17th November 1931 to 14th September 2017
Surgeon, inventor, bioengineer, role model, mentor and friend
Michael Freeman was a remarkable, accomplished man with an outstanding intellect and a sparkling wit. His father died when he was young and Michael was sent to board at Stowe School from 1945 to 1950. There he excelled, developing a life-long thirst for knowledge and gained an Open Scholarship and Closed Exhibition to Corpus Christi College, Cambridge. He achieved First Class Honours in the Natural Science Tripos in 1953 before proceeding to the London Hospital Medical College completing his clinical studies in 1956. At Cambridge, he had met his life-long friend John Insall who accompanied him to London. Together they shared an interested in knee arthroplasty. After graduation, he wasted no time passing his FRCS in 1959 and undertook orthopaedic training at the London, Westminster and Middlesex Hospitals.
He completed an MD thesis on Ligamentous Injuries in 1964. His findings regarding the relationship of mechanoreceptors on the contraction of the gastrocnemius (in the cat) remain to this day the foundation of non-operative rehabilitation of the ligamentous injuries at the ankle. That year he received the Robert Jones Medal from the British Orthopaedic Association. He also established a research partnership with Prof SAV Swanson at Imperial College becoming Co-Directors of the Biomechanics Unit in the Department of Mechanical Engineering at Imperial. In 1968, he was an ABC Fellow and appointed to the London Hospital on an eight-elevenths consultant contract, allowing him to continue his research on arthritis and joint prostheses at Imperial.
As his research evolved, the Biomechanics Unit started to manufacture joint prostheses. This was not received with great enthusiasm by the University and resulted in the establishment of Finsbury Instruments, with members of his former research team at the helm.
He engaged in pioneering work with joint replacements for the foot and ankle which he was later to abandon with disappointment that these could not be made to work with the biomaterials which were available. His interests progressed with hip and knee arthroplasty. This resulted in the first condylar knee arthroplasty being implanted at the London Hospital in 1969. The early 1970s saw the arrival of the Imperial College London Hospital (ICLH) hip resurfacing, using high density polyethylene acetabular components and cobalt chrome heads. With every new development, he was meticulous in documenting changes and recording the outcome of every patient he treated. From this constant scrutiny, he made modifications to rectify any deficiencies he identified. By the early 1980s he had concluded that hip resurfacing was unreliable and had to be stopped. He then proceeded with the development to his full neck retaining total hip prosthesis.
His attention to detail and studious examination of outcomes was supported by several scientific grants and numerous publications, such that Michael became a magnet for fellows from across the world who wished to study with him. At no time did he shy away from reporting any unsatisfactory result to prevent others from repeating any mistakes. In 1982, he left Imperial and transferred his research to the Bone and Joint Research Unit, in the newly constructed Arthritis and Research Council building at the London Hospital Medical College.
He published prolifically both in peer reviewed journals and many book chapters. He was generous in sharing his enormous database with visiting fellows and trainees to enable them to advance their careers. He was always encouraging towards trainees, listening to their ideas and supporting them in their own studies. His welcoming approach produced strong international following in the profession.
In addition to his clinical and research activities, at various times he served on grant-awarding committees for the Arthritis and Rheumatism Council, the Medical Research Council and the Panel for Medical Research of the Department of Health and Social Security. He also found time to be a member of the Board of Governors of the London Hospital and the Brent and Harrow Area Health Authority. He served on the Editorial Board of the Journal of Bone & Joint Surgery [Br] and the Journal of Arthroplasty where he became the first European Editor-in-Chief of JOA from 1996 to 2001.
From 1983 to 1985 he was President of the International Hip Society. In conjunction with Hugh Phillips and Robin Ling, he established the British Hip Society serving from 1989 to 1990 as its first president. He was President of the British Orthopaedic Association from 1992 to 1993. Acting with Jacques Duparc, he helped establish the European Federation of National Associations of Orthopaedics and Traumatology, serving EFORT as its second President from 1994 to 1995.
In 1996, he retired from the now Royal London Hospital but continued to be employed by the Medical College until 1997. At this point he had remarked that throughout his career when he had designed prostheses and replaced joints, he had never really understood how the knee worked! The opportunity to explore this omission arose through a chance collaboration with the Charles University in Prague. Working with Dr (now Professor) Vera Pinskerova, he embarked on a programme of anatomical and MRI studies of cadaver and living knees, identifying the three-dimensional shapes of the articular components of the joint. Over several years with co-workers, he published in detail the mechanism of lateral femoral rollback and medial femoral stability. This reinforced his opinion that a stable knee prosthesis should be designed with a medially-spherical femoral condyle to mate with matched tibial concavity, while the lateral compartment should remain unconstrained. The final chapter came when Finsbury Orthopaedics was taken over by DePuy in 2010, which wished to discontinue manufacturing his preferred knee design. The led to a collaboration with Medacta Orthopaedics. With the involvement of his close associates, further development in the design of the medially-spherical knee prosthesis was undertaken. Deficiencies in the existing design at the patellofemoral joint were addressed and an absolutely, unconstrained lateral compartment was introduced. As always, he insisted that the new design was extensively monitored before it was generally released.
