The Robert W. Jackson includes a significant number of historical prostheses, including a number of local items that are not represented in other collections. Dr. Jackson clearly had an interest in the evolution of this technology and its associated materials.
Shown here is a highly constrained GUEPAR (Groupe pour l’Etude des Prothèses Articulaires) total knee prosthesis, introduced in 1970. Compare this to the unconstrained Zimmer total knee replacement that was likely made in the following decade. The unusual black colour of the tibial liner is due to the use of carbon-infiltrated polyethylene, which was abandoned when it proved to have little advantage over standard HDPE.
These bone screws from Dr. Jackson’s collection are something of a mystery as they clearly predate his career by a considerable margin. They are likely made from cow bone. They were found in a bag labelled “Dr HEY-GROVES// BRISTOL 1920”, a reference to Ernest Hey Groves (1872 – 1944), a prominent English surgeon whose work focussed on mending of complex fractures.
A further clue may be found in a collection of similar bone and ivory items donated by Toronto orthopaedic surgeon, Dr. Allan Gross, which is attributed to University of Toronto Professor of Surgery, William Edward Gallie (1882-1952).
Broadly speaking, this material likely points to a period of exploration of animal ivory and bone as a biocompatible material. Much of this research was likely encouraged by the terrible compound bullet fractures of the First World War, which many orthopaedic surgeons, including Hey Groves and Gallie, experienced.
The Judet Hip Implant (c. 1950s)
This is one of several similar acrylic hip prostheses in Dr. Jackson’s collection. Such prostheses replaced the femoral head in cases of severe deterioration. This example was sold by the technology’s developers, the Parisian surgeon brothers Drs. Robert and Jean Judet, who first implanted their acrylic hip in 1947. The prosthesis became popular over the 1950s; two similar implants in the collection were manufactured in England. The metal features inside serve both as reinforcement and as x-ray markers.
As with the bone screws above, these items predate Dr. Jackson’s time in practice and point to his historical interest in the field. However, as he was entering practice practice, orthopedics was facing a wave of issues with acrylic-based materials. This concerned primarily the breakdown of acrylic bone cement, but included the failure of Judet-type hip implants. Acrylic tends to fail suddenly after a period of stability, rather than gradually. Nevertheless, there are cases of Judet implants lasting many decades.
The MacIntosh Knee Implants (c. 1960s – 1970s)
The MacIntosh Knee Plateau (AKA the “ashtray implant”) is a Toronto success story that is little known outside the orthopedic community. It was developed at the Toronto General Hospital (TGH) beginning in 1954 and is named for its inventor, orthopedic surgeon David L. MacIntosh (1914-2013.)
This uncemented implant was tested using several materials, including acrylic, titanium, and Teflon, and the Vitalium cobalt alloy. After 1964, only Vitallium was used. It was available in several sizes and saw widespread use. Shown here are Vitallium plateaus of various sizes, as well as a plastic version that may be an earlier Teflon variant.
The MacIntosh Implant Evolves (c. 1970s and 1980s)
Beginning in the late 1960s or early 1970s, an effort began at TGH and the University of Toronto to develop the MacIntos implant into a partial implant with the addition of a plastic (likely HDPE) femoral component. This arrangement was the opposite of the emerging standard for the knee joint prosthesis, which uses a metal femoral implant bearing on an HDPE tibial surface.
The best evidence for this work, which never reached production, is a 1977 patent (US patent 4,034,418), assigned to the University of Toronto. Robert W. Jackson was listed as the lead inventor. A great deal of effort went into this project, including the development of a ceramic tibial plateau shown here. Dr. Jackson’s collection is practically the only substantiation source of evidence for this research.
The collection includes one example of such an implant, removed from a patient, which has failed badly. It is included here, still in its sterilization pouch.