consid ...
on 2 December 1942. He ended his military service in May 1944, when he joined the orthopaedics staff at
Shaftesbury Shaftesbury () is a town and civil parish in Dorset, England. It is on the A30 road, west of Salisbury, Wiltshire, Salisbury and north-northeast of Dorchester, Dorset, Dorchester, near the border with Wiltshire. It is the only significant hi ...
Hospital.


Back to Manchester

The end of the war was also the beginning of a national scheme for the cure of crippled children, which involved the use of open-air rural orthopaedic hospitals. One of these was the
Robert Jones and Agnes Hunt Orthopaedic Hospital The Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) in Gobowen, near Oswestry, Shropshire, England is a specialist orthopaedic hospital which provides elective orthopaedic surgery. It is managed by the Robert Jones and Agnes Hunt Orthopa ...
at
Gobowen Gobowen is a village in Shropshire, England, about 3 miles north of Oswestry. The population according to the 2011 census was 3,270. History The village was previously called ''Bryn-y-Castell'' ("Hill of the Castle" in English) after the House ...
, near
Oswestry Oswestry ( ; ) is a market town, civil parish and historic railway town in Shropshire, England, close to the England–Wales border, Welsh border. It is at the junction of the A5 road (Great Britain), A5, A483 road, A483 and A495 road, A495 ro ...
in
Shropshire Shropshire (; abbreviated SalopAlso used officially as the name of the county from 1974–1980. The demonym for inhabitants of the county "Salopian" derives from this name.) is a Ceremonial counties of England, ceremonial county in the West M ...
, and
Harry Platt Sir Harry Platt, 1st Baronet, FRCS, KStJ (7 October 1886 – 20 December 1986) was an English orthopaedic surgeon, president of the Royal College of Surgeons of England (1954–1957). He was a founder of the British Orthopaedic Association, of ...
recommended that Charnley went there in order to improve his skills as an orthopaedic surgeon. He was resident in the hospital for six months in 1946, during which he developed his interest in
bone grafting Bone grafting is a type of transplantation used to replace missing bone tissue or stimulate the healing of fractures. This surgical procedure is useful for repairing bone fractures that are extremely complex, pose a significant health risk to the ...
. In order to satisfy his curiosity about bony union, he persuaded a junior colleague to test a surgical procedure on his leg, which resulted in a wound infection that forced the colleague to bed for some weeks. Thereafter, Charnley returned to Manchester, again with the support of Platt, who had brought to the Royal Infirmary a group of young and brilliant orthopaedic specialists, which included Lloyd Griffiths. Charnley and Griffiths became joint honorary assistant orthopaedic surgeons in 1947. They both needed more clinical independence, and Platt arranged that Charnley saw some more clinical patients in other hospitals. In May 1948, he participated in a work trip to the United States, visiting hospitals there, together with other young orthopaedic surgeons. The experience caused him to consider the possibility of basing himself in the USA, but that country's restrictions on experimental surgeries were unacceptable to him. He was interested in two basic orthopaedic problems: the effect of compression on the healing of
cancellous bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, an ...
, and the lubrication of joints. He was convinced that collaborations with mechanical engineers, with whom he developed strong relationships, were fundamental to expanding his knowledge and improving his work. Charnley's research was based on two different aspects: clinical, for the treatment of patients with osteoarthritis, and biomechanical, with experiments to determine the fundamentals of bony union and the conditions governing the spontaneous regeneration of articular cartilage. When he returned to Manchester after the war, the facilities available did not live up to his expectations. From then on, he began to think of reducing the number of clinical sessions he was undertaking, in order to carry out his research elsewhere. He finally opted for this path in 1958, informing the Manchester Royal Infirmary surgeons' committee that he wished to hand over three of his four clinical sessions in order to set up a hip surgery centre at Wrightington Hospital,
Lancashire Lancashire ( , ; abbreviated ''Lancs'') is a ceremonial county in North West England. It is bordered by Cumbria to the north, North Yorkshire and West Yorkshire to the east, Greater Manchester and Merseyside to the south, and the Irish Sea to ...
. The committee agreed to his request for a period of three years, after taking into account his skills and reputation. The decision was to be reviewed at the end of that period.


