Rubin_The Direct Anterior Approach to Hip Reconstruction, 2e

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CHAPTER 2 A Definitive History of the Direct Anterior Approach

fibrocartilage underwent metaplasia to form hyaline cartilage after implantation. 9 He died at the age of 65 years, several days after performing his vitallium mold hip arthroplasty on famous radio and TV star Arthur Godfrey. 12 William Stewart Halsted (1852-1922) William Stewart Halsted is considered by some to be the “father of modern surgery.” 13 He was born in 1852 in New York City and was homeschooled until the age of 10 years. He attended Yale College (class of 1874) and was captain of the football team. He then matriculated to medical school at the Columbia University College of Physicians and Surgeons, where he graduated among the top 10 students in his class. 14 His career took him from New York Hospital to Johns Hopkins Hospital. As an educator, he instilled strong surgical principles into all those he trained at Johns Hopkins in the early 20th century. He made strides in local anesthesia, hernia sur gery, mastectomy, surgical instrumentation, and mod ern surgical training programs. He was a champion of new antiseptic techniques that stemmed from Lister and Pasteur. Halsted spread several of his surgical principles, including hemostasis, careful anatomic dissection, exact approximation of tissues during closure, and gentle han dling of tissues. Halsted was an active, daring surgeon in New York before his cocaine addiction, which started after his research on cocaine’s local anesthetic properties. 13 After inpatient treatment and rehabilitation at the Butler Hospital in Providence, RI, Halsted returned to the practice and teaching of surgery in Baltimore at Johns Hopkins. He became a very slow, compulsive operator, in contrast to his early years in New York. His medical students quietly referred to his lengthy hospital rounds as “shifting dullness.” 13 Halsted gave certain Hopkins resi dents autonomy to do major and innovative operations on their own. A number of his trainees went on to revo lutionize new fields of surgery. Harvey Williams Cushing and Walter Dandy would make great strides in neurosur gery, and William Young would have a great impact in the field of urology. Harvey Williams Cushing (1869-1939) Harvey Williams Cushing was a Yale College graduate (class of 1891) and baseball varsity athlete. His medi cal training was completed at Harvard Medical School, where he earned his MD degree in 1895. He served as a surgical intern at Massachusetts General Hospital. Over the span of his career, he was a pioneering neurosurgeon, cerebral pathologist, and Pulitzer Prize–winning biogra pher. 15 Halsted’s influence is evident in Smith-Petersen’s description of Cushing’s exposure of the cerebellum. This was the inspiration for Smith-Petersen’s work on the anterior approach to the hip. 9

The teachings of Dr Harvey Cushing – respect for struc tures and structural planes – were directly responsible for a new approach to the hip joint. . . .The cerebellum exposure, by reflection of muscle flaps with their periosteal attachments, was probably the one that gave me the idea of combining the anterior hip approach with the periosteal reflection of muscles from the lateral aspect of the ilium. 9 —Smith-Petersen (1948) Sir John Charnley (1911-1982) Sir John Charnley was a British orthopedic surgeon who was born in 1911. His father was a chemist, and his mother was a nurse. Taking an early interest in the sciences, he went on to study medicine at the Victoria University of Manchester. 16 He is credited with using a transtrochanteric approach for exposing the hip and pio neered the development of cemented THA in the 1960s after developing the prosthetic acetabular socket. The operation is performed through a lateral exposure by elevating the greater trochanter. At the end of the operation the trochanter is reattached to the outer sur face of the femur . . . The patient is splinted with the leg in abduction for three weeks, and is allowed to take full weight on the hip five weeks after the operation. Recent experiences suggest that plaster is not essential. . . . The average stay in hospital is eight weeks. 3 His commitment and devotion to patient care were unparal leled. His early low-friction THA cases used Teflon (polytet rafluoroethylene [PTFE]) as a bearing surface. These had favorable frictional properties but failed after 2 years due to granulomatous tissue reactions. Thus, he moved to test other materials and began using high-density polyethylene. Before implanting any new components in patients, he injected his own thigh with particulate debris; one thigh was injected with PTFE particles, and the other was injected with high-density polyethylene. 16 He waited 8 months and noticed a large bump on the PTFE side and no tissue reac tion on the high-density polyethylene side. 16 Objectives must be reasonable. Neither surgeons nor engineers will ever make an artificial hip-joint that will last 30 years and at some time in this period enable the patient to play football. 3

Wayne Oren Southwick (1923-2016) Dr. Wayne Oren Southwick was a pioneering surgeon in the area of orthopedic surgery. He was born and raised in Nebraska and received undergraduate and medical doc torate training at the University of Nebraska. He com pleted residency training at the Johns Hopkins Hospital and was exposed to the principles that Dr. Halsted had instilled into the institution. 17 Dr. Southwick was a leader in orthopedic surgery, with instrumental work on the anterior approach to the cervical spine 18,19 and the Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024