new polymer, Craven developed a multi-station wear testing device ... and
there it sits on the countertop in front of me. Pure world-changing history
sits on this countertop with a thin coat of dust.
In the adjacent cabinet, I see the culprits that almost destroyed all of
Sir John Charnley’s work. The Teflon cups that were retrieved from human
subjects lie on a shelf, with massive erosion and uneven wear. If
polyethylene was the answer to prayers, Teflon was the evil plague that
shook Charnley’s confidence to the core. By 1962 it was becoming clear
that Teflon was a long-term failure in every case, and while the metal alloy
hip stem was performing well, the hip socket Teflon cup was essentially
“melting away” with wear from the metal ball. I lean over, my face close
to the white, waxy-appearing Teflon, and I realize I am face-to-face with
the actual implant I have seen in a photo in a Charnley publication. This
implant was the final straw in a string of failures confronting Charnley. He
never performed animal studies, and in 1962, there was no regulatory
body in England that oversaw the approval of medical devices. Charnley
would conceive an idea, fabricate the implants (either by himself or in
concert with his corporate partners) and proceed to surgery. There were
no tracking mechanisms and no outcomes measures to analyze patients.
Charnley would operate another twenty years after his polyethylene
discovery, but the fact that he kept the failed Teflon cups gives us another
clue about the man. He was a true pioneer, able to meet with, “Triumph
and Disaster and treat those two impostors just the same,” in the words of
Kipling, and the curios of Teflon, instead of being objects of shame, are an
important chapter in the development of joint arthroplasty. The greatest
innovators have always diligently sought legitimacy, embracing the truth
of their outcomes, scraping through the patina of early promising results
and unearthing reality.
Theodore Roosevelt was born in New York City in 1858, famously
struggling with childhood asthma attacks before “making his body” and
embracing strenuous exercise as an adolescent. After graduating Harvard
College in 1880, and returning to the city to attend Columbia Law School,
the exuberant Roosevelt was elected a New York assemblyman as a baby-
faced twenty-four-year-old. A free-market capitalist, Roosevelt ascribed to
the conventional conservative theories of the day, favoring a laissez-faire