of materials readied for surgical implantation. A person with a total hip
replacement likely has metals from Africa, Asia, and North America, and
polymers from North America.
The shoulder prosthesis used by Péan in Paris in 1893, was made of
platinum and rubber, but half a century passed until joint replacement with
a large metal alloy stem became a reasonable enterprise. In 1937, just as
antibiotics were about to become clinically useful, pioneering orthopedic
surgeons tested various alloy screws in animals, finally settling upon an
admixture of metals that is similar to what we use today. Processing and
sterilization greatly improved, and orthopedic implants earned a proper
place in the armamentarium of disease treatment, but were limited to joint
replacement and plating of fractures. In the infancy of the implant
revolution, the only sensible application of minerals was with bulky hunks
of metal, but that would change by decade’s end with the insertion of wires
into the body.
Today, millions of patients around the world have cardiac devices
implanted in their bodies. This was unthinkable just a few decades ago,
when patients suffering from heart attacks or arrhythmias were simply
allowed to die. Almost every reader can recall a story of a forebear who
was struck down by a heart attack or stroke, and such accounts of angina
and apoplexy are so common that we forget how remarkable it is that we
expect (demand?) to recover fully after a cardiovascular event. The most
common use of metal in the heart is in coronary artery stents and the use
of wires in pacemaker applications. It is commonly stated that over
500,000 coronary stent operations are performed every year around the
world,^12 (I will show that this is dramatically underestimated) and
implantation of pacemakers is expected to exceed two million units by
2021.^13 Stent utilization trailed pacemaker placement by more than thirty
years—in essence, it was easier to poke wires into the muscle of the heart
than to thread an expandable mesh cage into a minuscule coronary artery.
Virtually every last medical intervention involves some type of modern
material and newfangled technique. Don’t believe me? Take, for example,
a simple visit to an urgent care center after scraping your leg on a rusty
nail. You’ll be greeted by a triage nurse who will enter your information
into an electronic medical records database (invented and refined in the
last few years), an IV (with modern, pliable polymers) will be started to
run antibiotics (developed in the last half century), delivered from a bag