What Happens During Hip Replacement Surgery?



Museum of Medicine and HealthTeacher resource: Medicine through TimeIncludes object images and description, discussion points and activities relating to the following themes:Medicine in War Understanding the body: anatomy and imaging techniquesSurgery and keeping the body sterileThe National Health Service (NHS)Self-diagnosis/treatment and alternative remediesBackground information for medical items (1)Image 1Penicillin syringePenicillin, the world’s first antibiotic which could stop bacterial infections, was discovered by Alexander Fleming in 1928. It was used in treating infected wounds on the front line of fighting during WW2. This metal syringe is made out of a former oil bottle for a BREN gun. It was made during the Second World War by the Royal Electrical and Mechanical Engineers. Formed in 1942, REME are a corps of the British Army responsible for regular inspection, maintenance and modification of Army equipment. It was made out of metal so it could not break as glass syringes did on the battlefield. George Archibald Grant Mitchell owned and donated the syringe. He served in the Royal Army Medical Corps throughout World War II in North Africa and Italy and was an advocate of using penicillin on wounded men to prevent sepsis. Despite being discovered in 1928, penicillin was first mass manufactured during WW2. In 1945, G.A.G. Mitchell received an OBE for his work with penicillin.Image 2Direct blood transfusion setWorld War 1 saw the rapid development of blood banks and transfusion techniques. Canadian doctor and Lieutenant Lawrence Bruce Robertson persuaded the Royal Army Medical Corps to adopt the use of blood transfusion at the Casualty Clearing Stations for the wounded. In October 1915, Robertson performed his first wartime transfusion with a syringe to a patient suffering from multiple shrapnel wounds.Image 3Red Cross arm bandThe introduction of triage was an important part of treating patients in mass-casualty situations such as wartimes. Triage is basically the process of sorting casualties into immediate, urgent, and non‐urgent with the use of the holding category in the warfare situation. These categories remain valid today in mass casualty and warfare situations.The British Red Cross was formed in 1905 to help lessen the suffering of injured soldiers. Part of Red Cross volunteers’ role was to triage patients.Image 4Surgical instrument setBox of surgical instruments. Includes amputation saw and knives, tourniquet and trephine (for drilling a hole into a patients’ head). This box set was the Arthur William Dumville Surgical Prize for the session 1878-79 and was presented to Harry Payne, a student of medicine at Owens College, Manchester (now the University of Manchester).Image 5Lister SprayIn 1865, Joseph Lister read about the work done by Louis Pasteur on how wine was soured. Lister believed that it was microbes carried in the air that caused diseases to be spread in wards. People who had been operated on were especially vulnerable as their bodies were weak and their skin had been cut open so that germs could get into the body with more ease.Lister decided that the wound itself had to be thoroughly cleaned. He then covered the wound with a piece of lint covered in carbolic acid. His success rate for survival was very high.Lister then developed his idea further by devising a machine that pumped out a fine mist of carbolic acid into the air around an operation. The number of patients operated on by Lister who died fell dramatically.Background information for medical items (2)Image 6Post mortem set in mahogany caseThe instruments were made by Wood of Manchester for use in post mortem. John and William Wood were surgical instrument makers and cutlers at 74 Kings Street in Manchester city centre (not far from where the old Manchester Infirmary used to be where Piccadilly Gardens is now). The Woods were in business from 1833 to 1933. The skills needed to make surgical instruments were basically the same as for making cutlery, which is the area of work they had started in. Post mortem sets became one of their specialities.Historically, many of the earliest advances in understanding the body’s organs, how they function and interrelate have been done through post mortems and recording findings (see also images 7 and 8).Image 7Gray’s AnatomyIn 1855, Henry Gray approached his colleague Henry Vandyke Carter with his idea to produce an inexpensive and accessible anatomy textbook for medical students. Dissecting unclaimed bodies from workhouse and hospital mortuaries through the Anatomy Act of 1832, the two worked for 18 months on what would form the basis of the book. Their work was first published in 1858 in London. Updated versions of the book are printed to this day.Image 8Dissection room imageThis is the dissecting room of the old Medical School at the University of Manchester, where medical students dissected dead bodies in order to learn more about the different parts of them function and fit together. This is an essential part of doctors’ training to help them understand the human body.Image 9Brain modelUnderstanding of the brain and how it functions has been studied since the time of the ancient Egyptian and ancient Greeks. This work continued through the Renaissance and into the 1800s when the invention of the microscope helped scientists see details more closely and the discovery of electricity helped to explain how the brain transmits messages through nerves. More recent work has helped surgeons understand the function of different parts of the brain and learn new techniques for operating on it.This model was constructed from detailed drawings of human brains from dissected corpses and was used in teaching medical students.