Robin Sydney Mackwood Ling, (7 September 1927 – 9 October 2017) was an English surgeon who invented the Exeter hip system, a
hip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi (half) replacement. Such joint replacement o ...
. As an
orthopaedic surgeon
Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...
at the Princess Elizabeth orthopaedic hospital,
Exeter
Exeter () is a city in Devon, South West England. It is situated on the River Exe, approximately northeast of Plymouth and southwest of Bristol.
In Roman Britain, Exeter was established as the base of Legio II Augusta under the personal comm ...
, he co-operated with an engineer, Dr.
Clive Lee
Alan John Clive Lee (18 February 1939 – 2 November 2021) was a British design engineer known for co-creating the Exeter hip system in association with orthopaedic surgeon, Robin Ling. Unlike any other hip replacement, the collarless polishe ...
from the University of Exeter, to develop a new hip replacement. Their work led to improved quality of life for millions of people.
Ling came from a medical family in
Yorkshire
Yorkshire ( ; abbreviated Yorks), formally known as the County of York, is a Historic counties of England, historic county in northern England and by far the largest in the United Kingdom. Because of its large area in comparison with other Eng ...
, England. He studied medicine in Oxford and London. Becoming a consultant in orthopaedic surgery in Exeter, he performed the first 'Exeter-stem' hip replacement in 1970. His research and observations on the initial operations have resulted in the Exeter hip stem changing from a shiny stem, to matte stem and then back to shiny, with a further change to modular design and being the most popular hip implant in the United Kingdom.
Early life
Robin Ling was born in London on 7 September 1927
and grew up in the town of
Keighley
Keighley ( ) is a market town and a civil parish
in the City of Bradford Borough of West Yorkshire, England. It is the second largest settlement in the borough, after Bradford.
Keighley is north-west of Bradford city centre, north-west of Bi ...
, in the
West Riding of Yorkshire
The West Riding of Yorkshire is one of three historic subdivisions of Yorkshire, England. From 1889 to 1974 the administrative county County of York, West Riding (the area under the control of West Riding County Council), abbreviated County ...
.
His parents and grandfather were doctors. "Old Dr Ling", as his grandfather was known, treated the more prosperous part of the town, whilst his father, "Dr Billy" covered the poorer areas. Dr. Mona Ling, Robin's mother, managed the medical practice during the
Second World War
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
.
Ling's early education was at Chelmsford Hall School in
Eastbourne
Eastbourne () is a town and seaside resort in East Sussex, on the south coast of England, east of Brighton and south of London. Eastbourne is immediately east of Beachy Head, the highest chalk sea cliff in Great Britain and part of the la ...
.
He and his two younger brothers spent World War II in
British Columbia
British Columbia (commonly abbreviated as BC) is the westernmost province of Canada, situated between the Pacific Ocean and the Rocky Mountains. It has a diverse geography, with rugged landscapes that include rocky coastlines, sandy beaches, ...
where they lived with the Koerners, refugees from the Nazis in Europe, and he attended
Shawnigan Lake School
Shawnigan Lake School is a co-educational independent boarding school located on Vancouver Island in Shawnigan Lake, British Columbia, Canada. It was founded by Englishman Christopher Windley "C. W." Lonsdale in 1916, and was partly modelled aft ...
on
Vancouver Island
Vancouver Island is an island in the northeastern Pacific Ocean and part of the Canadian Provinces and territories of Canada, province of British Columbia. The island is in length, in width at its widest point, and in total area, while are o ...
.
After the war, Ling gained admission to the
University of Oxford
, mottoeng = The Lord is my light
, established =
, endowment = £6.1 billion (including colleges) (2019)
, budget = £2.145 billion (2019–20)
, chancellor ...
to study medicine, which he completed in 1952 at
St Mary's Hospital, London
St Mary's Hospital is an NHS hospital in Paddington, in the City of Westminster, London, founded in 1845. Since the UK's first academic health science centre was created in 2008, it has been operated by Imperial College Healthcare NHS Trust, wh ...
.
Surgical career
After graduating in medicine, Ling began training in orthopaedics in London. By 1961, he had completed training positions in Vancouver and Edinburgh, where, at the
Royal Infirmary of Edinburgh
The Royal Infirmary of Edinburgh, or RIE, often (but incorrectly) known as the Edinburgh Royal Infirmary, or ERI, was established in 1729 and is the oldest voluntary hospital in Scotland. The new buildings of 1879 were claimed to be the largest v ...
and the
Princess Margaret Rose Orthopaedic Hospital
The Princess Margaret Rose Orthopaedic Hospital was a hospital in Fairmilehead, Edinburgh, opened in 1932 and closed in 2000. After closure, with services transferred to the new Royal Infirmary of Edinburgh, it was demolished and the site sold fo ...
, Edinburgh, he was appointed consultant.
In 1963, Ling became a consultant at the
Princess Elizabeth Orthopaedic Hospital in Exeter, where he became interested in hip replacement.
The Exeter hip
Ling's ambition was to create a hip replacement that could be secured to bony skeleton with acrylic bone cement.
Through extensive laboratory analyses of modified hip implants, Ling and engineer Dr Clive Lee built on the work of
Sir John Charnley
Sir John Charnley, (29 August 1911 – 5 August 1982) was an English Orthopedic surgery, orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the wo ...
to demonstrate that over a period of time, bone cement can undergo "
creep" and act as a thick liquid. This mechanism permits the transmitting weight through the joint to the skeleton and allows patients to remain pain free and active for years.
Ling and Lee, using acrylic bone cement, eventually constructed an implant that could be firmly fixed to the bony skeleton.
They proposed a tapered implant profile that would encourage the stem to stay firmly attached to the skeleton for a long period of time.
