had dedicated the first decade of his practice to fracture care, including
surgical treatment of shoulder fractures.
For centuries, physicians and scientists have primarily communicated
their discoveries to their colleagues via print journals. For academic
university physicians, the credo of “publish or perish” mandated that a
doctor actively conduct research and vie for journal acceptance. A young
surgeon like Charlie Neer, imbued with optimism, energy, and a fresh set
of eyes, was the perfect candidate to expose the inadequacy of orthopedics
after the war. Dr. Neer’s classic 1953 article, “Fracture of the neck of the
humerus with dislocation of the head fragment,” had highlighted the
heretofore abysmal outcomes associated with nonoperatively and
operatively treated severe fractures of the shoulder. On the last page of
text in that article Dr. Neer included a photo of the shoulder implant he
had designed, concluding, “replacement prosthesis presents logical
possibilities and may prove of value in dealing with major injuries of the
humeral head.”^2 The world had its first peek at the future.
In 1955, Dr. Neer reported on a series of twelve patients who had
undergone articular replacement of the humeral head.^3 Using the implant
he had designed, he was able to show dramatically improved outcomes
when treating trauma patients. Implantation of the Neer prosthesis
following trauma was a major step forward, but in this paper, Charlie Neer
hinted at another indication. Of the twelve patients, all but one had
suffered from a fracture-dislocation of the shoulder. A seventy-year-old
housewife (patient number eleven) was treated for “hypertrophic
osteoarthritis,” the world’s first partial (“hemi”) shoulder replacement for
arthritis, on March 16, 1954. The patient returned to the Midwest, later
writing Dr. Neer and telling him that she was “free of pain and leading a
new life.” Instead of limiting the use of the shoulder implant to patients
who had shattered their shoulder, Dr. Neer was offering the device for
treatment of shoulder arthritis.
As the postwar boom led to unprecedented growth and prosperity,
physicians were sanguine that disease could be challenged in ways never
imagined. Antibiotics opened the door to entering the abdomen and
operating on abdominal organs and the bowels. Mechanical ventilation
during and after surgery bolstered surgeons’ ability to operate on ever-
more critically ill patients. Pharmacological discoveries led to an
explosion of medicines that made diseases like diabetes, malaria, gout,