Implants

Things left inside the body. Plates, screws, nails and rods, and above all the artificial joint: the ivory and acrylic experiments, Charnley, and the plastic cup that wore out catastrophically before he found one that did not. The most useful thing in this segment is a repetition. Charnley's Teflon failure and the 2010 recall of a metal-on-metal hip are the same failure fifty years apart, debris from a bearing surface provoking destructive reaction in the tissue around it, and metal-on-metal had already failed once before that. What caught it the second time was neither the manufacturers nor the trials but the national joint registries, in England and Australia, independently.

Part of Orthopedics

90 moments in this segment.

  1. - Petit-type tourniquet, Europe, 1780-1805. The tourniquet is used to apply pressure to stop heavy bleeding, especially during amputations. Splinting and bandaging to immobilise a fracture is attested for at least three thousand years, in Egyptian, Greek, Indian and Chinese practice alike, long before the word orthopaedics existed.
  2. - Chinese woodcut; Bone-setting devices. Woodcut fromShangke buyao(Supplement to Traumatology) by Qian Xiuchang, published in 1818 (23rd year of the Jiaqing reign period of the Qing dynasty). Bonesetters were unlicensed, frequently hereditary practitioners of manipulation who persisted alongside and in competition with the medical profession into the twentieth century, and in some regions to the present.
  3. - Chinese woodcut; Fixation appliance for injured kneecap. Woodcut fromShangke buyao(Supplement to Traumatology) by Qian Xiuchang, published in 1818 (23rd year of the Jiaqing reign period of the Qing dynasty), showing an appliance for setting and fixing injured kneecaps. Bone-setting emerged as a specialised skill in China roughly three thousand years ago, wound physicians are attested from the Zhou dynasty, and die-da is the Chinese bone-setting and traumatology tradition, historically linked with martial arts communities.
  4. - Petit-type tourniquet, London, England, 1823-1829. The tourniquet is used to apply pressure to stop heavy bleeding, especially during amputations. Splinting and bandaging to immobilise a fracture is attested for at least three thousand years, in Egyptian, Greek, Indian and Chinese practice alike, long before the word orthopaedics existed.
  5. - Bone plate, Europe, 1914-1918. Bone plates are used to support fractures and encourage them to heal in proper alignment. Plates and screws were used from the late nineteenth century onward.
  6. - Ilizarov Apparatus External Fixator. An Ilizarov Apparatus is a type of external fixation used to treat limb deformities. Gavriil Abramovich Ilizarov developed his circular external fixator in 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  7. - Patient with external fixator in the leg. Patient with external fixator in Angola. Gavriil Abramovich Ilizarov developed his circular external fixator in 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  8. - Patient with external fixator in Angola. 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  9. - Patient with external fixator in the femur. Patient with external fixator in Angola. Gavriil Abramovich Ilizarov developed his circular external fixator in 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  10. - HIP PROSTHESIS BALL AND SOCKET. Scope and content: The original finding aid described this as: Capture Date: 6/19/1975 Photographer: JOHN MARTON. State programmes to supply artificial limbs to veterans, from the American Civil War onward, are a major driver of the prosthetics industry.
  11. - MCKEE FARARR HIP PROSTHESIS BALL AND CUP. Scope and content: The original finding aid described this as: Capture Date: 3/20/1975 Photographer: JOHN MARTON. The McKee-Farrar prosthesis, metal on metal, launched in 1961.
  12. - KNEE PROSTHESIS. Scope and content: The original finding aid described this as: Capture Date: 6/16/1976. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s.
  13. - HIP JOINT RIG FOR TECH MAGAZINE ARTICLE. Scope and content: The original finding aid described this as: Capture Date: 2/11/1976 Photographer: DONALD HUEBLER. The history of joint replacement is not primarily a history of surgical technique.
  14. - HIP JOINT SPECIMEN TO HOLDER. Scope and content: The original finding aid described this as: Capture Date: 11/4/1974 Photographer: DONALD HUEBLER. Pathological bone specimens in museum collections are the physical record of conditions that antibiotics and vaccines later made rare in wealthy countries.
  15. - HIP PROSTHESIS DEVICE FROM TEST 26. Scope and content: The original finding aid described this as: Capture Date: 5/14/1975 Photographer: MARTIN BROWN. State programmes to supply artificial limbs to veterans, from the American Civil War onward, are a major driver of the prosthetics industry.
  16. - HIP JOINT SIMULATOR. Scope and content: The original finding aid described this as: Capture Date: 7/22/1977 Photographer: MARTIN BROWN. The history of joint replacement is not primarily a history of surgical technique.
