“Inventing the ‘Oxford Knee™’: the development of partial knee replacement surgery, 1966-2009”

Joint replacement is a multibillion-dollar industry, but historians have given little attention to its emergence, except for the story of Charnley’s hip recounted by Julie Anderson and others in 2007. Using a unique set of hitherto unresearched primary sources donated to the Thackray Museum of Medicine by surgeon John William Goodfellow and engineer John Joseph O’Connor, this thesis explores the history of partial knee replacement surgery between 1966 and 2009 through a detailed case study of the Oxford Knee (OK). By 2009 the OK had become the most used and clinically researched partial knee device in the world, and this thesis answers how that came to be. The inventors, Goodfellow and O’Connor, aimed to mimic the knee’s natural movement, something that had not been achieved before, using a three-part design. The loose meniscal bearing kept in place by ligaments’ knee forces was at the core of their concept. Through decades of research and development, the success of the OK relied on the creation of surgical instruments and surgeons’ training alongside design changes. So extensive were these changes that the OK has three official phases. The ingenuity and originality of the design also meant that the OK needed to prove itself. The team made multiple attempts at getting an FDA premarket approval between 1982 and 2004 and dealt with the rebuttals by arthroplasty registries, first and foremost the Swedish Knee Arthroplasty Registry, on the partial knee high revision rates. These interactions led the OK team to publish multiple clinical studies, eventually determining whether revision rates were the best measure of success for partial knees. Through this research, I thus establish that the story of the Oxford knee’s success is very different in key respects to that of the story of Charnley’s hip replacement related by Anderson and others.