By David Falcone - Orthopedics Today correspondent
Many people believe the modern era of orthopedics was born when Russell A. Hibbs, M.D, took the surgical helm of New York Orthopedic Hospital in 1898. His introduction of innovative surgical interventions for the treatment of orthopedic injuries helped the practice move from the repair of broken bones to the surgical specialty that it is today.
His legacy lives on into the new millennium through the application of his theories on spine, hip and knee surgery, the devices used in those procedures, and an educational society that bears his name.
Hibbs was born in 1869 and raised in Birdsville, Kentucky. he attended Vanderbilt University and received his medical training at the University of Louisville, graduating in 1890. Following graduation from medical school, Hibbs began a family practice in Wickliffe, in the far southwestern corner of Kentucky. However, not long after hanging his shingle, a personal tragedy-the loss of a close family member-caused him to leave medicine. "He became very depressed and quit his practice," said Frank H. Bassett III, M.D., of Duke University in Durham, N.D. "He then went to Arkansas and became a recluse, some people say an alcoholic, and he just disappeared from society," added Bassett, a fellow Kentuckian with an interest in orthopedic history.
Hibbs rallied himself from the depths of his depression and traveled east to the residency program at New York Orthopedic Dispensary and Hospital and became a resident surgeon there in 1894. The hospital, which was founded to treat needy children afflicted with musculoskeletal diseases, had one of the earliest orthopedic training programs in the United States.
"At New York Orthopedic Hospital he trained under a physician named Shaffer, who was a well-known orthopedic surgeon and the chief of surgery. Shaffer had a very well established carriage trade in orthopedics, and one took an extended European cruise for a number of months. When he came back, Russell Hibbs had made a number of changes, which he didn't like," Bassett said. "Shaffer went to board of trustees to have Hibbs fire and, or course, they gave Hibbs equal time. At the end of their meeting they appointed Hibbs to be the chief of orthopedics and fired Shaffer," he added.
In 1898, Hibbs took the position of surgeon and in 1900 was appointed surgeon-in-chief of the hospital and dispensary at the age of 29. By this time, Hibbs had already published six articles on topics ranging from surgery for the treatment of mastoid disease, a case study of the quintet labor and delivery, and two studies on shortening the limbs in patients with "tuberculous disease."
One of his earliest surgical innovations was a technique for lengthening the Achilles tendon. However, he is most known for being the first surgeon ever to perform a spinal fusion. Hibbs devoted much of his time to the treatment of deformities of the joints caused by tuberculosis. He noted on his arrival in New York that there were few cures for tuberculosis of the spine and hip.
In 1904, he hypothesized that orthopedic tubercular patients would respond positively to an environmental change in much the same way that patients with tuberculosis of the lungs did. He took his idea to the hospital board and was instrumental in founding a branch of the New York Orthopedic Hospital in the "country" of White Plains, N.Y. His research was published as The Treatment of Joint Tuberculosis in the Open Air in a City Hospital in 1906.
Using concepts he had published on an operation for stiffening the knee joint, Hibbs realized the same could be done for the articulating joints of the spine. On January 9, 1911, he performed a landmark and extremely controversial surgery to fuse the "spinous processes, laminae and intervertebral articulations" to prevent the progression of curvature of the spine in a patient with spinal tuberculosis.
Describing the procedure in An Operation for Progressive Spinal Deformities, Hibbs wrote that he stripped the periosteum from the posterior arches and split the spinous processes to overlap the interspinous spaces. Fragments of bone from the laminae were placed in the interlaminar spaces.
In addition, each intervertebral articulation was curetted and denuded of cartilage to form a bleeding bed and thus make the fusion possible. Acquiring enough bone to perform the fusion, especially in pediatric cases, allowed Hibbs to succeed where others failed and stands as a testament to his meticulous operative skills.
After the procedure the patients were kept in bed for 8 to 10 weeks and then allowed movement only with the use of a brace. Hibbs' triumph with the outcomes of the surgery led him to treat most of the patients he encountered with spinal tuberculosis, or Pott's disease, with fusion.
Three years later, Hibbs drew on the experience he gained from perfecting this procedure to develop a fusion process for halting the progression of spinal deformity in patients with scoliosis. In 1917, when Hibbs reported on his first three scoliosis patients treated with fusion, some questioned the rationale of halting the progression rather than correcting the deformity. In response to suggestions, Hibbs began preoperative corrections using plaster casting and turnbuckle jackets. Once some correction was achieved, the fusion was performed, and once healed, the patient was again placed in a plaster jacket and kept in bed for six weeks.
Once mobile, the patient was required to wear a removable plaster jacket for an additional 6 to 12 months. In the next five years, Hibbs would treat 56 more scoliosis patients with his revolutionary and much debated treatment and, in turn, alter the treatment of scoliosis patients forever.
Near the end of his career in 1931, Hibbs reported his results for the treatment of scoliosis by spinal fusion. He performed 427 operations on 360 patients, of whom 44% had poliomyelitis. In 17 years he had seven patient deaths and only 15 pseudoarthroses.
In addition to his surgical innovations, Hibbs was committed to teaching and furthering orthopedic knowledge. In 1918 he became a professor of orthopedic surgery at Columbia University's College of Physicians and Surgeons. Hibbs' appointment was the first for a New York Orthopedic Hospital surgeon and initiated the long-standing bond between the hospital and the university.
In 1927, he donated $10,000 to found an orthopedics library that would be available to physicians in training. After Hibbs' death in 1932, his colleagues and friends raised an endowment for the library and renamed it for him. The Russell A. Hibbs Memorial Library is one of the oldest orthopedic libraries in the United States and provides orthopedic surgeons at Columbia University with the materials needed to support their clinical, educational, research, and publication activities.
Hibbs' name is also kept alive in the field of scoliosis research. In recognition of his contributions to surgical interventions for spinal deformities, the Scoliosis Research Society grants the Russell Hibbs Award for the preeminent clinical or basic science paper presented at its annual meeting.
In 1947 the Russell A. Hibbs Society was formed as an orthopedic travel club for continuing medical education and furthering orthopedic knowledge. Until the 1960s, the club included only alumni of New York Orthopedic Hospital. Frank Bassett was one of the first non-New York Orthopedic members invited to join. One of his first nominees for membership was Robert W. Gaines, Jr., M.D., of the University of Missouri, in Columbia. Gaines is currently co-chair of the society, which recently began a major restructuring.
The society had always focused on general orthopedics and included surgeons from all subspecialties within orthopedics. Over the years, this had led to a splintering of the membership and the society began to fade away. In the year 2000, Gaines and fellow co-chair, Scott J. Mubarak, M.D., of San Diego Children's Hospital canvassed the membership and narrowed the society's focus to the spine.
In addition, the society will begin to recruit international members instead of being limited to Americans only. "We view the future of the Russell A. Hibbs Society to be an international spine deformity society that will be a small, think-tank dedicated to spine research," Mubarak said. Membership will be limited, however, to only 75, a move that will allow the organization to retain an intimate feel, he added.
The newly reorganized Hibbs Society had its first meeting in Cairns, Australia.