Charnley was fully aware of the implications of a successful hip replacement with the likely future demands and responsibilities. Once again the “Teflon Experience” was not without practical benefits.

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  I am making no attempt to encourage other surgeons to adopt this procedure for at least another three or four years or until an authoritative body such as the British Orthopaedic Association might request it … the designs have not been made available to manufacturers…
  
  
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  This operation must be reserved …for very disabled patients and the warning that a second operation might be necessary after some years … should be given. (1963)

The seriousness of the procedure, the need for regular follow-up and monitoring of outcome, as well as provision of revision facilities, are well documented.

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  An important aspect of the use of total prosthetic replacement is acceptance by the patient of a planned policy of “revision” with the establishment of a centre which holds itself permanently responsible for maintenance of this type of surgery and
  
  
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  I regard it mandatory that any surgeon aiming to take up the “total prosthesis” should make available to the public a service which can cope with the maintenance operations (1966)
  
  
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  To countenance the insertion of total hip replacement into a patient of 25 years of age in 1971, without a service station planned and organised for 1996, is like selling motor cars without providing mechanics and workshops. (1971)

Charnley’s views are succinctly summarised in a statement:

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  We have continuously to ask ourselves what type of late failure we must be prepared for, and we must protect patients too ready to submit to this practice after seeing patients who have been dramatically “cured” by this method. The past history of the arthroplasty of the hip joint is no great credit to orthopaedic surgery. (1967)

Charnley took no royalties and any financial benefits were channelled into research. Neither the design nor the methods of manufacture of the prosthetic components or the instruments were patented. It was the rapidly increasing demand and commercial pressure on the manufacturer in the face of mounting competition and copying that forced Charnley to allow the release of the LFA components, but not until the second half of 1970. Charnley informed the past Residents of his decision by a personal letter.

Statements made by Charnley many years ago serve as reminder of how far sighted he was.

It was therefore decided upon to make a prospective study of those patients operated on between November 1962 and the end of December 1965 and to continue this annually until they could no longer attend. This would produce truly long–term studies … (1970)

This attempt at “truly long–term studies” must be seen in the light of the continuing developments based on the ongoing clinical experience. All the operations carried out in the 3 year period November 1962 and December 1965, were included.

Some detailing of the various procedures is essential in order to offer a better understanding of the first 3 years in the history of the Charnley LFA.

Although referred to as the “FIRST 500” the total number of operations, and thus hips included, was 909. Patients’ mean age at the operation was 65 years (range 22–86). The details are shown in Tables 3.1, 3.2, and 3.3.