The Classic: A New Operation for Artificial Hip Joint in Bony Anchylosis

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Lewis Albert Sayre (1820–1900; Fig. 1) was the dominant figure in orthopaedic surgery in the United States during the 19th century. His father, a wealthy farmer in New Jersey, died when Lewis was only ten years old, and he was brought up by his uncle, a banker in Lexington, Kentucky. He graduated from the Transylvania University in Lexington before attending the College of Physicians and Surgeons in New York City from which he obtained his medical degree in 1842. By 1853, he had become a visiting surgeon at Bellevue Hospital, where he was an important factor in the founding of Bellevue Hospital Medical School. Because of his special interest, his large practice consisted mainly of patients with diseases and injuries of the bones and joints. For this reason, in 1861 he was appointed Professor of Orthopedic Surgery, Fractures and Dislocations at Bellevue Hospital Medical School. This was the first such a position in an American medical school. In addition to his practice, Sayre had the energy to serve as the health officer for the City of New York from 1860 to 1866. In this capacity, he made great improvements in public health, particularly because he recognized the contagious nature of cholera. His activity in the public sphere reached its apex in 1880 when he became president of the American Medical Association, the only orthopaedic surgeon to be so honored. During his tenure in office, he gave strong support for the establishment of the Journal of the American Medical Association, which began publishing in 1882.

Sayre was a prolific author, and his books were widely read throughout the world in translations. His greatest contributions to orthopaedic surgery were in the treatment of tuberculosis of the spine and other joints. Such a dynamic personality could not avoid controversy and indeed he did not try to avoid it. It is interesting to note that his three sons all became orthopaedic surgeons.

This Classic article consists of two case reports of hip resection for ankylosis after infections. The first of these is reported in full. The second is omitted because of its length. This second case ended, unfortunately, with the death of the patient from pneumonia six months postoperatively. The autopsy reported noted: “Upon examination of the artificial joint, it was found to be provided with a complete capsular ligament, and the articulating surfaces were tipped with cartilage, and furnished with synovial membrane.” The report of these cases gave impetus to the use of joint resection for the restoration of joints ankylosed in positions that greatly impaired their function.

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