(see also image 21)Image 10Heart modelHumans have known about the heart since ancient times, although its precise function and anatomy were not clearly understood. The Greek physician Galen (2nd century CE) knew blood vessels carried blood and identified venous (dark red) and arterial (brighter and thinner) blood, each with distinct and separate functions, although he did not realise that the heart pumps blood around the body.It was not until William Harvey’s work in the 1600s that a clear idea of the heart and its place in the circulatory system was established. Increased understanding of the heart meant that, by 1967, the first heart transplant was possible, although early patients did not survive long.This model was constructed from detailed drawings of human hearts from dissected corpses and was used in teaching medical students.Background information for medical items (3)Image 11X-rayThis is an x-ray film done in 1944 of the stomach of Mr F Baxter. The stomach contains a barium meal, making the organ visible to the doctors who wanted to examine in. Wilhelm R?ntgen is credited with discovering X-rays in 1895. They allowed doctors to see inside the body without cutting it open. Side effects of x-ray exposure included skin damage caused by radiation leading to cancers. The more recent digital x-ray process, which have become popular in radiography, an electronic detector is used rather than film, uses the lowest possible dose of radiation. Image 12ForcepsObstetric forceps in a sterilisation box.Forceps are used during difficult childbirths to hold and support the child’s head whilst helping its journey into the world. Forceps were first used in the 1600s.Image 13Charnley hipThis is a Charnley total hip prosthesis dating from 1965. John Charnley qualified as a doctor in 1935 from Victoria University of Manchester. During the Second World War he was enlisted as a Lieutenant in the Royal Army Medical Corps. He was medical officer during the evacuation of troops from Dunkirk in May 1940. After the war Charnley returned to Manchester Royal Infirmary where he worked as an orthopaedic surgeon. Charnley set up a centre for hip surgery at Wrightington Hospital in Wigan in 1958. Working with biomedical engineers and designers was the key to his success in developing an artificial hip. He also developed an air filtration system in the operating theatre to reduce the risk of infection occurring during surgery. This hip replacement has been removed from a patient and the cement is still visible. Image 14ProstheticArtificial leg. Multi-coloured above-knee artificial leg prosthesis. Belonged to teenage girl.The ancient Egyptians were early pioneers of prosthetics, although many of them are believed to have been for appearance rather than function. The development of prosthetic limbs has continued through history (including the infamous hooked hand and peg leg). In the 20th and 21st centuries, new materials have made prosthetics more useful and adaptable than ever (for instance, para-athletes’ running blades) and have led to increasing function through the use of computer and robotic technology.Image 15Violet ray machineThe Violet Ray was a device developed in the 1800s for application of electrotherapy treatment to the body. The device delivers high voltage, high frequency low current using inert noble gases via the blown glass tubes. The wand created a visible electric ray its colour could actually be orange, red or violet. The Violet Ray became incredibly popular during the 1920s and 1930s. It was promoted using wide ranging and untested claims and was apparently able to cure ‘arthritis, baldness, circulation problems, nerve, spinal and debilitation problems, sprains, eye disorders, and even possession’. Although a large number of the exaggerated claims surrounding the High Frequency Violet Ray have now been disproven, the device is still popular and is used in many places around the world Background information for medical items (4)Image 16LeucotomeThis instrument was developed by James McGregor, senior psychiatrist at Warlingham Park Hospital, Surrey in the 1940s. It was used to treat severe psychiatric disorders such as schizophrenia. It was described as an instrument ‘more nearly resembling a mechanical egg whisk than an implement of modern surgery’ by neurosurgeon Wylie McKissock in 1943.Surgery to treat psychiatric disorders, which effectively destroyed parts of the brain, has long been controversial. It was