From 1965, together with Lee, Ling worked on replacement
arthroscopy
Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the jo ...
at the
School of Engineering, University of Exeter. It was here, that the "Exeter hip" was invented.
Originally called the "Ling-Lee hip", it was first implanted in 1970 and became the most common artificial hip to be inserted.
Unlike previous designs, this hip replacement was inserted through the posterior approach
and required just one assistant.
The stem of the Exeter hip was a distinct, polished, tapered and cemented part unlike any former hip prosthesis. Its longstanding success was due to this polished tapered design with its capability to perform like a wedge. It was deliberately not bonded, and therefore free to move at the stem-cement border, and consequently behaved as a self-locking point, successfully and persistently tightening step by step during the life of the hip. For the first five years, the Exeter stem was carefully observed in Exeter only. Around 1975 the stem was being made from a heavier steel and the polished surface was not retained. Appearance and cost had led to a matte rather than polished surface, which caused complications of stem loosening and
osteolysis. The Exeter stem returned to the original polished surface by 1986 once these complications were realised.
The stem finally changed to a modular system.
Ling, as well as Charnley before him, had in the 1980s, made provisional recommendations for a hip replacement registry, opposed by the department of health but later supported by the
National Audit Office (United Kingdom)
The National Audit Office (NAO) is an independent Parliamentary body in the United Kingdom which is responsible for auditing central government departments, government agencies and non-departmental public bodies. The NAO also carries out valu ...
and
NICE
Nice ( , ; Niçard: , classical norm, or , nonstandard, ; it, Nizza ; lij, Nissa; grc, Νίκαια; la, Nicaea) is the prefecture of the Alpes-Maritimes department in France. The Nice agglomeration extends far beyond the administrative c ...
.
Ling was known for carefully following up his patients.
A review of the earliest Exeter hip implants, at 33 years after the first replacements, revealed that 92% did not undergo mechanical loosening.
Sir John Charnley himself was also reported to have observed and commended Ling.
Copies of the Exeter hip have been marketed by leading manufacturers of artificial hips.
Internationally, as well as in the UK, 30 years following the first implant, it was the most implanted cemented hip replacement. By the end of 2010, more than one million operations had been done.
Surgical positions
Ling acted as president of the
British Orthopaedic Research Society between 1979–80 and was president of the
British Orthopaedic Association
The British Orthopaedic Association is a professional association in Britain for doctors who specialize in orthopaedic surgery.
History
The British Orthopaedic Association was founded in 1918. One of the founders was Harry Platt, who went on to s ...
for 1986–7. He was vice-president of the
European Orthopaedic Research Society 1989–1991, president of the
British Hip Society 1991–93, and president of the
International Hip Society 1997–98.
Honorary positions
In 1986, Ling was appointed honorary professor of
bioengineering
Biological engineering or
bioengineering is the application of principles of biology and the tools of engineering to create usable, tangible, economically-viable products. Biological engineering employs knowledge and expertise from a number o ...
in the School of Engineering of the
University of Exeter
The University of Exeter is a public university , public research university in Exeter, Devon, England, United Kingdom. Its predecessor institutions, St Luke's College, Exeter School of Science, Exeter School of Art, and the Camborne School of Min ...
. In 1989, he was given an honorary fellowship of the
Royal College of Surgeons of Edinburgh
The Royal College of Surgeons of Edinburgh (RCSEd) is a professional organisation of surgeons. The College has seven active faculties, covering a broad spectrum of surgical, dental, and other medical practices. Its main campus is located on ...
followed by the
Order of the British Empire
The Most Excellent Order of the British Empire is a British order of chivalry, rewarding contributions to the arts and sciences, work with charitable and welfare organisations,
and public service outside the civil service. It was established ...
in 1992. He was made a fellow of the
Australian Orthopaedic Association
The Australian Orthopaedic Association (AOA) is a not for profit organisation that represents over 1800 Australian orthopaedic surgeons.
History
The association was formed over several meetings in 1936. At the first, 6 October 1936, a subcommi ...
in 1999 and an honorary fellow of the British Orthopaedic Association in 2000.
Personal and family life
Ling married Mary (née Steedman) in 1955, a casualty nurse from South Africa,
whom he met at St Mary's hospital. They had two daughters.
He was described as "generous with his time to all surgeons" and "warm and modest".
Ling's love of sailing began during his placement at Shawnighan Lake School on
Vancouver Island
Vancouver Island is an island in the northeastern Pacific Ocean and part of the Canadian Provinces and territories of Canada, province of British Columbia. The island is in length, in width at its widest point, and in total area, while are o ...
, British Columbia, Canada. It continued when his parents bought a classic yacht. After moving to the
Dart
Dart or DART may refer to:
* Dart, the equipment in the game of darts
Arts, entertainment and media
* Dart (comics), an Image Comics superhero
* Dart, a character from ''G.I. Joe''
* Dart, a ''Thomas & Friends'' railway engine character
* Dar ...
estuary,
South Devon
South Devon is the southern part of Devon, England. Because Devon has its major population centres on its two coasts, the county is divided informally into North Devon and South Devon.For exampleNorth DevonanSouth Devonnews sites. In a narrower se ...
, England, on retirement, Ling accomplished his lifelong aspiration of owning his own sailing boat, duly named Enfin.
He died on 9 October 2017 at the age of 90 years.
References
{{DEFAULTSORT:Ling, Robin
1927 births
2017 deaths
Physicians of St Mary's Hospital, London
British orthopaedic surgeons
People from Keighley
Alumni of the University of Oxford
Members of the Order of the British Empire
History of surgery
Shawnigan Lake School alumni