Orthopaedic Surgery
Prior to world war two, Orthopaedic Surgery was regarded as part of General Surgery and had no separate academic identity. Clinical activity was centred on the care of the injured, largely seen in Glasgow as the province of general surgeons, many of whom continued to treat fractures and dislocations until they retired or died.
This changed in 1942 when the University Court received a Bequest from a Glasgow businessman, Frederick Young, which provided the capital for the salary of a Lecturer in Orthopaedic Surgery. The post was attached to the Department of Professor Charles Illingworth, the Regius Professor of Surgery, who had the foresight and interest to develop the speciality.
He appointed Roland Barnes, a Lancashire surgeon working in Manchester Royal Infirmary, as Chief Assistant to Professor Sir Harry Platt, one of the handful of academic surgeons in the UK. Part of Barnes’ training had been at the Hospital for Special Surgery in New York, where he developed an interest in bone tumours which was to form part of the activity in his own department.
He had also supervised a war time unit in Warrington for the treatment of military and civilian peripheral nerve injuries. His remit in Glasgow was to develop undergraduate teaching in a separate unit devoted to orthopaedic surgery.
He met with great resistance from the general surgeons and was not given any dedicated beds at the Western Infirmary, having to rely on borrowed theatre space in Professor Illingworth’s Unit. Instead, he was given beds for elective surgery in a converted military hospital at Killearn, on the road to Loch Lomond.
Despite these early difficulties, the unit developed with the recruitment of young surgeons, discharged from the Services after the war, as NHS consultants. These included J T Brown, T W Howat, T B Gardiner, and Athol Parkes, an anatomist turned hand surgeon who developed an outstanding unit for the treatment of peripheral nerve and hand injuries.
In 1959, Roland Barnes was promoted to be the first Professor of Orthopaedic Surgery in the University (read more) and was at last given a dedicated ward in the Western Infirmary. He continued in post until his retirement in 1972, when he was succeeded as Professor by David Hamblen who moved from the University of Edinburgh where he had been the Senior Lecturer in Professor J I P James’ Unit.
The Department then went through a period of rapid change with the closure of Killearn Hospital and the movement of the elective beds into the new Gartnavel General Hospital. This was much closer to the Western Infirmary but still necessitated split site working, requiring regular movement of staff between the two hospitals.
In 1974, the Department at the Western Infirmary moved into new purpose designed accommodation in the Phase I Building. This provided adequate office space, research laboratories, as well as a Departmental Library with full teaching facilities. The Unit’s outpatient clinics and operating theatres were housed on the same level, and these linked facilities facilitated the development of both postgraduate and undergraduate teaching as well as a wide range of clinical research.
Clinical Activities
The Department’s interest in trauma continued, particularly in the management of hip fractures in the elderly. In addition to better methods of surgical fixation, there was an improvement in rehabilitation from a joint collaboration with the geriatricians to create a dedicated Orthogeriatric service in 1983.
Activity in elective surgery centred on joint replacement of the hip, knee, shoulder and ankle, all of which were included in well documented prospective follow-up studies. The increased risk of infection from introducing artificial materials into the body led to another pioneering area of applied research in collaboration with Dr Bill Whyte of the Building Services Research Unit of the University. He designed a laminar flow ventilation system for use in the operating theatre as well as trialling a range of bacteriological occlusive clothing for theatre staff which reduced infection rates.
In 1958, Professor Barnes had persuaded Professor Cappell of the Pathology Department to appoint Dr Mary Catto as a Lecturer in Orthopaedic Pathology. Her specialist training in London allowed her to set up the Scottish Bone Tumour Registry which provided the focus for referrals from other hospitals. The surgical treatment of most of these cases was undertaken by the Unit, later in collaboration with the Department of Oncology as the role of adjuvant chemotherapy increased. This unique resource continued up to the present and formed the basis of the National Service to serve Scotland for these uncommon but demanding tumours.
Another specialist area of development for the much more common problem of back pain was instituted by Gordon Waddell (1942-2017, read more), who worked as the spinal surgeon in the Unit from 1977 to 1995. His researches re-evaluated conventional treatments for back pain and played a central role in establishing new models of care which he developed in collaboration with psychologists, physiotherapists, osteopaths and general practitioners. His outstanding work was recognised with an Honorary Professorship from the University in 1992 and a CBE in 2003.
