The Classic

A cementless endoprosthesis implanted in 1940 by Austin Moore and Harold Bohlman is the basis of one of the most interesting collaborations in the history of orthopedic surgery. Austin T. Moore (Fig. 1) was born on July 21, 1899 in Ridgeway, South Carolina and graduated from Wolford College at Spartansburg, South Carolina in 1920. For his devotion to crippled children and adults, he received an honorary doctorate degree from Wolford College 40 years later. After receiving an M.D. degree from the Medical College of South Carolina, he traveled north to work with Professor A. Bruce Gill at the University of Pennsylvania in 1927. Moore loved hard work and considered it the essential ingredient of happiness. Although he wrote few articles for medical journals, he was a masterful bedside and operating room teacher. Harold Ray Bohlman (Fig. 2) was a native of Gauge County, Nebraska and a graduate of the 1923 class of Johns Hopkins Medical School, where he eventually became a clinical professor of surgery (orthopedics). He was one of the pioneer investigators of the use of metal implants and antibiotic therapy for the treatment of bone infections. In 1937, after Charles Venable and Walter Stuck introduced the use of Vitallium into orthopedic surgery, Bohlman designed a Vitallium replacement for the femoral head and inserted it in the hip joint of seven patients with nonhealing femoral neck fractures. Venable's and Stuck's experiments with Vitallium had been performed in dogs in a shed on a ranch near San Antonio, Texas. Bohlman's preliminary experiments were performed on a farm in Maryland; he buried the prostheses in soil with control metal alloys to verify the claims of the noncorrosive properties of Vitallium. Bohlman was also one of the early military and civilian pilots in the United States. On September 28, 1940 he flew to South Carolina and, with Austin Moore, performed the historic replacement of the proximal 12 inches of the upper end of the femur of a 53-year-old man that had been destroyed by a recurrent giant cell tumor. Eight years later, when the patient died of a heart attack, the implant, including the entire proximal femur and hemipelvis, was examined in detail at autopsy and microscopically to determine why the patient had walked so well without a support, using only a cane for long distances. There was no evidence of recurrence of the giant cell tumor, and the implant was described as “just as bright and shiny as the day it was inserted and at no point on it was there any evidence of corrosion.” Bohlman's energy was inexhaustible, and his collaboration with Moore, as recorded in the following article, is an important landmark in the history of American orthopedic surgery.