practised mainly during the 1930s to 1950s and is hardly done anywhere in the world nowadays, as medical understanding of such disorders has shown much better ways to treat these conditions.Image 17Binaural stethoscopeStethoscopes are used to listen to a patient’s heartbeat and lungs. René Laennec was embarrassed pressing his ear against a woman’s chest. He rolled up some paper, placed one end in his ear and the other on her chest. The funnel delivered a clear sound. From this he designed the stethoscope in 1816. The quality of examination of the patient increased with this invention. The development of materials like rubber meant doctors could listen with both ears. This model dates from the early 1900s and was designed by Andrew Fleischer, who also updated the chest piece to make sounds clearer.Image 18Pill rollerBefore access to free health care through the NHS, many people would rely on the pharmacist for health advice and medicines, as doctors at the time were expensive. Pharmacies would contain all sorts of different ingredients and equipment, and medicines would often be prepared in the shop by hand. ?Image 19Joseph Jordan's snuff box, 1836Formal medical education in Manchester began in 1814 when Joseph Jordan opened the first anatomy school in the English provinces. Previous lecture courses in medicine had included a series given by Peter Mark Roget, then a physician at Manchester Infirmary (1804–8), but better known for his later?Thesaurus. Jordan, however, offered dissections as well as lectures. Before the Anatomy Act of 1832, the only legal supply of corpses for anatomical purposes in the UK were those condemned to death and dissection by the courts. Medical men were sometimes driven to body snatching to further their knowledge of the human anatomy.Image 20CAT scanCAT/CT scans (invented in 1972) are 360-degree X-ray ‘slices’ through a body which a computer can put together, so that inside the body can be looked at from lots of anglesMedicine in war Objects Penicillin syringeDirect blood transfusion setRed Cross arm bandSurgical instrument setLister SprayOpening questions / discussion How are injuries in war different to those in regular, everyday situations?How do doctors have to work differently in war situations?How might war have changed medicine?Many advances in medicine have happened because of or during wars, including blood transfusions and prostheses. Hippocrates, the Greek philosopher and physician who has been called ‘the father of medicine’, is quoted as saying that ‘war is the only proper school for a surgeon’. Is war totally bad? (This could be debated with groups taking one side or the other).Object investigationGive each group a picture of one object.Initially ask the groups to discuss what the object might be and how it might relate to the theme. Emphasise that they should note down clues that the object gives them. This could be divided into ‘facts’ and ‘speculation’. They need to decide how they can back up their ideas.Ask each group to feedback their ideas, perhaps while showing the image on the interactive whiteboard. Encourage other students to ask questions and get the presenting group to justify their suggestions.Developing knowledge and understandingWar Doctor – divide the class into groups. Give each group the ‘Medical advances in wartime‘ sheet and allow them time to read about different medical advances. Then give each group a copy of the War Doctor sheet. Encourage them to imagine they are the doctor in this situation and work out what tools they might use. Ask them to suggest (in broad terms) how the patient might be treated and any problems they foresee.To conclude, build up a timeline of medical developments across this period.(shorter/simpler activity)Medical advancements timelineAllow time for students to read the ‘Medical advances in wartime‘ sheet about different medical advances. Then ask them to create a timeline of these advances.Cross-theme connectionsUnderstanding the body: anatomy and imaging techniques and Surgery and keeping the body sterileLinks to Manchester Museum collectionAncient herbal remedies (Materia Medica collection) in contrast to penicillin. Medical advances in wartimePenicillin syringePenicillin, the world’s first antibiotic which could stop bacterial infections, was discovered by Alexander Fleming in 1928. It was used in treating infected wounds on the front line of fighting during WW2. The syringe was not made of glass as this could break.Direct blood transfusion setWorld War 1 saw the rapid development of blood banks and transfusion techniques. Canadian doctor and Lieutenant Lawrence Bruce Robertson persuaded the Royal Army Medical Corps to adopt the use of blood transfusion at the Casualty Clearing Stations for the wounded. In October 1915, Robertson performed his first wartime transfusion with a syringe to a patient suffering from multiple shrapnel wounds.Red Cross arm bandThe introduction of triage was an important part of treating patients in mass-casualty situations such as wartimes. Triage is basically the process of sorting casualties into immediate, urgent, and non‐urgent