  17. - Kirschner wires ulna. X-ray of a left ulna humerus, showing four Kirschner wires. Fracture and foreign-body localisation need no contrast medium, no injection and little interpretation training, which is why radiography was adopted for bone faster than for anything else.
  18. - Hip replacement Image 3684-PH. An A-P X-ray of a pelvis showing a total hip joint replacement. Fracture and foreign-body localisation need no contrast medium, no injection and little interpretation training, which is why radiography was adopted for bone faster than for anything else.
  19. - Kuntshner intramedullary nail 2. Intermedullary nail for use in orthopedic surgery. Gerhard Kuntscher introduced intramedullary nailing in Germany from around 1939 to 1940.
  20. - Ilizarov11. X-Ray of a fractured tibia and fibula, part 2 (four months following fracture). Fracture and foreign-body localisation need no contrast medium, no injection and little interpretation training, which is why radiography was adopted for bone faster than for anything else.
  21. - Limb Lengthening with Dr. Rozbruch: A Documentary. Documentary on limb lengthening with S. Robert Rozbruch. Distraction osteogenesis was unknown in the West for around twenty years after Ilizarov developed it.
  22. - Orthofix applied to right tibula. After sustaining a tranverse fracture of the right fibula/tibia, I was fitted with an orthofix to align the fracture during the healing proces. Gavriil Abramovich Ilizarov developed his circular external fixator in 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  23. - RightFemurIV. A Bone-allograft is inserted to the lower portion of the femur using screws and cables. The history of joint replacement is not primarily a history of surgical technique.
  24. - LIMB LENGTHENING DOCUMENTARY: DR. ROZBRUCH and DR. FRAGOMEN. Documentary on limb lengthening with S. Robert Rozbruch and Austin Fragomen. The method descends from Ilizarov's distraction osteogenesis, developed in Kurgan from 1951 onward.
  25. - The John Charnley Research Institute 1.mp4. Film on the John Charnley Research Institute at Wrightington. Retrieval and explant analysis of used components is one of the few ways a bearing failure can be characterised after the fact.
  26. - Titanium plaatje voor pols. Medical screws and plate made of titanium, used for fixation after a fracture of the wrist. The history of joint replacement is not primarily a history of surgical technique.
  27. - Controversial medical device withdrawn from market. ABC News Australia on a controversial medical device withdrawn from the market. The DePuy ASR was recalled in 2010; total affected patient numbers and settlement figures vary by source and jurisdiction.
  28. - History of the AO: The First 50 Years. AO Foundation film on its first fifty years. The AO was founded in Switzerland in 1958 by a group including Maurice Müller, Martin Allgöwer, Hans Willenegger and Robert Schneider; Müller died in 2009.
  29. - FDA Asks J&J, Hip Makers for Data on Metal in Blood. Bloomberg reports the FDA asking Johnson and Johnson and other hip makers for data on metal levels in blood. Cobalt and chromium debris from a failing metal bearing is measurable systemically.
  30. - Orthonyxiespange. A nail correction brace, also known as an orthonyxic brace or simply a nail brace, is used to correct the misalignment of fingernails or toenails in order to prevent the nails from growing. The history of joint replacement is not primarily a history of surgical technique.
  31. - Schlittenprothese. Projectional radiographs of a medial unicompartmental knee prosthesis. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s.
  32. - Undercover investigation exposes implant scandal. Telegraph undercover investigation into the implant scandal. Device regulation in Europe at the time relied on notified bodies rather than on a central approval authority.
  33. - 50 years of the Charnley Hip Replacement. Wrightington marks fifty years of the Charnley hip replacement. Wrightington was a former tuberculosis sanatorium, repurposed as skeletal tuberculosis declined.
  34. - Blausen 0446 HarringtonRods. Harrington Rods used in Spinal Fusion. Paul Harrington introduced the Harrington rod distraction system, the first widely used internal fixation system for idiopathic scoliosis when combined with fusion.
  35. - Radiograph with knee angles. Projectional radiograph with angles used to evaluate knee replacement: FFC: frontal femoral component angle FTC: frontal tibial component angle LFC: lateral femoral component angle LTC: lateral tibial component angle. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s.
  36. - California Joint Replacement Registry: Learn By Listening. California Health Care Foundation on the California Joint Replacement Registry. Registry coverage in the United States has been fragmented compared with the national schemes in England, Wales, Australia and Sweden.
