Wrightington Hospital

Charnley, J., Total Prosthetic Replacement of the Hip Joint Using a Socket of High Density Polyethylene , Wrightington Hospital Publication No. 1 Centre for Hip Surgery, (1966)... 

Co-development of Silane-crosslinked HDPE by University of Leeds, Wrightington Hospital, and Thackray. 

This chapter focuses on the historical development of UHMWPE for use in hip replacemenfs by John Chamley. The main sources of this chapter have been Chamley s journal publications and books, as well as an outstanding biography of Chamley written by William Waugh (1990). Preparation of this chapter also entailed interviews and the review of archives and implants at Wrightington Hospital, DePuy International (Leeds), and the Thackray Museum of Leeds. 

These three interim implant designs, preserved in the collection at Wrightington Hospital, are shown in Figure 4.3. The PTFE components in Figure 4.3 were retrieved at revision surgery and are severely worn. The wear is most evident in the sectioned 25.3 mm diameter acetabular component. The femoral components, on the other hand, appear pristine. The femoral heads are polished to a mirror finish (note the reflection of my hands holding the camera). 

Chamley s 1961 publication indicates that "the research cormnittee of the Manchester Regional Hospital Board has built and equipped a research workshop in the hospital and has provided the salary for a fitter and turner who will make the surgical implants." Chamley s research workshop and laboratory still remain at Wrightington Hospital, and they have been partly converted into a museum. 

The first UHMWPE hip comf>onents were fabricated either at the green lathe in his home workshop (the photo behind the lathe was taken of Chamley), or at the machine shop in Wrightington Hospital. 

Craven built the first wear testing rig at Wrightington for Chamley between 1959 and 1960. With little money available to support research, the stainless steel parts of the wear tester were scrounged from the local scrap yard, where the proprietor was accustomed to reserving raw materials for the hospital. The rig, shown in Figure 4.8 on display in Wrightington Hospital, consist of four stations. 

Distribution of THA wear rates observed in two studies from Wrightington Hospital. 

Charnley J. 1966. Total prosthetic replacement of the hip joint using a socket of high density polyethylene. Report No. 1. Wigan Center for Hip Surgery, Wrightington Hospital. 

The Smith-Petersen implant is an early example of a hemiarthroplasty, in which only the femoral side of the hip joint is replaced. By contrast, in a total hip joint replacement, both the femoral and acetabular surfaces are replaced. The radiograph, shown in Figure 6.1, was obtained at the Chamley Museum at Wrightington Hospital (Wigan, England) and illustrates this early design. 

Radiograph of Wiles prosthesis found at the Chamley Museum at Wrightington Hospital (Wigan,... 

Radiograph is an eariy McKee design from Wrightington Hospital (Wigan, England). 

McKee-Farrar and the Ring prosthesis taken from implants in the collection at the Thackray Medical Museum, along with a radiograph of a dislocated Ring prosthesis obtained from the Charnley Museum at Wrightington Hospital... 

Wrightington Hospital Management Committee Centre for Hip Surgery Wrightington Hospital Near Wigan... 

This chapter would not have been possible without the assistance of many supportive colleagues in England. Professor John Fisher (University of Leeds), Dr. Mike Wroblewski (Wrightington Hospital), and Harry Craven (Lancashire) were all instrumental in providing details regarding the undocumented history of Wrightington during the time of Charnley. Drs. Ken Brummit and... 

Wroblewski et al. from Wrightington hospital have performed a long-term prospective observational cohort study... 

UHMWPE has been used in knee replacements since the late 1960s, when Frank Gunston developed a cemented implant design at Wrightington Hospital [5, 6]. This early knee replacement resurfaced the individual condyles of the femur and the tibia. Total knee arthroplasty (TKA), which replaces the articulation between the femur and tibia, as well as between the femur and the patella, was developed in the 1970s, primarily at surgical centers in North America. The basic anatomical landmarks and implant features of a typical total knee replacement are illustrated in Figure 7.1. 

In the past 6 years, a number of reports about Hylamer have emerged from Europe [44, 64—73]. These studies have generally shown elevated wear rates for Hylamer in combination with zirconia femoral heads, as well as stainless steel femoral heads. These elevated wear rates, however, were not always associated with early revision. Wroblewski et al. from Wrightington Hospital found that the clinical results with a mean follow up of 6 years (range 3 to 8 years) were excellent despite an average wear rate of 0.22 mm/y. Despite these excellent results, Wroblewski wrote that they had discontinued use of Hylamer at Wrightington because the high initial rates of penetration did not settle to the expected low levels within the anticipated time [66]. 

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