Wrightington and hip implant

Wrightington had formerly been a centre for the treatment of
tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...
. Improved living conditions and pasteurisation of milk had caused a decline in the incidence of that illness and many hospitals were seeking new medical endeavors upon which to focus. In the case of Wrightington, it was Charnley's hip surgery centre that came to the fore. Charnley's first aim at Wrightington was to build a biomechanical laboratory that could be used to test his instruments and inventions. He organised a fund raising campaign for this purpose and the laboratory opened on 23 June 1961. His first studies concerned lubrication of joints. At that time, some surgeons were supporting the hydrodynamic theory, which assumed that the two faces of a joint are not perfectly congruous, and that a film of
synovial fluid Synovial fluid, also called synovia, elp 1/sup> is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its egg white–like consistency, the principal role of synovial fluid is to reduce friction between the articul ...
is responsible for the low friction of the surfaces. Charnley disagreed with that theory; through his experiments, he was able to demonstrate that the low friction does not depend on the fluid presence. The studies led to the development of the Low Friction Arthroplasty concept, which assumed that the low friction depended mostly on the
friction coefficient Friction is the force resisting the relative motion of solid surfaces, fluid layers, and material elements sliding against each other. Types of friction include dry, fluid, lubricated, skin, and internal -- an incomplete list. The study of t ...
of the facing materials, and only marginally on the fluid presence. This discovery caused him to begin looking for a slippery substance that could be used for the socket of a total hip replacement operation.
Polytetrafluorethylene Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene, and has numerous applications because it is chemically inert. The commonly known brand name of PTFE-based composition is Teflon by Chemours, a spin-off from DuP ...
(PTFE, also known as Teflon) seemed to meet this requirement. After some apparently successful experiments with the material, he adopted it for his hip replacement surgeries. They were carried out as follows: discarding the head of the
femur The femur (; : femurs or femora ), or thigh bone is the only long bone, bone in the thigh — the region of the lower limb between the hip and the knee. In many quadrupeds, four-legged animals the femur is the upper bone of the hindleg. The Femo ...
; replacing it with a metallic implant that was fixed with acrylic cement; and, using a PTFE acetabular socket, insertion of the implant into the
acetabulum The acetabulum (; : acetabula), also called the cotyloid cavity, is a wikt:concave, concave surface of the pelvis. The femur head, head of the femur meets with the pelvis at the acetabulum, forming the Hip#Articulation, hip joint. Structure The ...
. At first, the result seemed to be satisfactory, however, approximately one year after the first operations (about 1960), it became clear that PTFE was not a suitable material. It showed signs of wear and, most importantly, its reaction with soft tissues caused the formation of granulomatous masses that in almost all cases required a further operation to enable their removal. This setback in Charnley's research affected him for some time. His determination pushed him to seek an alternate material. He continued to test various materials, until a salesman approached him offering
Ultra-high-molecular-weight polyethylene Ultra-high-molecular-weight polyethylene (UHMWPE, UHMW) is a subset of the thermoplastic polyethylene. Also known as high-modulus polyethylene (HMPE), it has extremely long chains, with a molecular mass typically between 2 and 6 million amu. The l ...
(UHMWPE), which he rejected because of his lack of understanding of the problem; his assistant told him privately that he would endeavor to test it. It was serendipity, and he immediately grasped the potential of the HMWP; after some tests, Charnley implanted it for the first time in November 1962. Mindful of his previous failure with the PTFE socket, he waited for a year, during which time he carefully observed the status of his patients. Five years later, when he was convinced that HMWP was a safe material, he announced his discovery, making it possible for other surgeons to use it. As time went by, the number of operations increased, and Charnley designed a machine which mechanically built prostheses and sockets, as well as an apparatus for evaluating patients for their hip disorders before and after the operation. He collaborated very closely with the firm of Chas. F. Thackray Ltd in Leeds, whom he had first asked to make instruments for him in 1947. Charnley refined his hip replacement operation throughout his long association with Thackray's and was still working on improvements when he died. At first Thackray's made the stainless steel stems, while Charnley made the sockets himself, turning them on a lathe in his workshop at home. Later his technicians made instruments under close supervision and then Thackray's manufactured them. As time went on, Thackray's contributed their own design suggestions; this continual exchange of ideas was a significant factor in the advance of the hip operation. Charnley was convinced that the best way to fix the prosthesis into the femur was to use
bone cement Bone cements have been used very successfully to anchor artificial joints (hip joints, knee joints, shoulder and elbow joints) for more than half a century. Artificial joints (referred to as prostheses) are anchored with bone cement. The bone cem ...
that acted as a
grout Grout is a dense substance that flows like a liquid yet hardens upon application, often used to fill gaps or to function as reinforcement in existing structures. Grout is generally a mixture of water, cement, and sand, and is frequently employe ...
rather than as a glue and that interlocked the two parts. He believed that the cement had to have some essential features: *It had to be prepared without unnecessary additives; *The exact constituents should be published; *It had to be sterilised with formaldehyde; *The package should include two measured quantities of
barium sulphate Barium sulfate (or sulphate) is the inorganic compound with the chemical formula Ba SO4. It is a white crystalline solid that is odorless and insoluble in water. It occurs in nature as the mineral barite, which is the main commercial source of ...
to allow the surgeon the choice of different degrees of radio-opacity. The cement that reflected these features was produced by CMW Laboratories Limited and was called CMW bone cement. Charnley also realised that it was of fundamental importance to retrieve the artificial joints from patients who had died some years after the surgery, in order to study the wear of the materials and the tissue changes, thus enabling improvements in the procedure.