  37. - The Birmingham Hip Resurfacing Story - Archive - Joseph Daniel 2005 The McMinn Centre. Archive presentation from the McMinn Centre on the Birmingham Hip Resurfacing. This is material from a centre with a direct commercial interest in the device, and it should be read as an interested party's account.
  38. - Systemic Exposure in Large and Small Diameter Metal-Metal Total Hip Replacements - Hena Ziaee 2007. Presentation on systemic metal exposure from large and small diameter metal on metal hip replacements, recorded in 2007. Metal on metal bearings had already failed once, as McKee-Farrar, before they were reintroduced.
  39. - Archive: From Sir John Charnley to the Present: Have We Made Progress in Hip Replacement?. University of Washington archive lecture asking whether hip replacement has progressed since Charnley. Charnley's Teflon failure and the 2010 ASR recall are the same failure fifty years apart, bearing debris provoking destructive tissue reaction.
  40. - Ilizarov on right leg. 1951 at Kurgan in western Siberia, a young provincial doctor treating a backlog of poorly healed war injuries far from the Soviet academic centres.
  41. - The patriotic open osteosynthesis. The surgical treatment of mandibular angle fracture. Plates and screws were used from the late nineteenth century onward.
  42. - 5 Cr.Sommer, O.Filipov, B.Gueorguiev, Tuebingen, Germany, 2016. The history of joint replacement is not primarily a history of surgical technique. It is a history of materials, of wear debris, and of how the body reacts to particles.
  43. - ACTA Summit 2016 - Prof Stephen Graves. Stephen Graves at the Australian Clinical Trials Alliance summit in 2016. Graves led the Australian joint replacement registry whose data independently identified the ASR failure.
  44. - Scoliosis Surgery - Dr. Stephen Tredwell - Q#5: WHAT IS THE HISTORY OF HARRINGTON ROD SURGERY?. Orthopaedic surgeon Stephen Tredwell on the history of Harrington rod surgery. A generation of patients instrumented with Harrington rods is now decades post-operative, and their long-term outcomes are a documented research subject.
  45. - Hip prosthesis zones by DeLee and Charnley system, and Gruen system. Hip prosthesis zones, by the DeLee and Charnley system, as well as the Gruen system. Charnley moved to high molecular weight polyethylene, reduced the femoral head diameter to 22 mm to lower frictional torque, and used polymethylmethacrylate bone cement for fixation.
  46. - Range of acetabular anteversion. Lateral view of a hip prosthesis, showing acetabular anteversion of 5° and 25°, which are the limits of normal range. State programmes to supply artificial limbs to veterans, from the American Civil War onward, are a major driver of the prosthetics industry.
  47. - Acetabular anteversion of hip prosthesis. State programmes to supply artificial limbs to veterans, from the American Civil War onward, are a major driver of the prosthetics industry.
  48. - The Evolution of Spine Surgery. Setting Scoliosis Straight Foundation on the evolution of spine surgery. Spinal fusion priority around 1911 is contested between Russell Hibbs and Fred Albee, and both claims are taught.
  49. - What does the NJR’s 14th Annual Report tell us?. National Joint Registry on its fourteenth annual report. Registry annual reports are free public documents and are the primary published record of implant survivorship in England and Wales.
  50. - The Patient’s Perspective. National Joint Registry session on the patient's perspective. Registry data is collected from patients who are rarely the audience for it, which is a recurring criticism the registries themselves have taken up.
  51. - History of the Total Hip by Dr. Dunn. University of Utah lecture on the history of the total hip. The line runs from Gluck's ivory joint of 1891 through Smith-Petersen, the Judets, McKee-Farrar and Ring to Charnley's low friction arthroplasty.
  52. - Documentary "The Bleeding Edge" shines light on medical device risks. CBS Mornings on The Bleeding Edge, a documentary about medical device risk. Journalism and regulators, rather than manufacturers, carried much of the public account of the metal on metal failures.
  53. - Investigating faulty medical implants | The Investigators with Diana Swain. CBC on the journalism behind the faulty medical implant investigations. The Implant Files was a coordinated international reporting project into device regulation.
  54. - The history of scoliosis surgery before rods. Betty story with photo book.. A patient's account of scoliosis surgery before instrumentation rods existed, illustrated from her own photograph book. Before Harrington instrumentation, correction relied on casts, traction and fusion without internal support.
  55. - IMMDSReview ORAL HEARINGS - Tuesday 5th March 2019 - SESSION 2. Oral hearings of the Independent Medicines and Medical Devices Safety Review, March 2019. The review examined how the health system responded to patient reports of harm from medicines and devices.
