age sixty-seven. Dr. Smith-Petersen was a native of Norway who attended
high school and college in Wisconsin, then completed his medical
schooling and orthopedic residency training at Harvard. Renowned for his
singleness of purpose, personal magnetism, and dramatic flair while
operating,^7 his greatest contributions regarded the hip. Even while still a
resident in orthopedics, he developed a novel surgical approach to the hip,
which has been utilized around the world for decades. Frustrated with the
poor results of the rudimentary treatment of hip fractures of the femoral
neck he had been taught in residency, Dr. Smith-Petersen innovated the tri-
flanged hip nail that vastly improved the lives of millions of patients, and
continues, with slight modifications, to be the treatment of choice today. It
was this device that Dr. Charles Neer reviewed in his first paper.
Dr. Smith-Petersen’s greatest discovery was an implant that rendered
itself obsolete, and sparked an insurrection against one of mankind’s
supreme foes, arthritis.
Once physicians could see hip arthritis on an X-ray, the question
became: what is of greater consequence, the bone spurs that tentacle out
like coral from the femoral head and acetabulum (hip socket), or the bone-
on-bone articulation that results from the loss of the articular cartilage
coating? It’s not surprising that surgeons concluded that the surrounding
bone spurs might be the culprit, as the critical biomechanical studies had
not yet been performed that would reveal how astonishingly slippery
healthy cartilage is. Like lifting the hood of a car, applying automotive
rubber cleaner on belts and tubes, and expecting the engine to run better,
the bony projections around the hip joint were attacked in hopes of
improving the performance of the hip. In the 1920s, surgeons began
making large skin incisions around the hip, deeply exploring the muscles
around the hip socket, and using hammers, chisels, and large pliers-like
biters to excavate and gouge away the carapace that entombed an arthritic
hip joint. While this improved some patients’ hip range of motion and
addressed some of their pain, surgeons like Dr. Smith-Petersen were
unconvinced. Advancing the technique further, a small group of surgeons
modified the procedure to include a makeshift biological covering of the
femoral head. Harvesting a swatch of the broad tendon on the side of the
thigh (the fascia lata), a surgeon could festoon an improvised gliding
surface where the articular cartilage had been lost. Surgeons were hoping
(in vain) the body would accept the tendinous tissue and refabricate a new