What have the Americans ever done for us?

Jasper Johns, Flag, 1954. MoMA

It's true that the greatest advances in skeletal trauma and orthopaedics are predominantly European in origin (and many of them are British), but our friends in the States catch up quickly. I remember being at the American Academy meeting about 15 years ago, having been doing a lot of MIPPO fixation for damage control for about 3 years, after the Hannover trauma stars like Krettek had published really wonderful papers on it. At the AAOS meeting they had one guy presenting about 10 femoral MIPPO's to a sceptical audience. Now they're completely on top of it.

Areas where they do have a great track record of innovation include spines and an interest of mine, lower limb revision arthroplasty. Kelly Vince on knees, for example, is a truly great surgeon and educator, one of many North Americans (I know he's Canadian) in that field, and there are lots of revision hip stars like Paprosky, the Mayo guys, lots of them.

Which brings me to Charlie Engh, who has graced numerous CCJR meetings. He is the man behind the AML cementless fully porous coated stem, which like Paprosky's Solution stem really cracked the problem of the difficult femoral revision. There are now quite a few imitations. I can't stand modularity on revision femoral stems - I regard it primarily as a marketing ploy for companies, and it pushes the price up - as it's nearly always unnecessary and complicates matters. The AML had a modular head and that was it, although there a couple of variants now. This is not an advert - I use one of its competitors, I'm just paying homage to Charlie.

Anyway, here is a great reminiscence by the man himself, on his career and the development of orthopaedics in the USA over that period. It's followed by a minimum of 10 year follow up on the fully porous coated femoral revision stem - a landmark paper in my view.




That piece mentions the other Engh brother, Gerry, also an orthopaedic surgeon. I once saw him present a case - with videos - of a patient with no arms who drove a car with their feet on the wheel. Gerry did an ACL reconstruction (I think on both knees) followed by medial AND lateral unicompartmental knee arthroplasties. The end of the talk showed a new video - back driving the car. I'm not making this up. Wonderful.


Here's the 10 year outcome paper. Relatively few cases, but difficult ones, and a long follow up. Most surgeons and patients would be happy to get a good 10 years (and more) in cases like this.