with the use of the holding category in the warfare situation. These categories remain valid today in mass casualty and warfare situations.The British Red Cross was formed in 1905 to help lessen the suffering of injured soldiers. Part of Red Cross volunteers’ role was to triage patients.Surgical instrument setBox of surgical instruments. Includes amputation saw and knives, tourniquet and trephine (for drilling a hole into a patients’ head). This box set was the Arthur William Dumville Surgical Prize for the session 1878-79 and was presented to Harry Payne, a student of medicine at Owens College, Manchester (now the University of Manchester).Lister Spray In 1865, Joseph Lister read about the work done by Louis Pasteur on how wine soured. Lister believed that it was microbes carried in the air that caused diseases to be spread in wards. People who had been operated on were especially vulnerable as their bodies were weak and their skin had been cut open so that germs could get into the body with more ease.Lister decided that the wound itself had to be thoroughly cleaned. He then covered the wound with a piece of lint covered in carbolic acid. His success rate for survival was very high.Lister then developed his idea further by devising a machine that pumped out a fine mist of carbolic acid into the air around an operation. The number of patients operated on by Lister who died fell dramatically.War DoctorYou are a doctor working during World War 2 (1939 to 1945). You have access to the medical items listed on the separate sheet. You also have access to bandages, clean bedding and materials to keep your medical space as clean as possible.How would you try and help these patients? How helpful are the items you have? How likely do you think they would be to survive?PatientConditionSuggested treatment (including medical items to use)Possible problemsPatient 1A soldier with a piece of shrapnel sticking out of a large wound to his head.Patient 2A soldier whose leg is only partially attached after a mine exploded near him. He has some other cuts from the shrapnel as well.Patient 3A soldier who was shot in his shoulder. There is no exit wound for the bullet.Understanding the body: anatomy and imaging techniques (1)Objects Post-mortem set / instrument setGray’s AnatomyX-rayDissection room image caption should read old medical schoolBrain modelHeart modelStethoscopeJoseph Jordan Snuff boxOpening questions / discussionHow did scientists and doctors discover what the inside of the body is like?How did scientists and doctors record their findings?What equipment did they use to learn more about anatomy?Show common items such as an egg, a chocolate bar, a wrapped present. Ask students what is inside? How do they know? How can we tell for sure (only by unwrapping/opening)?Has anyone in the class ever had an X-ray? A CAT scan? An MRI? What was the experience of them like?Object investigationGive each group a picture of one object.Initially ask the groups to discuss what the object might be and how it might relate to the theme. Emphasise that they should note down clues that the object gives them. This could be divided into ‘facts’ and ‘speculation’. They need to decide how they can back up their ideas.Ask each group to feedback their ideas, perhaps while showing the image on the interactive whiteboard. Encourage other students to ask questions and get the presenting group to justify their suggestions. Give students the context information for the objects. What surprises them?Developing knowledge and understandingDiscussion: historically, dissection has been the main way to find out about the insides of human bodies- and still is. What more modern ways of finding out have been developed?Timeline activity: give students the Developments in understanding the human body sheets, along with the relevant images (Joseph Jordan's snuff box, Dissecting room, heart and brain models, stethoscope, Gray’s Anatomy, plus the images of imagining techniques below). First ask students to read the information and match to the images, before then asking them to create a timeline of developments, with their own brief notes.Focus on the dissecting room image with the students. Why is/was it so important for medical students on their way to becoming doctors to have such a good understanding of the body? (not just placement and function of organs, but understanding of nerves, blood flow, interconnections between organs and other parts of the body, need to be prepared when something unexpected happens during surgery)Understanding the body: anatomy and imaging techniques (2)Developing knowledge and understanding (continued)Bring examples of atlases, OS maps, UK driving atlases, AtoZ city maps etc. Challenge students to:Find particular placesWork out routes between places, including how long it will takeAsk students to record and later feedback all the steps they took. How easy was the process?Now bring up Google Maps or and repeat some of the examples the students did. Why is it so much easier to do this on the computer than working with paper maps? (digitised mapping, algorithms to work