Innovation, Assessment And The Hip Prosthesis

Abstract

This project examines the introduction, development and assessment of the Charnley hip-prosthesis from the 1960s to the present. We aim to elucidate the historical processes that inform current policy towards hip replacement operations. Our focus is on the contributions of doctors, industrialists, health managers, patients and the media to the innovation process, the networks that link them. We examine the aspirations and expectations of each of these groups, and how they framed the device and its evaluation, and the impact of the competitive environment on innovation process. We also explore perceptions of risk associated with concerns about infection, the viability of cement, quality control in materials and manufacture, and surgical operative conditions and procedures. Finally, we seek to trace the history of clinical assessment and cost-benefit analysis from the 1960s to the present.

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Summary

Background

The artificial hip is recognised as one of the major benefits of post war medicine. Though its effects on mortality may not be great, it has greatly improved the quality of life for many older people. The history of the initial invention, especially the contributions of John Charnley at the Wrightington Hospital, near Wigan, Lancashire, is reasonably well known. Our aim is to explore the later history - the development of the prosthesis, its reception by professionals, patients and policy makers; and the dynamics of the companies involved in the manufacture and distribution of prostheses.

Research Design

As historians we rely chiefly on documents - from scientific papers and professional reports, to newspapers and diaries, to policy statements and company accounts; but in this study, when many of the key participants are still accessible, we shall also use a wide range of interviews with many different kinds of informants - patients, doctors, managers, industrialists and policy makers. Through colleagues in the USA and in continental Europe, we shall supply a comparative dimension where possible.
Through documents and interviews, we shall explore the ways in which hip prostheses were designed, made, sold, used, evaluated and experienced. We shall dissect the changing interest of the many parties involved, to understand the patterns of innovation and adaptation over time. We are particularly interested in the changing and varied perceptions of risk (e.g. re surgery, quality of materials, and effects of failure); and we also want to see how the informal methods of assessment used for the early hip prosthesis compare with the more formal modes which have grown up over the last decade.

Policy and Academic Implications

By analysing the dynamics of hip prostheses, and by interacting with the various communities involved, we hope to:

1. provide models for the study of other innovations, past and present, in the UK and elsewhere,
2. increase the historical awareness of the various parties involved -
   including professionals, patient associations, manufacturers, ,managers and policy makers - so as to facilitate informed interaction.
3. explore the historical development of assessment methods, both formal and informal, especially as they apply to medical technologies.; and in this way to better understand their roles and limitations.

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Contacts

Professor John Pickstone

Ms Julie Anderson

Dr David Cantor

Ms Francis Neary

Professor James Raftery

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Outputs

Conference Papers

Pickstone, J; Anderson, J; Neary, F. (Oral) Innovation, Assessment and the Hip Prosthesis. Seminar: Centre for Res. Innovation & Competition. 2001, University of Manchester.

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News

Devices and Designs: Medical Innovation in Historical Perspective 11-13 July 2003, University of Manchester
http://www.chstm.man.ac.uk/events/innovation.htm
The project group has been involved with the organisation of this conference and the IHT Programme has contributed sponsorship of the event. The IHT Programme will be well represented with 9 projects presenting.

eMusk Conference 18-20 June 2003, University of Teeside
http://emusk.tees.ac.uk/conference.cfm
Julie Anderson will be giving a keynote address on behalf of the project titled "The History of Hip Replacements"

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