screws, and the treatment of hip fractures in the 1950s started to include
partial hip replacement.
If, as noted earlier, “specialization is the fundamental theme for the
organization of medicine in the 20th century,”^21 then hyper-specialization
and the use of surgical implants is the fundamental theme of post–World
War II medicine. If you seek proof of the explosion of surgery, consider
that the Hospital for Special Surgery (HSS) in 1968, more than one
hundred years after its creation, still only had three operating rooms.
While Dr. Mark Coventry performed the first “FDA-approved total hip” at
the Mayo Clinic in 1969, the first Charnley metal-on-ultra-high-
molecular-weight-polyethylene hip had been performed at HSS in 1968^22
under the guidance of surgeon-in-chief Philip Wilson Jr. and Dr. Harlan
Amstutz, later the chairman of orthopedics at UCLA.
Total hip replacement is arguably the most reliable, long-lasting, and
patient-pleasing implant in the history of surgery. Sir John Charnley
deserves the credit for innovating the use of polyethylene and bone cement
in medicine, and his contribution to the world of medicine is still felt
today by millions of people every year. The total knee replacement,
however, was a product of HSS surgeons and engineers, and the “total
condylar knee” (1974) was the world’s first successful and widely utilized
knee replacement.^23 The success of joint replacement and the improved
reliability of spine surgery mandated that HSS increase the number of
operating rooms to eight in 1972 and eleven in 1990, and double that
today.
The slow expansion of the world’s most renowned orthopedic hospital
in its first fifty years had nothing to do with lack of leadership or
commitment; HSS did not come into full bloom until the elements of the
implant revolution had been conceived and refined. The postwar embrace
of bioengineering and biotechnology fueled an orthopedic research
program that is unmatched anywhere in the world, particularly in sports
medicine. Like the Mayo Clinic, the use of high-tech diagnostic tools, the
emphasis on resident education, and the yearning to create a center of
excellence that attracted patients from around the world has made the HSS
a beacon of hope.
Every surgical specialty has a short list of the most important clinics
and hospitals where they began. Neurosurgeons acknowledge Henry
Cushing’s Johns Hopkins, urologists give the nod to Hugh Young and