out routes, live traffic information, GPS etc).Now show the image from Gray’s Anatomy (and possibly also the heart model). How did scientists work out the anatomy shown here? (Physically dissecting dead human bodies) How would doctors working with this sort of image be able to cope with Situs inversus (main organs are mirror-imaged - ) or dextrocardia (the heart points the wrong way - )?So, what is the equivalent of ‘Google Maps’ for bodies? (images included below)X-rays (first used in 1895/96) can give an image of a slice of the body, but only show up harder structures.CAT/CT scans (invented in 1972) are 360-degree X-ray ‘slices’ through a body which a computer can put together, so that inside the body can be looked at from lots of anglesMicro-CT scans (invented in the early 1980s) are done at a better resolution (‘like a camera with more pixels’) and are high enough quality to be used to 3D print parts of the body, so surgeons can touch and feel before operatingMRI scans (invented in 1971) are similar to CT scans but use strong magnetic fields and radio waves, which makes some (especially softer) parts of the body to be seen more easily.Cross-theme connectionsSurgery and keeping the body sterile and the National Health ServiceLinks to Manchester Museum collectionAncient medicine - not much had changed in being able to see ‘inside’ the body. Just dissection for a long time and using illustration to record information. Ancient Egyptian internal organsGreek Womb clay modelDevelopments in understanding the human body (1)In 1855, Henry Gray approached his colleague Henry Vandyke Carter with his idea to produce an inexpensive and accessible anatomy textbook for medical students. Dissecting unclaimed bodies from workhouse and hospital mortuaries through the Anatomy Act of 1832, the two worked for 18 months on what would form the basis of the book. Their work was first published in 1858 in London. Updated versions of the book are printed to this day.Micro-CT scans (invented in the early 1980s) are done at a better resolution (‘like a camera with more pixels’) and are high enough quality to be used to 3D print parts of the body, so surgeons can touch and feel before operatingFormal medical education in Manchester began in 1814 when Joseph Jordan opened the first anatomy school in the English provinces. Previous lecture courses in medicine had included a series given by Peter Mark Roget, then a physician at Manchester Infirmary (1804–8), but better known for his later?Thesaurus. Jordan, however, offered dissections as well as lectures. Before the Anatomy Act of 1832, the only legal supply of corpses for anatomical purposes in the UK were those condemned to death and dissection by the courts. Medical men were sometimes driven to body snatching to further their knowledge of the human anatomy.X-rays (first used in 1895/96) can give an image of a slice of the body, but only show up harder structures.Humans have known about the heart since ancient times, although its precise function and anatomy were not clearly understood. The Greek physician Galen (2nd century CE) knew blood vessels carried blood and identified venous (dark red) and arterial (brighter and thinner) blood, each with distinct and separate functions, although he did not realise that the heart pumps blood around the body.It was not until William Harvey’s work in the 1600s that a clear idea of the heart and its place in the circulatory system was established. Increased understanding of the heart meant that, by 1967, the first heart transplant was possible, although early patients did not survive long.This model was constructed from detailed drawings of human hearts from dissected corpses and was used in teaching medical students.Developments in understanding the human body (2)Stethoscopes are used to listen to a patient’s heartbeat and lungs. René Laennec was embarrassed pressing his ear against a woman’s chest. He rolled up some paper, placed one end in his ear and the other on her chest. The funnel delivered a clear sound. From this, he designed the stethoscope in 1816. The quality of examination of the patient increased with this invention. The development of materials like rubber meant doctors could listen with both ears. This model dates from the early 1900s and was designed by Andrew Fleischer, who also updated the chest piece to make sounds clearer.MRI scans (invented in 1971) are similar to CT scans but use strong magnetic fields and radio waves, which makes some (especially softer) parts of the body to be seen more easily.Understanding of the brain and how it functions has been studied since the time of the ancient Egyptian and ancient Greeks. This work continued through the Renaissance and into the 1800s when the invention of the microscope helped scientists see details more closely and the discovery of electricity helped to explain how the brain transmits messages through nerves. More recent work has helped surgeons understand the function of different parts of the brain and learn new techniques for operating on it.This model was constructed from detailed drawings of human brains