Coventry was dedicated to broadening orthopedic knowledge and practice

Midwestern pioneer brought many advances to field of orthopedics and modernized the department at Mayo Clinic.

Issue: January 2003

Mark B. Coventry

Although best known for performing the first total hip arthroplasty using a Food and Drug Administration-approved bone cement, Mark B. Coventry pioneered other advances in orthopedics. Among other things, he established the first total joint registry.

Mark B. Coventry, MD is most known for two accomplishments: performing the first total hip arthroplasty in the United States using a Food and Drug Administration-approved bone cement and popularizing the proximal tibial osteotomy.

To fully understand his accomplishments, however, consider that he was also the first to use cortisone for an orthopedic injury, that he designed the use of prophylactic anticoagulants for pulmonary emboli, that he established the first total joint registry, and that he initiated an innovative specialty-specific department organization.

Coventry, the son of a general surgeon, was introduced to medicine while accompanying his father on house calls. William, the father, taught his son to treat patients as people and not as conditions — a lesson the younger Conventry would remember throughout his long career.

A keen intellect

“He almost had a regal appearance, with movie-star rugged features,” said Bernard F. Morrey, MD, former chairman of the department of orthopedics at Mayo Clinic in Rochester. “His features were an asset; people wanted to please him. However, those features were matched with a very keen intellect. He was an innovator and very good at assessing data and deciding the course of action. He was very analytical and very objective.”

Morrey said Coventry remained dedicated to orthopedics until the end of his career. “I was on his service just a few months before he retired,” Morrey recalled. “One day, he said, ‘You know we are going to do things a little differently. I am experimenting with a new way to prep and drape a patient using these new drapes.’ So here was a guy who wasn’t going to benefit at all from this experiment, but within a few months of his retirement he was still looking at the best way to prep and drape the total hip patients.”

“He made me,” said Miguel E. “Mike” Cabanela, MD, professor of orthopedic surgery at Mayo Medical School. “He was as important to me as my own father.”

Cabanela remembers his mentor as an effective leader, a modern Renaissance man who ruled his department with an iron fist. “He not only had many innovative ideas about orthopedics, but he was well-read and had many interests, including food and wine. He was a good cook and would grow his own vegetables in his garden.”

Coventry was born in Duluth, Minn., in 1913, where his father had established the Duluth Clinic. He attended the local schools and, like his father and older brother, went to the University of Michigan. There he played wing on the varsity hockey team and was noted for his mean shot. He earned his bachelor’s degree in 1934 and his medical degree in 1937.

As an intern at the University Hospital in Ann Arbor, he was called to fill in for an ailing house officer and assumed responsibility for a 20-bed orthopedic ward. He later recalled that his experiences there were the impetus that led him to specialize in orthopedics.

Following his internship, he entered the Mayo Clinic in Rochester as a fellow in general surgery. He transferred to the orthopedic surgery department after one year. In 1942, he completed his residency and had already published three articles, one in the Journal of Bone and Joint Surgery, marking the beginning of a prolific, career-long love of writing that would eventually include 250 published articles and 31 book chapters as well as tapes, abstracts and editorials.

Cortisone use

In 1942, he joined the Mayo staff as a surgeon and instructor of orthopedic surgery. His career was almost immediately put on hold when he joined the Medical Corps of the United States Naval Reserve. He served the next four years in Guadalcanal, New Guinea and the Philippines.

Upon his return to Mayo Clinic, Coventry devoted himself to orthopedic care. In 1950, Philip S. Hench, MD, and Edward C. Kendall, MD, both of the Mayo Clinic, received a Nobel Prize for their development of cortisone. Shortly thereafter, Hench asked Coventry to inject hydrocortisone into a patient with acute bursitis of the shoulder.

In his memoirs, Coventry recalled the reaction: “He had severe calcific tendonitis, the pain from which was uncontrollable even with morphine, something not usually seen today. Within 14 hours after the ‘compound F’ was put into the area of calcium, the patient was moving his shoulder freely.”

Interest in hips

A visit during the 1950s by France’s Dr. Robert Judet, who detailed his work with endoprostheses, spurred Coventry’s interest in hip surgery. Soon, he was implanting the first Judet endoprosthesis in a patient at Rochester State Hospital.

In 1955 he was appointed chairman of the orthopedic department at the Mayo Clinic. He would go on to serve on the Mayo Clinic Board of Governors and as a professor at the Mayo Graduate School and the Mayo Medical School.