Against infection

The huge number of wound infection cases after hip replacement operations pushed Charnley to put effort also in the prevention field; he was involved in the research of a method to keep
bacteria Bacteria (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...
away from the wound during surgery. His first attempt consisted in introducing
antibiotic An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting pathogenic bacteria, bacterial infections, and antibiotic medications are widely used in the therapy ...
s such as gentamicin into the bone cement; the bacterial count decreased, but not enough. In 1961 he developed an enclosure that isolated the operating theatre from the rest of the room, into which filtered air could be passed. To improve his system, he asked F. H. Howorth, whose family firm had been building air filtration systems since 1854, for help. Howorth adapted Charnley's enclosure to provide better air handling and incorporate a diffusion system that allowed the passage of a larger flow of filtered air. Charnley understood that another source of contamination was through the surgeon's gown, and he developed a full-body gown that incorporated an exhaust system. This came into use from the 1970s, and was ventilated so that the surgeon always felt comfortable, whilst maintaining a negative pressure to avoid contamination. Both the enclosure and the body gown were redesigned and improved over time in order to make them more useful and easier to use.


Personal life

Although not inclined to sporting pastimes as a child, Charnley became a passionate skier as an adult. In 1957, during his annual skiing holiday in Zurs, he met Jill Heaver (1930–2016). Despite a twenty-year difference in ages - she was 26 and he was 46 - they married a few months later, on 15 June. They lived first in a house called "Naemoor" in Hale, in
Cheshire Cheshire ( ) is a Ceremonial counties of England, ceremonial county in North West England. It is bordered by Merseyside to the north-west, Greater Manchester to the north-east, Derbyshire to the east, Staffordshire to the south-east, and Shrop ...
, where Charnley immediately converted the attic in his workshop. The couple had two children. In the late 1960s, the Charnleys moved to a larger property in
Mere, Cheshire Mere is a civil parish and linear village along the old course of the A556 road in the unitary authority of Cheshire East and the ceremonial county of Cheshire, North West England, about south-west of Altrincham. Bucklow Hill is at its northe ...
.


Career

John Charnley is recognised as the founder of modern hip replacement. His contributions to the field are found in the hip replacement surgery method, in the optimization of the surgery flows and in the drastic infection rate decrease. Through his teaching activities, he transmitted his technique and knowledge to a wide audience of international surgeons and thus his academic and scientific work was spread worldwide. As of 2011, many of his students were still teaching hip replacement. In 1974, Charnley was awarded the
Cameron Prize for Therapeutics of the University of Edinburgh The Cameron Prize for Therapeutics of the University of Edinburgh is awarded by the University of Edinburgh College of Medicine and Veterinary Medicine, College of Medicine and Veterinary Medicine to a person who has made any highly important and v ...
. He was awarded the 1975
Lister Medal __NOTOC__ The Lister Medal is an award presented by the Royal College of Surgeons of England in recognition of contributions to surgical science. It is named after the English surgeon Joseph Lister (1827–1912), whose work on antiseptics estab ...
for his contributions to surgical science. The corresponding Lister Oration, given at the Royal College of Surgeons of England, was delivered on 26 May 1976, and was titled 'The Origins of Post-Operative Sepsis in Elective Surgery'. Charnley was
knight A knight is a person granted an honorary title of a knighthood by a head of state (including the pope) or representative for service to the monarch, the church, or the country, especially in a military capacity. The concept of a knighthood ...
ed in 1977.


Books

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References


Bibliography

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Further reading

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External links


The John Charnley Research InstituteWrightington HospitalJohn Charnley Collection
University of Manchester Library The University of Manchester Library is the library system and information service of the University of Manchester. The main library is on the Oxford Road campus of the university, with its entrance on Burlington Street. There are also ten other ...
{{DEFAULTSORT:Charnley, John 1911 births 1982 deaths 20th-century English medical doctors People educated at Bury Grammar School British orthopaedic surgeons Alumni of the Victoria University of Manchester People from Bury, Greater Manchester Fellows of the Royal Society Fellows of the Royal College of Surgeons of England Knights Bachelor Commanders of the Order of the British Empire Recipients of the Lasker–DeBakey Clinical Medical Research Award 20th-century English surgeons British Army personnel of World War II Royal Army Medical Corps officers