from dissected corpses and was used in teaching medical students.CAT/CT scans (invented in 1972) are 360-degree X-ray ‘slices’ through a body which a computer can put together, so that inside the body can be looked at from lots of anglesThis is the dissecting room of the old Medical School at the University of Manchester, where medical students dissected dead bodies in order to learn more about the different parts of them function and fit together. This is an essential part of doctors’ training to help them understand the human body.X-rayCT scannerCT scan of human brainMicro CT scan of Richard III’s skullMRI scan of human brainSurgery and keeping the body sterile (1)Objects Charnley hipSteriliser boxSurgical instruments setLeucotomeTrephine Brain modelLister sprayOpening questions / discussionHave you ever had surgery or known anyone else who has? Where? When? Has anyone got a relative who has had a hip replaced?How do surgeons know where to cut?How do surgeons know what to look for/what to do?Why do surgical instruments need to be sterilised?What might happen if surgery is done without sterilisation?How did doctors discover that sterilisation is good/germs bad?Object investigationGive each group a picture of one object.Initially ask the groups to discuss what the object might be and how it might relate to the theme. Emphasise that they should note down clues that the object gives them. This could be divided into ‘facts’ and ‘speculation’. They need to decide how they can back up their ideas.Ask each group to feedback their ideas, perhaps while showing the image on the interactive whiteboard. Encourage other students to ask questions and get the presenting group to justify their suggestions. Give students the context information for the objects. What surprises them?Developing knowledge and understandingPossible practical activities to show how challenging surgical techniques can be, such as:engrave egg without cracking the shell (use a needle or point of a sharp knife)remove the peel from an orange with a plastic knifehide a marble or similar in the middle of a lump of plasticine (multiple lumps needed). Challenges such as: who can find it using the fewest cuts? Who can find it using the smallest cut (analogy with laparoscopic ‘keyhole’ surgery)Hip replacements were developed in Greater Manchester – show the image of the Charnley hip.Divide the class in half. These halves could work in smaller groups. Give one half of the class the sheets on John Charnley’s quest for Total Hip Replacement, the other the sheets on Modern Hip Replacement Surgery. Each half will be producing a presentation on their area for the other half of the class (if splitting the halves into groups, each group could give individual presentations or could work together to produce a ‘super presentation’).This could presentation could include making posters or other visuals to capture key points.When the presentations are made, ask the other half of the class to make notes on what they learn. Then create new pairs or small groups which include members of both original halves. Each new pair/group should summarise what has changed and what has stayed the same between Charnley’s work and modern hip surgeSurgery and keeping the body sterile (2)Developing knowledge and understanding (continued)Explore posters from different eras which attempt to educate people about the dangers of germs and lack of hygiene, including video adverts from 21st century.What makes them effective or not? Students devise their own education/public information campaign – what methods and outlets would they use?Play the ‘Discovery of penicillin’ game (courtesy of )Cross-theme connectionsUnderstanding the body: anatomy and imaging techniques and the National Health ServiceLinks to Manchester Museum collectionNeolithic skulls which have been trephined (had a hole cut in to release pressure/evil spirits)John Charnley’s quest for Total Hip Replacement John Charnley was born in Bury in 1911 and began his surgical career in the 1930s. After serving in Dunkirk and running an orthopaedic hospital in Cairo during the Second World, he returned to Manchester.John Charnley replaced Sir Harry Platt as Consultant Orthopaedic Surgeon at Manchester Royal Infirmary (MRI) in 1947. The post required that Charnley be Consultant at Wrightington in Wigan (Greater Manchester) for one day per month. Wrightington had been a specialist hospital treating tuberculosis (TB) since the early 1930s. By the time he assumed his post, new antibiotics were making more radical surgery on infected joints possible. Charnley’s research in Manchester after the Second World War on the treatment of fractures had already revealed his close interest in the application of engineering principles to orthopaedic surgery. By the mid-1950s in-patients at Wrightington could look forward to returning home a lot earlier. The freeing up of bed space raised the possibility of developing orthopaedic research and led Charnley to establish a unit for non-TB hip conditions.With a generous three years' leave of absence from the Manchester Royal Infirmary, Charnley began