Coventry was especially adept at remaining on the cutting edge of orthopedic technology. Following a presentation discussing the concept of proximal tibial osteotomy, Coventry performed the first operation in 1960 and popularized the procedure, which carries his name. He traveled to Europe to study further advances and renew interest in osteotomies. While investigating the new hip replacement procedures, he encountered Dr. John Charnley.

The Charnley hip

“There were several options in mainland Europe and England that were being offered to replace the total joint,” Morrey said. “Coventry thought that Charnley’s approach and philosophy was the most sound.”

He returned to Rochester, and with the FDA’s subsequent approval for investigational use of methylmethacrylate, Coventry performed the first total hip arthroplasty using the bone cement in the United States in March 1969. Soon he was as successful as the English innovator.

“It is amazing that he had the ability to pick out the hip that lasted. He went to England and toured all the centers and came back with the one that would be the model for the future,” Cabanela said.

Morrey said that Coventry “also instituted a total joint registry where he kept track of the patient’s clinic number and basic characteristics, the very first one. Today, 33 years later, that total joint registry has become a total joint database, including clinical characteristics as well.”

The registry includes about 75,000 to 80,000 implant procedures. “Our total joint database, which continues to generate data and ideas for numerous peer-reviewed articles, was started by recognizing the need to understand the long-term impact of these procedures,” Morrey said.

Ethical individual

Edmund Y. S. Chao, PhD, the Lee H. Riley Jr. Professor of Orthopedic Surgery at Johns Hopkins University, remembers Coventry as a principled educator and clinician.

“He was the most ethical individual that I have ever met. He was firm but also very kind,” Chao said. He was recruited by Coventry in 1971 and worked for him in Mayo’s biomechanics laboratory for 21 years.

“There is no question about it, he is my idol. I am not an orthopedic surgeon and that makes it worth even more. He taught and guided me through all the details of joint reconstructive surgery. From then on I have always looked at him as my mentor and friend.”

Chao said Coventry saw the “big picture” of joint replacement. “He stressed the importance of position in component placement. Later on, many instruments were developed through his ideas.”

In fact, Coventry designed some of the original hip and knee surgery instruments in order to improve the placement of the implant and the alignment of the lower limb. “Today, we are using robotics through image-guided surgery that is essentially the perfection of his concepts,” Chao said.

Another of Coventry’s concepts that inspired Chao is the importance of mechanical analysis as a condition for preoperative planning in osteotomy and joint replacement surgery. He attributes this as one of the key factors to improving surgical outcome and firmly established the value of a bioengineer in patient care.

Anticoagulation

As the popularity of total hip replacement grew in the 1970s, surgeons noted a growing incidence of pulmonary embolism in some patients. “At this time it wasn’t very well-understood how these could be prevented,” Morrey said. “In 1970 he suggested using a low-dose coumadin regimen that today is still considered the gold standard by many. So, 33 years later what he suggested and what was his first attempt at anticoagulation is still the one we use with only slight modifications in dosage.”

Coventry also contributed to the control of heterotopic ossification about the hip. “Working with Jennifer Jowsey, he suggested the use of radiation to control heterotopic ossification. Today, that is the treatment of choice, only with a lower dosage,” Morrey said.

Coventry was innovative as an administrator and educator as well. In the late 1960s he reorganized his orthopedic department based on specialty, including the then unfamiliar departments of hand and pediatric orthopedic surgeries. Morrey compared this to the innovative concept the Mayo brothers had when founding the orthopedic department separate from general surgery in 1910.

“In 1910 the Mayo brothers had the insight to know that they wanted orthopedics independent of surgery. Then 60 years later, Coventry had the similar insight and vision to develop the sectional organization structure there.”

Honesty and accolades

Cabanela, president of the Hip Society co-founded by Coventry, described Coventry as a caring administrator. “People would flock to him because he was such a charming person,” he said. He remembers that Coventry would host Christmas parties as the department chair and would greet all 80 members of the department by name as well as their spouses and children.

Chao said he has tried to model his academic style on Coventry’s, particularly his honesty. “He said you have to make sure that the students learn from you, but that they don’t believe in anything that you do. They have to find out themselves; don’t force it on them. Therefore, whenever he gave lectures he would honestly and painstakingly tell people the negative side of the method.”

Coventry served as president of the American Orthopaedic Association, Clinical Orthopaedic Society, The Hip Society, the Orthopaedic Research and Education Foundation, and other societies. He was the editor of the Yearbook of Orthopedics for 12 years and served on the editorial boards of JBJS, and the Journal of Arthroplasty.

He died in 1994, 10 years after retiring from Mayo.

“I think that we don’t have many people like him today,” Chao said. “We are so goal oriented and do not treat medicine, surgery, and patient care with integrity, charity and humanity.