In 1957, British orthopedic surgeon John Charnley saw what William Harris today calls “the promised land.”
That glimpse was the first total hip replacement, an operation that almost miraculously restored pain-free movement and active lives to patients whose hip-joint damage, often rooted in arthritis, had made even the simple act of walking across the room difficult.
Empowered by advances in materials, Charnley dispensed with the surgical half-measures of the past, removed the damaged joint entirely, and started over, replacing the cuplike hip socket with one made of Teflon, known for its slipperiness. He cut off the top of the thighbone and inserted the end of a rodlike metal implant into its center, cementing it in place. The round head of the implant — like the natural one at the top of the thighbone — fit into the Teflon hip socket.
The procedure seemed to work, but not for long. Within a year, complications arose. The routine movement of the balls in the sockets made the Teflon wear too quickly, loosening the implants. Charnley was forced to reoperate on nearly 300 patients after they developed what he described as an infection around the implant.
“The shining side of that unmitigated disaster was that he had seen the promised land,” said Harris, who was 27 when Charnley performed the first operation. “These people were so good [after the operation]. He said, ‘What we need is a better plastic.’”
Charnley filled that need with a more-resistant material called high-density polyethylene, which he began using in a new version of the artificial hip joint in 1962. Years passed, then a decade, with no sign of the accelerated wear that had doomed the Teflon socket.
By 1974, Harris was a noted orthopedic surgeon at Massachusetts General Hospital and clinical professor of surgery at Harvard Medical School. One day he saw a California lawyer, referred by doctors in San Francisco, who had undergone hip replacement surgery seven years earlier. The procedure had initially brought pain relief and renewed freedom of movement. But the hip pain had returned.
Harris was startled when he looked at his new patient’s X-rays. Large portions of his thighbone had been eaten away. Cancer was the only thing Harris could think of that destroyed bone like that, but it also seemed unlikely. First, cancer had never been associated with hip replacement. And second, bone cancer wasn’t typically found in the femurs of 55-year-old men.
Further tests brought good news, confirming that the patient was cancer-free. But those results were tempered by the fact that his doctor remained stumped.