Obituary: A Remembrance of Nas S. Eftekhar (1935-2016)
Dr. Eftekhar (Fig. 1) is widely recognized for designing the first TKA implants that included a short-stemmed, metal-backed tibial component (Mark I and Mark II), and for introducing the concept of modularity in knee implant design .
Dr. Eftekhar established the total hip and knee replacement program at Columbia-Presbyterian Hospital, which specialized in low-friction arthroplasty. In 1969, he performed the first total knee replacement in the United States at Columbia-Presbyterian Hospital . In his nearly 30-year career as Clinical Professor of Orthopaedic Surgery at New York Presbyterian/Columbia University Medical Center, Dr. Eftekhar performed more than 4000 total hip and knee replacements .
A protégé of the renowned orthopaedic surgeon Sir John Charnley, Dr. Eftekhar's steadfast adherence to Sir Charnley's low-friction principles stemmed from his 18-month training at the famed Wrightington Hospital in Wigan, England beginning in October 1967. At that time, infection was a major problem for Sir Charnley's low-frictional torque arthroplasty. In order to prevent infection, Sir Charnley and his team experimented with using body exhaust suits during surgery. Dr. Eftekhar studied the permeability of surgical gowns, and his findings remain an exhibit in the Hip Center at Wrightington Hospital today.
“Dr. Eftekhar and other Fellows working with Sir Charnley in those early years of hip replacement set a very high standard of surgery, research, and development,” B. Michael Wroblewski MB ChB, FRCS (Ed), MSc (Mech Eng), Director of the Charnley Research Institute at Wrightington Hospital told CORR®.
The Charnley Research Institute records show that from October 1967 to November 1968, Dr. Eftekhar performed 95 primary low-friction arthroplasties (including three conversions from intertrochanteric osteotomy and two from hip fusions) and one revision late in his stay.
A technically gifted surgeon, Dr. Eftekhar would not accept anything less than perfection.
“I have never met another hip surgeon who more often achieved the preoperative plan that he set out to accomplish during surgery,” Richard Iorio MD, Professor of Orthopaedic Surgery at New York University Langone Medical Center and the Hospital for Joint Diseases told CORR®. “During his Charnley low friction arthroplasty, he would perfectly juxtapose the cut greater trochanteric surfaces with an impeccable wiring technique.”
His pursuit of perfection likely earned him a new job. By chance, Dr. Frank Stinchfield, the Chairman of the Orthopaedic Department at Columbia-Presbyterian Medical Center at the time, observed Dr. Eftekhar performing a total hip replacement at Wrightington and soon invited him to join his faculty in New York. Dr. Eftekhar stayed for nearly 30 years.
Beyond his surgical prowess, Dr. Eftekhar was an innovator, developing and holding patents on the Mark I (1969) and Mark II (1973) total knee replacements. Ronald P. Grelsamer MD, Dr. Eftekhar's fellow in 1985-1986 told CORR® that he always respected Dr. Eftekhar's admirable quest for the truth.
“He was under incredible pressure from industry to market his Mark I total knee design and also a monoblock femoral stem for use in total hips (with an offset 22 mm ball); he resisted bringing these products to market unless they had 10 to 15 years of excellent results,” Dr. Grelsamer said. “He clearly was not very interested in the money that could have resulted from those marketing endeavors.”
Indeed, Dr. Eftekhar's focus remained on the patient. In his book, Principles of Total Hip Arthroplasty, Dr. Eftekhar wrote, “Not the hip; the patient is considered first, and the hip is reconstructed by individualizing the clinical problem based on anatomical and pathological findings” .