Research Interests
Inevitably a small department, with a maximum of four academic staff, has to depend on recruiting postgraduate students or collaborating with other disciplines to expand its research activity. Orthopaedic Surgery was able to do this using the longstanding links with the Bioengineering Unit in Strathclyde University which was set up by Professor Barnes with Professor Bobby Kenedi and his successor, Professor John Paul. This link was expanded by Ian Kelly, when he was Senior Lecturer, and resulted in a number of grants and shared research students and projects.
The studies initially used the gait analysis laboratory at Strathclyde to provide objective measurements of the functional outcomes following joint replacement surgery. Later, a simplified portable version of the force plate and flexible goniometers used for these measurements was developed and installed in the clinical unit at Gartnavel General Hospital. Professor Hamblen became Visiting Professor and Ian Kelly Visiting Senior Lecturer in the Bioengineering Unit, and Professor Paul was given an Honorary Professorship in Glasgow University.
Ian Kelly (1948-2004) moved to the Royal Infirmary as an NHS consultant in 1989, becoming clinical director in 1994. His specialty was the shoulder joint, on which he was an international authority. He worked closely with the Bioengineering Unit and the Centre for Rheumatic Diseases first at Baird Street Hospital and then at the Royal Infirmary. Professor Hamblen also collaborated with the Centre for Rheumatic Diseases on the unstable cervical spine in rheumatoid arthritis.
Osteoporosis is the underlying cause of most hip fractures in the elderly and was the subject of a long-running research study in collaboration with Dr Derek Smith of the Bone Metabolism Unit of the Department of Medicine, Western Infirmary (see Endocrinology). Funding was obtained to develop a computerised bone scanner using gamma-rays (OSCAR) for detecting early loss of trabecular bone in the forearm. The technique was later incorporated into a portable mobile device for use in clinical areas.
The expanded facilities in the new Phase I Building at the Western infirmary provided space for a fully equipped tissue and cell culture laboratory. These facilities allowed Professor Hamblen to continue studies on the cellular behaviour in the membranes that develop around metal and polyethylene implants leading to bone destruction and loosening. This work soon extended into the more complex field of molecular biology and genetic cytokine expression.
Fortunately, in 1990, Dr Stewart Ralston, a Wellcome Senior Lecturer, joined the Unit bringing with him the necessary expertise in these fields. Sadly after 15 months he moved to a more senior post in Aberdeen, but remained involved in a number of joint projects. These included the mechanism of fibroblast adhesion at the site of tendon repair and the pathogenesis of Dupuytren’s contracture in the hand. These studies were initiated by Jim Crossan, a Lecturer and Hand Surgeon in the Unit, in liaison with Professor Adam Curtis in the Department of Cell Biology.
Teaching
Like all clinical academic units, orthopaedic surgery was expected to take a pivotal role in the organisation of both undergraduate and postgraduate teaching. The move to the Phase I Building of the Western Infirmary provided dedicated space to deliver the necessary improvements.
A new departmental library was created with an extensive collection of textbooks and journals, many of which were not available in the main Hospital Library and were purchased using funding donated by grateful patients. An X-ray Museum was created with an encyclopaedic collection of x-rays illustrating trauma and orthopaedic conditions and their treatment. These were filed in separate envelopes, each with full documentation and cross referenced to a computerised catalogue. There was also an extensive collection of teaching slides built up over many years occupying four full size filing cabinets. These were available for lectures and were also arranged in sets on common topics with accompanying audiotapes for student self-teaching. Some of this material was later shared with other medical schools via a national distribution organised through the British Orthopaedic Association.
In addition to bedside and clinic teaching of attached students, the Department developed a close collaboration with the Department of Rheumatology for a topic-teaching module in the Integrated Year. Another novel idea which proved popular with the students was some shared lectures with the Department of Anatomy to provide a clinical background to basic science teaching.
Conclusion
Both Professor Barnes and Professor Hamblen were elected as President of the British Orthopaedic Association, an appointment which brought national and international recognition of the academic department and its activities during their term of office. Professor Hamblen retired in 1999 to take over the Chairmanship of the Greater Glasgow Health Board and subsequent attempts to identify and recruit a suitable successor all failed with the effect that the University suspended the chair and the department.
Professor David Hamblen
Images unless otherwise noted, provided by Professor Hamblen