work on developing a total hip replacement. A biomechanics laboratory was completed in 1961 and The Hip Centre, with consulting rooms, conference and research facilities, followed a year later. -6354762500Charnley's first prosthesis consisted of two Teflon cups. This evolved to a femur implant of stainless steel with a large 'ball', to one with a smaller 'ball' that fitted into a Teflon cup. Both parts of the new artificial joint were held in place by pink, acrylic, dental cement. In the laboratory, Teflon looked like the ideal material for implants – it was slippery, hard wearing and inert. But early replacement operations failed in large numbers and Charnley came very close to giving up on plastics.However, following a timely visit from a plastics salesman, Charnley’s technician, Harry Craven, tested High Density Polyethylene (HDPE) against Charnley’s wishes.Craven managed to convince Charnley of the merits of this new plastic material when he found that HDPE wore only 1/2000 of an inch after two days - far less than Teflon.The resulting implant, with few modifications, is among the most successful replacement hips used today.Modern Hip Replacement Surgery Hip replacement surgery is a procedure in which a doctor surgically removes a painful hip joint with arthritis and replaces it with an artificial joint often made from metal and plastic components. It usually is done when all other treatment options have failed to provide adequate pain relief. The procedure should relieve a painful hip joint, making walking easier.What Happens During Hip Replacement Surgery?Hip replacement surgery can be performed traditionally or by using what is considered a minimally-invasive technique. The main difference between the two procedures is the size of the incision.During standard hip replacement surgery, the patient is given general anesthesia to relax their muscles and put them into a temporary deep sleep. This will prevent them feeling any pain during the surgery or have any awareness of the procedure. A spinal anesthetic may be given to help prevent pain as an alternative.The doctor will then make a cut along the side of the hip and move the muscles connected to the top of the thighbone to expose the hip joint. Next, the ball portion of the joint is removed by cutting the thighbone with a saw. Then an artificial joint is attached to the thighbone using either cement or a special material that allows the remaining bone to attach to the new joint.The doctor then prepares the surface of the hipbone -- removing any damaged cartilage -- and attaches the replacement socket part to the hipbone. The new ball part of the thighbone is then inserted into the socket part of the hip. A drain may be put in to help drain any fluid. The doctor then reattaches the muscles and closes the incision.While most hip replacement surgeries today are performed using the standard technique (one 8 to 10 inch cut along the side of the hip), in recent years, some doctors have been using a minimally-invasive technique. In the minimally-invasive approach, doctors make one to two cuts from 2 to 5 inches long. The same procedure is performed through these small cuts as with standard hip replacement surgery.The small cuts are thought to lessen blood loss, ease pain following surgery, shorten hospital stays, reduce scar appearance, and speed healing.\sThe National Health Service (NHS)Objects ForcepsPenicillin syringeSurgical instrumentsCharnley hipProstheticOpening questions / discussionHow do you think people managed before the NHS (free at the point of use) started?Who benefited most from the formation of the NHS? (e.g. sectors of society, doctors…)How do you think this changed doctors’ work and approach to patients?Object investigationGive each group a picture of one object.Initially ask the groups to discuss what the object might be and how it might relate to the theme. Emphasise that they should note down clues that the object gives them. This could be divided into ‘facts’ and ‘speculation’. They need to decide how they can back up their ideas.Ask each group to feedback their ideas, perhaps while showing the image on the interactive whiteboard. Encourage other students to ask questions and get the presenting group to justify their suggestions. Give students the context information for the objects. What surprises them?Developing knowledge and understandingMatch NHS-era developments to their decade using the task sheet and an A3 copy of the timeline sheet below (answer sheet also given). The actual dates are given on cards as well if you wish to use them as an alternative to the timeline. Introduce the idea that ever since the birth of the NHS, there have always been scarce resources. In nearly 70 years since the NHS was founded, costs of medical procedures have risen, but there are also many more procedures which doctors have created to solve medical problems.Revisit the timeline from the previous activity and encourage pairs/groups to discuss which points on it they think cost the NHS and any which may have made operations and/or recovery quicker. An extension discussion could involve