  56. - Knee prosthesis zones by Knee Society 2015, AP view. Edit Postoperative X-ray of normal knee prosthesis of a 73 year old man who had osteoarthritis. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s.
  57. - Postoperative X-ray of normal knee prosthesis, lateral view, annotated. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s. The knee lags the hip by roughly a decade and a half.
  58. - Postoperative X-ray of normal knee prosthesis, anteroposterior view, annotated. John Insall, English-born and working at the Hospital for Special Surgery in New York, is the central name in modern total knee arthroplasty, associated with the total condylar design of the 1970s. The knee lags the hip by roughly a decade and a half.
  59. - Medical Device Dangers: A special KVUE broadcast | KVUE. KVUE special broadcast on medical device dangers. American reporting on implants ran alongside the international Implant Files investigation.
  60. - Presenter discusses hip highlights from Australian joint replacement registry. Discussion of hip findings from the Australian Orthopaedic Association National Joint Replacement Registry. The Australian registry recorded 9.3 per cent revision for the ASR, independently of the English and Welsh figures.
  61. - History of Shoulder Surgery 11 14 19. Columbia Orthopedics lecture on the history of shoulder surgery. Charles Neer designed the modern shoulder prosthesis and Paul Grammont developed the reverse configuration; Neer died in 2011.
  62. - THE HISTORY AND BENEFIT OF TOTAL JOINT REPLACEMENT REGISTRIES - KNEE. SICOT session on the history and benefit of joint replacement registries, knee. Knee replacement is now the higher-volume operation in most national registries.
  63. - THE HISTORY AND BENEFIT OF TOTAL JOINT REPLACEMENT REGISTRIES - INTRODUCTION. Introduction to a SICOT session on joint replacement registries. The Australian registry recorded 9.3 per cent revision for the same device, independently and in a different hemisphere.
  64. - THE HISTORY AND BENEFIT OF TOTAL JOINT REPLACEMENT REGISTRIES - ANKLE. SICOT session on joint replacement registries, ankle. Ankle replacement is a small-volume operation, which makes registry data the only realistic way to assess it.
  65. - THE HISTORY AND BENEFIT OF TOTAL JOINT REPLACEMENT REGISTRIES - HIP. SICOT session on the history and benefit of joint replacement registries, hip. Registries, not manufacturers and not trials, caught the ASR failure: the National Joint Registry for England and Wales recorded 12 to 13 per cent revision at five years against 5 to 6 per cent expected.
  66. - Comparison of the designs of three different Fassier, Duval nails. Figure 6: Comparison of the designs of three different Fassier-Duval nails Figures 6A, 6B, and 6C show the profile and features of the tips of the male rods manufactured by Universal Orthosystems, Pega Medical, and Uma Surgicals respectively. The history of joint replacement is not primarily a history of surgical technique.
  67. - Two postoperative radiographs of a patient who underwent rodding surgery for osteogenesis imperfecta. Figure 2: Immediate postoperative radiographs of the patient 2A: right femur; 2B: right tibia. Fracture and foreign-body localisation need no contrast medium, no injection and little interpretation training, which is why radiography was adopted for bone faster than for anything else.
  68. - 9_1 Biomaterials: Definition and history of biomaterials. Lecture on the definition and history of biomaterials. The bearing material is the recurring failure point in joint replacement, from Charnley's PTFE to the metal on metal recalls fifty years later.
  69. - Are we getting better at what we are doing?. National Joint Registry session asking whether outcomes are improving. The NJR exists because joint replacement is done in high volume in wealthy countries, and its data is what detected the ASR failure.
  70. - The evolving picture of shoulder and elbow arthroplasty. National Joint Registry on shoulder and elbow arthroplasty data. Shoulder replacement follows the same registry logic as the hip and knee, at much lower volume.
  71. - 2016 07 National Joint Replacement Registry Dr Andreas Loefler. Andreas Loefler presents Australian National Joint Replacement Registry data. Australia's registry has a national reach that makes it one of the strongest datasets in the field.
  72. - Evolution of Instrumentation in Scoliosis. Lecture on the evolution of scoliosis instrumentation. The sequence runs from Harrington through Luque segmental wiring to Cotrel-Dubousset and pedicle screw constructs.
  73. - Bruch des Prothesenkopfes bei Hueft-Totalendoprothese 86M - CR ap - 001. Bruch des Prothesenkopfes bei Hüft-Totalendoprothese: Linkes Bild mit intakter Prothese, aber schon reichlich periarthikuläre Ossifikationen. The history of joint replacement is not primarily a history of surgical technique.