Throughout his career, he received numerous awards in recognition of his contributions to orthopaedics including Honorary Fellowship of the BOA in 2003. However, it remains a mystery why the public honours system overlooked him. Nevertheless, all those who worked with him held him in the highest regard, not just for his scientific mind and clinical work, but also for his gentle bedside manner and recognition that sufficient time must be provided to understand the patient’s complaint and ensure they understood the limitations of any intervention. If things had not gone to plan he would be the first to offer an apology and enquire if they had any ideas how they might wish to have things rectified. His style was an exemplar to us all. His immense knowledge and charm was also on display at scientific congresses where he was in demand as a chairman as he could stimulate discussion after most presentations. He was quick thinking and could make incisive comments. In an awkward moment, he could defuse the situation with an amusing observation.
Michael is survived by his third wife Patricia, his six children and 11 grandchildren. The children mixing as one large, happy family once more reflected the warmth of his personality. He will be greatly missed by his family but also his extended family of former trainees and fellows, as well as the whole orthopaedic community. His contribution will live on through his publications and inventions, and hopefully the values he has instilled in those who follow him.
Professor Robin Ling OBE has died at the age of 90. He will be remembered as a true gentleman, a master hip surgeon, an innovator and a scientist whose research and teaching have influenced surgeons around the world and thereby improved the quality of life for countless patients.
Robin Sydney Mackwood Ling was born on 7 September 1927 and brought up in the West riding of Yorkshire where his parents and grandfather were doctors in the same town; his grandfather, who looked after the more affluent side of town, was known as “old Dr. Ling”; his father, who cared for residents in the less wealthy areas, was “Dr. Billy”. His mother, Mona, ran the four-man medical practice during the war.
Educated in Chelmsford Hall in Eastbourne, Robin was dispatched at the outbreak of war to Canada with his two younger brothers where they lived with the Koerners, a philanthropic family who had emigrated to Canada from central Europe to escape the Nazis.
On returning to the UK he read medicine at Magdalen College, Oxford, and St Mary's Hospital in Paddington.
It was at St Mary's that Robin met Mary Steedman, a casualty nurse born in South Africa, who was preparing to return to Cape Town to read medicine having been awarded a scholarship. They married after a brief courtship and enjoyed 62 years of a happy and fulfilled marriage.
Throughout his life Robin had a passion for sport. His love of sailing started during his residency at Shawnighan Lake school on Vancouver Island and he and his brothers later persuaded their parents to buy a classic yacht, Veronique. On retirement, he moved to the Dart estuary and fulfilled his life-long ambition of owning his own sailing boat, aptly named Enfin.
Robin became interested in hip replacement surgery following his appointment as consultant orthopaedic surgeon at the Princess Elizabeth Orthopaedic Hospital in Exeter in 1963. There were very few types of hip replacement available in the 1960s and he sought to create an implant that could be securely fixed to the bony skeleton using acrylic bone cement. He collaborated with Dr. Clive Lee, an engineer at the University of Exeter, and designed a different geometry of implant that he believed would optimise fixation and thereby the long-term success of a hip replacement. The surgical instruments that he created allowed the hip to be inserted through the posterior approach, with only one assistant.
The first Ling-Lee hip was inserted in 1970 and the Exeter hip, as it is now known, is today the most implanted cemented hip replacement in the world due to its outstanding long-term function.
His observation of how the implant worked in the human body led to extensive research in the laboratories at the University of Exeter. Robin and Clive proved how bone cement (PMMA - a polymer) can undergo time-dependent deformation on loading and how this phenomenon (creep) is valuable in transmitting load through the joint, setting the scene for decades of pain-free activity in patients. His explanation of how “taper-slip” cemented stems function is part of mainstream orthopaedic teaching around the world and all major hip manufacturers now market an implant that functions in this way.
Robin Ling’s work was not just confined to the implant itself - he also developed sophisticated cementing techniques to improve the clinical result. These techniques constitute contemporary practice and are widely taught at symposia and workshops internationally.
Robin’s contribution to revision hip surgery resulted from a close relationship with Professor Slooff from Nijmegen in the Netherlands. Robin developed for the femur a technique of impacting morcellised bone graft into the large bone defects that can result from implant loosening. In combination with a cemented taper-slip stem, healing of the graft with reconstitution of bone stock and an excellent clinical outcome resulted. The technique of femoral impaction grafting in revision hip surgery has become an established technique in the armamentarium of specialist hip surgeons. The technique is less often practiced now since primary stems so rarely loosen.
Robin’s scientific work and teaching did not prevent him from contributing in all areas of professional life. He sat on numerous editorial boards and chaired many regional and national committees. He was President of the British Orthopaedic Research Society, 1979-80; President of the British Orthopaedic Association, 1986-87; President of the British Hip Society, 1991-93; President of The International Hip Society, 1997-99 and Honorary Professor of Bioengineering in the School of Engineering at the University of Exeter. He was awarded numerous Visiting Professorships at universities around the world.
He was appointed Officer of the Order of the British Empire in January 1992.
Robin is survived by his wife, Mary, and two daughters, Jenny and Katie, as well as four grandchildren. Jenny is an orthodontist in Wells and Taunton. Katie is an interpreter for the European commission in Brussels.
Robin Ling was a giant in the field of hip surgery. His intellect and world-class contribution to the specialty are recognized by hip surgeons on all continents. As a surgeon, he was a perfectionist, always striving to get the very best outcomes for his patients; he would never leave the operating table until he had completed the most meticulous surgery possible. As a mentor, colleague and friend, he had the wonderful attributes of complete integrity, tremendous personal warmth and, in addition, a disarming modesty. He will continue to be a role model and inspiration to very many people.
There will be a Memorial Service to celebrate the life of Robin Ling to be held at 11 a.m. on Friday 23rd February in Exeter Cathedral.