collecting current news articles about new medical developments in the NHS and/or pieces on NHS funding and discuss how the NHS balances up the needs of different patients when resources are limited and which historical NHS advances may have saved money by making operations and/or recovery cheaper.Cross-theme connectionsSurgery and keeping the body sterileOther linksOnline general timeline of NHS: Laparoscopic 'keyhole' surgery introduced (less invasive, quicker recovery times)Breast screening introduced (to reduce incidents of breast cancer)Prescription charges introducedCT scans introducedDNA structure revealedThe contraceptive pill made availableWorld's first single harvest blood stem-cell transplant at Christie Hospital Cancer Centre, ManchesterFirst test-tube babyNational register for organ donation is set upFirst bone marrow transplantFirst kidney transplantMRI scans introducedA programme to vaccinate everyone under the age of 15 against polio and diphtheria is launchedFirst NHS heart transplantFirst hip replacementFirst heart, lung, and liver transplantThe Abortion Act makes abortion legal up to 28 weeksIntroduction of robotic arm leads to ground-breaking heart operationsNHS established. Trafford General in Manchester becomes first NHS hospitalBritish scientist, Sir Richard Doll establishes a clear link between smoking and lung cancer146704750900291950s001950s402971034160151970s001970s22719858894281940s001940s266452643009641960s001960s530126425962091980s001980s654019417906571990s001990s775770810278682000-09002000-09center730910088616663246822010-002010-19481972195219781953197919541980s1958198019601987196119881962199119671994196820071948NHS established. Trafford General in Manchester becomes first NHS hospital.1952Prescription charges introduced1953DNA structure revealed1954British scientist, Sir Richard Doll establishes a clear link between smoking and lung cancer1958A programme to vaccinate everyone under the age of 15 against polio and diphtheria is launched1960First kidney transplant1961The contraceptive pill made available1962First hip replacement1967The Abortion Act makes abortion legal up to 28 weeks1968First NHS heart transplant1972CT scans introduced1978First test-tube baby1979First bone marrow transplant1980sMRI scans introduced1980Laparoscopic 'keyhole' surgery introduced (less invasive, quicker recovery times)1987First heart, lung, and liver transplant 1988Breast screening introduced (to reduce incidents of breast cancer)1991World's first single harvest blood stem-cell transplant at Christie Hospital Cancer Centre, Manchester1994National register for organ donation is set up2007Introduction of robotic arm leads to ground-breaking heart operationsAdvances in medicine during the lifetime of the NHSSelf-diagnosis/treatment and alternative remediesObjects Violet ray machineleucotomeOpening questions / discussionHave you ever felt unwell and done an internet search to see what was wrong? Did this help?Why do people not to go to the doctors with medical problems?Does your family have any ‘unusual’ remedies for illnesses and ailments? What are they?How much can we rely on less traditional forms of healing?Object investigationGive each group a picture of the violet ray machine or the leucotome.Initially ask the groups to discuss what the object might be and how it might relate to the theme. Emphasise that they should note down clues that the object gives them. This could be divided into ‘facts’ and ‘speculation’. They need to decide how they can back up their ideas.Ask each group to feedback their ideas, perhaps while showing the image on the interactive whiteboard. Encourage other students to ask questions and get the presenting group to justify their suggestions.Give students the context information for the items. What surprises them? Emphasise that both devices were considered helpful to medicine in different way (the violet ray machine had no scientific basis, while the leucotome was based on a poor understanding of psychiatric disorders) but have since been shown to be unhelpful.Developing knowledge and understandingSplit the class into groups and ask them to investigate one of:HomeopathyAcupunctureHome remediesChiropracticDuring their research, either each group should to aim to find positives and negatives about their area, or give two groups each area, one focusing on pros and the other on cons.Students could produce a presentation of their findings or the teacher could organise a debate where each approach is presented and questioned by others.Discussion point: many of the above are not backed by scientific research. Does this mean they should be taken less seriously than conventional medicine? Some of them were believed to be scientific at one point, but scientific understanding has since developed. Can the students identify which approaches now have or ever have had scientific backing?Cross-theme connectionsThe National Health ServiceLinks to Manchester Museum collectionAncient herbal remedies: Juniper berries and honey bees (Materia Medica collection) ................
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