  74. - Forearm internal fixation. This is an AP and lateral X ray image of a radius bone fracture that has been internally fixated 1 year ago but the fracture didn't heal and resulted in Non union because the gap between fracture fragments was too big, the patient was male 34 years old, healthy. The history of joint replacement is not primarily a history of surgical technique.
  75. - The History of Internal Fixation: and Lessons Learned. University of Utah lecture on the history of internal fixation and the lessons drawn from its failures. Early plating by William Arbuthnot Lane and Albin Lambotte preceded the systematic approach of the AO group founded in 1958.
  76. - Suturo post operacio pri endoprotezado de koksartiko okaze de koksartrozo. The history of joint replacement is not primarily a history of surgical technique. It is a history of materials, of wear debris, and of how the body reacts to particles.
  77. - OrthoPioneers - John Charnley | Modern Hip Replacement and Laminar Flow Theatre Ventilation. On John Charnley, hip replacement and laminar flow theatre ventilation. Charnley's clean-air enclosure and body-exhaust suit addressed deep infection, a separate problem from the bearing failure that destroyed his Teflon cups.
  78. - The History and Design of Intramedullary Nailing - From Kuntschner to Reamed Titanium Nails. Lecture on the history and design of intramedullary nailing from Küntscher onward. Gerhard Küntscher's nail was used on German casualties in the Second World War and reached wider notice through repatriated prisoners of war.
  79. - History of Limb Deformity Reconstruction | Distraction Osteogenesis to Computer-Assisted Fixators. Lecture on the history of limb deformity reconstruction from distraction osteogenesis to computer-assisted fixators. Gavriil Ilizarov patented his device as No. 98471 on 9 June 1952; the story that he improvised it from bicycle spokes is documented as false.
  80. - American and Chadian military general surgeons work together during N'Djamena based medical exercise. Gerhard Kuntscher introduced intramedullary nailing in Germany from around 1939 to 1940. Allied surgeons encountered it in repatriated prisoners of war who had been nailed by German surgeons.
  81. - Does investment in data collection and data validation justify the cost?. National Joint Registry session on whether investment in data collection and validation justifies its cost. The ASR case is the standard argument that it does.
  82. - Sir John Charnley and the Birth of Total Hip Arthroplasty. Account of John Charnley and the low friction arthroplasty developed at Wrightington. Charnley's first bearing material was PTFE, which failed catastrophically through wear debris; he then moved to ultra-high molecular weight polyethylene against a 22 mm head. Charnley died in 1982.
  83. - Paul Harrington and the Revolution of Spinal Instrumentation. Account of Paul Harrington and spinal instrumentation. The Harrington rod was later succeeded by the Cotrel-Dubousset system and by Eduardo Luque's segmental wiring, which came out of Mexico.
  84. - Maurice Müeller and the Origins of the AO Foundation. Account of Maurice Müller and the origins of the AO Foundation, founded in Switzerland in 1958. Müller died in 2009.
  85. - Shoulder Arthroplasty Past, Present and Future 2024 | William Levine, MD | SDSI Shoulder Course. William Levine on the past, present and future of shoulder arthroplasty. The reverse shoulder prosthesis attributed to Paul Grammont changed which patients could be offered a replacement at all.
  86. - Shoulder Arthroplasty: Past, Present and Future 2014 | Christian Gerber, MD | SDSI Shoulder Course. Christian Gerber on shoulder arthroplasty, recorded in 2014. Shoulder replacement developed decades behind the hip and knee and remains a much smaller registry population.
  87. - Zystisches Fremdkoerpergranulom an der Spitze einer Knieprothese in der Tibia 79M - CR und CT - 001. Zystisches Fremdkörpergranulom an der Spitze einer Knieprothese in der Tibia mit pathologische Fraktur. The history of joint replacement is not primarily a history of surgical technique.
  88. - From Import to Innovation: India’s Orthopedic Implant Revolution | Independence Day Special. On the growth of orthopedic implant manufacture in India. Domestic manufacture changes the cost structure of joint replacement in a country where most patients pay directly.
  89. - Protesi d’anca: la storia che spiega perché oggi durano di più. Italian discussion of why hip prostheses last longer now than they once did. The bearing surface is the recurring problem: PTFE failed for Charnley, and metal on metal failed twice, first as McKee-Farrar and again with the ASR.
  90. - Bäumchen et al. Ann Biomed Eng (2026) Fig 7AC. Radiographs of a tibial and a fibular fracture. Gerhard Kuntscher introduced intramedullary nailing in Germany from around 1939 to 1940.
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