Sir John Charnley (1911 - 1982): Architect of Orthopaedic Innovation

On the anniversary of his passing, we reflect on the enduring legacy of Sir John Charnley, a master surgeon, innovator, and bio-engineer who made extraordinary contributions to the field of hip surgery.

Born on August 29, 1911, in Bury, Lancashire, Charnley's journey from a distinguished academic career to a pioneering figure in orthopaedics remains an inspirational chapter in medical history. Charnley's early academic brilliance propelled him from Bury Grammar School to Manchester University, where he graduated with distinctions and excelled in the medical field. His journey continued with various roles, including house surgeon at Manchester Royal Infirmary and resident surgical officer at Salford Royal Hospital. The outbreak of World War II saw Charnley's commitment to service, where he served as a Regimental Medical Officer and later as an orthopaedic specialist in Cairo. Notably, his innovation led to the creation of the 'Charnley calliper,' adopted by the Army.

Post-war, Charnley's contributions to orthopaedics burgeoned. He became a lecturer in orthopaedic surgery and later a consultant orthopaedic surgeon at Manchester Royal Infirmary. In 1950, his seminal work, "The closed treatment of common fractures," laid the foundation for modern orthopaedic practices globally.

Manchester Royal Infirmary Ward Team, 1948. Charnley is standing in the back row, far right.

In 1962, Charnley concentrated his work at Wrightington, where he established the Centre for Hip Surgery. His biomechanical laboratory and the clinical unit became crucibles for pioneering advancements in hip surgery. Sir John Charnley's initial studies focused on joint lubrication, challenging the hydrodynamic theory prevalent among some surgeons. Disagreeing with this theory, Charnley's experiments revealed that low friction wasn't dependent on fluid presence. This led to the development of the Low Friction Arthroplasty concept, which emphasised the role of the friction coefficient of facing materials over fluid presence.

This discovery prompted Charnley to search for a suitable substance for total hip replacement. Polythetrafluoroethylene (PTFE), also known as Teflon, initially seemed promising. However, after facing issues, especially reactions with soft tissues, Charnley sought an alternative. Rejecting Ultra-high-molecular-weight polyethylene (UHMWPE) initially, he later embraced it after careful testing by his colleague Harry Craven in November 1962. Waiting a year to ensure safety, Charnley announced his discovery, enabling other surgeons to use UHMWPE.

Left: Resurfacing using Teflon (with example of worn Teflon cup and ball). Centre: Total hip replacement using Teflon (with example of worn Teflon cup). Right: Total hip replacement using HDP.

Collaborating closely with Chas. F. Thackray Ltd, his long-time partners since 1947, Charnley continually refined his hip replacement operation. Even at his passing, he was working on improvements. This collaboration, evolving from making steel stems to collaborative design, significantly advanced hip operations. The continuous exchange of ideas between Charnley and Thackray's was pivotal in shaping the progress of hip surgery.

Charnley's accolades included a CBE in 1970, knighthood in 1977, and election as a Fellow of the Royal Society in 1975. His distinction as the first practising orthopaedic surgeon elected to the Fellowship of the Royal Society underscores the magnitude of his contributions.

Sir John Charnley left an indelible mark on orthopaedic surgery, leaving a legacy that continues to shape the field. In closing, we extend our thoughts to Lady Charnley and their children, Henrietta and Tristram, as we honour the life and contributions of this remarkable surgeon-scientist