Mueller in Switzerland . Personality wise , they were quite different , but I became a good friend with the latter .
A year later on my return , I had a license to use the cement required and chose the Mueller method of approach . After 500 patients , there were only two failures with loosening of the bond to bone . Other surgeons had to observe or scrub in with my surgery to eventually attain a “ cement license .”
In the late ‘ 70s , I developed a mini incision for the operation , with the exception of obesity . This method was taught later at Biomet in Warsaw , Indiana , teaching orthopedic surgeons around the country the method of small incision in hips ( and later in knees ). After a number of years , I felt this could become a “ negative ” for future patients , depending on skill level , and ceased it , using my conscience as a guide .
In 1981 , my interest was drawn to a surgeon from Arlington , Virginia . He had a one-size-fits-all cementless hip and socket . It was recommended that more sizes ( seven ) would be more practical .
With that , after considerable expressions of dismay by the orthopedic communities , uncemented devices were made by several , then eventually all companies . A gradual broaching technique was used to prepare the femoral , and a round reamer on the acetabulum . This was the beginning of the modern age of THA . Many more years were added to longevity of the device , and replacing the polyethylene socket inlay after wear was easily performed .
In 1984 , I received an infected long stem prostheses from Boston , along with infection . After treating and eradicating the sepsis , Wright Medical of Memphis , Tennessee , helped me develop one of the first “ custom ” femoral implants to fit a very deformed femoral shaft . Two slightly undersized broaches were used to follow with the implant . It proved successful and led my direction to custom joints for deformities and younger patients . Now we have custom hips and knees , robotics and ceramic heads . Titanium is the choice without cement on the stem and socket . Metal on metal hips are effective , and have been around for many years .
DePuy and an engineer friend at the company started making custom implants for younger or extremely large individuals ( like tall basketball and football players ). Insurance did not want to cover the more expensive custom in conventional sized people , so I reserved it for tall and deformed hips .
A group of custom-oriented doctors started a Chartered Custom Hip Society . We met annually in the U . S . and Europe . We invited many competent engineers from various companies , and it proved important to developing the type and amount of porocoat necessary for bone ingrowth .
We also chartered the Hip and Knee Society and an Arthritis Society for further papers and presentations of types and results of joint replacement . This rose from the original 35 to now thousands of members .
Now , the hip replacement has become commonplace , with titanium stems , metal or ceramic heads , high density polyethylene or metal on metal sockets , with custom-made used by only some surgeons . Many today do not prefer to enter the surgery suite with a single custom implant , in spite of having slightly smaller custom broaches leading up to the final seating of the femoral shaft .
There are some companies working on customizing hips and knees with robotics . During the 90s , a well-known surgeon in London tried the robotic approach of making the more precise preparation of the knee before implant of the joint . It was a start , but to my knowledge , never reached our shores .
In closing , we must pay homage to Sir John Charnley and Professor Doctor Mueller for initiating a great wonder to help patients the world over in achieving a more functional , pain-free life . They opened the door to vast improvements by surgeons and the very necessary engineers in numerous companies . It remains an art , and it began with a surgeon having an engineering mind , trying to reach his goal . With smaller incisions , different approaches and three-dimensional surgery , a patient can expect two to three decades at least . One last point to be made is follow-up by the surgeon , at two-to-three-year intervals . After over 22,000 joint replacements , I cannot stress this too firmly .
I salute Sir John Carnley , the legend from Wrightington , England .
Dr . Eggers is a retired orthopedic surgeon and a member of the American Board of Orthopedic Surgeons . He is also a charter member of the Hip and Knee Society , the Arthritic Joint Surgery Society , and the Custom Hip Society . He is an addition to the National Top Orthopedic Surgeons ( Research and Development ) and has taught lectures and symposiums in America , Europe , Canada and South Africa .
December 2024 13