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Exeter’s total hip arthroplasty advances are among its many orthopaedic innovations
Princess Elizabeth Orthopaedic Hospital pioneers developed a highly successful hip implant, a new spinal approach and a method to restore femoral bone.
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Several orthopaedic visionaries have brought the specialty into prominence at the Princess Elizabeth Orthopaedic Hospital, in Exeter, United Kingdom, which opened in 1927.
“The chap who did more to establish it as an orthopaedic center of some repute was Norman Capener, who came in 1931,” said Robin S.M. Ling, OBE, MA BM (Oxon), Hon DSc, FRCS, Hon FRCSEd, who practiced in Exeter from 1963 to 1991.
But some recent and better known advances that occurred at the Princess Elizabeth Orthopaedic Hospital (PEOH) and the current Princess Elizabeth Orthopaedic Centre (PEOC) at the Royal Devon and Exeter Hospital Wonford, which opened in 1997, have propelled the practice of quality orthopaedic surgery in Exeter well into the 21st century.
Ling collaborated with Clive Lee, PhD, and a team of experts at the Department of Engineering Science, University of Exeter, to invent the Exeter Hip Replacement (Stryker), which was introduced in 1970.
According to Ling, Capener “was involved in developing an approach to the vertebral bodies called an anterolateral decompression,” used in tuberculosis of the spine. An interest in all aspects of orthopaedic surgery led Capener to invent the Exeter or “lively” hand splint that stabilized digits and allowed joint movement while maintaining alignment.
“Capener was the first to place Exeter on the orthopaedic map,” Graham A. Gie, MBChB, FRCS, FRCSEd(Orth), of Exeter, told Orthopaedics Today Europe. The majority of Capener’s work and inventions came to fruition in the workshops of the Devon Orthopaedic Association, which also served as a limb-fitting center for amputees.
“The hospital workshop achieved a national and international reputation under his supervision,” said Gie, president of the British Hip Society.
Ling performed the first total hip arthroplasty (THA) at PEOH in 1965 with the all-metal, collared McKee-Farrar hip implant. During the surgeries and follow-up Ling encountered problems he believed could and should be solved, including resorption of the femoral neck beneath the collar.
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Image: RD&E NHS Foundation Trust |
“The collar was the one thing I was convinced was not doing what it was supposed to,” Ling said. Efforts to better his results led to development of the cemented Exeter hip in 1969, which was totally collarless and had a fully tapered stem. “Because of its radical design, I said that I felt that its use should be limited to Exeter for 5 years,” Ling told Orthopaedics Today Europe.
Today, the polished modular Exeter stem is essentially the same shape as the original, but there are more sizes available to accommodate more patients.
The Exeter team was among the first to pressurize acrylic bone cement into bone in the socket. They developed instruments to not only prepare the acetabular bone, but pressurize the cement. “We gradually evolved similar methods for doing the same in the femur, and these methods have been progressively refined since their introduction,” Ling said.
One of four orthopaedic surgeons specializing in hip surgery at the PEOC today, Gie is known for the femoral impaction grafting technique he developed for revision THA that uses morcellized bone from the femoral head to fix a femoral stem proximally. He described it as a modification of acetabular impaction grafting popularized in Nijmegen, The Netherlands. “Success rates in the region of 95% at 10 years are now being reported worldwide,” Gie noted.
Beyond THA innovation, Exeter’s reputation in shoulder surgery, including “key-hole” surgery, was established by Timothy J. Bunker, MD, FRCS, who began his trauma and shoulder surgery practice at the PEOH in 1990. Christopher D. Jefferiss, MB, FRCS, and David C. Jameson-Evans, FRCS, respectively, brought hand surgery and pediatric orthopaedics to prominence in Exeter, Ling said. – by Susan M. Rapp
Graham A. Gie, MBChB, FRCS, FRCSEd(Orth), can be reached at The Exeter Foundation, Zenith House, 42 Magdalen Road, Exeter, EX2 4TE, United Kingdom; +44 1392-432363.Robin S.M. Ling, OBE, MA BM (Oxon), Hon DSc, FRCS, Hon FRCSEd, is retired.