"Obviously not many patients between 35 and 45 years of age will accept the advice to delay surgery for a more or less indefinite period of years (say 5 years) unless the method of presenting this advice is adjusted to their particular psychology. A good way of doing this is never to accept for operation at the first consultation very young patients with only moderate physical signs. It is essential to see the patient several times, at first perhaps at 6 monthly intervals."
Charnley understood well that younger patients with a high activity level were the problem group for this type of replacement, but he did accept for operation young patients whose crippled general condition prevented them from resuming a high activity level and wearing out the joint.
This restriction of surgery to the elderly population or the young crippled population was widely practised and taught by Charnley.
This is reflected in the case selection in results published from Wrightington and from other centres that adopted the Charnley method. This aspect of patient selection must be clearly understood by those who seek evidence of effectiveness in the published literature relating to the treatment of the young patient with an arthritic hip. The published results do not relate to young patients with an arthritic hip, they relate to young patients who have another built-in restraint giving them the activity level of an elderly inactive patient.
Charnley did use the McKee metal on metal joint in his clinical practice and he conceded that the McKee worked just as well in patients as his own commenting
"It is nice to know that both are British."
