John N. InsallJohn N. Insall, considered by many
to be the father of modern-day total knee replacement prostheses
and techniques, died peacefully on December 30, 2000.
John Insall was born in 1930 in Bournemouth, England, by the
sea. He was educated at the University of Cambridge and at London
Hospital Medical School, graduating in 1956. He received his training
at St. Bartholomew’s Hospital in Kent and at The
Royal Free Hospital in London. He then served as a resident in general
surgery and orthopaedic surgery at the Royal Victoria Hospital and
at Shriners Hospital for Crippled Children in Montreal. In 1961,
he was awarded a fellowship in orthopaedic surgery at The Hospital
for Special Surgery in New York City.
After two years of practice in England, he returned to the United
States in 1965 as an attending surgeon and director of the Knee
Service at The Hospital for Special Surgery. He served as professor
of orthopaedic surgery at Cornell University Medical College from
1980 to 1996. In 1991, he joined with Drs. W. Norman Scott, Michael
A. Kelly, and Peter D. McCann to form the Insall Scott Kelly (ISK) Institute
for Orthopaedics and Sports Medicine at New York City’s
Beth Israel Medical Center. He served as director of the ISK Institute
and its fellowship program. In 1996, he was appointed clinical professor
of orthopaedic surgery at the Albert Einstein College of Medicine.
Dr. Insall was a founding member of the Knee Society in 1983
and became its president in 1987. He was instrumental in the development
of the Knee Society scoring system. His colleagues recognized his
many achievements by establishing the Insall Award, which honors
an outstanding paper concerning clinical results and techniques
at the annual open meeting of the Society.
John Insall’s contributions to orthopaedic surgery are
legendary. His articles appeared in The Journal of Bone
and Joint Surgery over four decades, beginning with reports
on his experience with valgus tibial osteotomy for the treatment
of osteoarthritis of the knee. Subsequent articles dealt with techniques
for the treatment of patellar chondromalacia and malalignment as
well as iliotibial band transfer for the treatment of knees with
anterior cruciate ligament deficiency. His most outstanding publication
is the classic book Surgery of the Knee (now in
its third edition), coedited by his colleague and dear friend Dr.
Norman Scott.
Dr. Insall will be most remembered for his numerous contributions
to knee arthroplasty. His work with the total condylar knee prosthesis
began in 1974 at The Hospital for Special Surgery, and, with Albert
Burstein, he designed the Insall-Burstein knee prosthesis,
first implanted in 1978. With Michael Freeman, he pioneered the
philosophy of excision of the cruciate ligaments and soft-tissue releases
during knee arthroplasty. Among his special talents was his ability
to devise arthroplasty techniques that were forgiving yet effective,
allowing countless otherwise crippled patients throughout the world
to resume normal lives. His most recent design innovations involved
mobile-bearing inserts and fixed bearings that allow high
degrees of flexion.
Dr. Insall also developed exposure techniques (for example, the "quadriceps
snip"), quadricepsplasty for the treatment of patellar
instability, ligament releases for the treatment of angular deformity,
and intraoperative guidelines for femoral component rotation. He
was a pioneer in the two-stage revision for septic knee arthroplasty.
In addition, he was responsible for the design of many instruments used
intraoperatively to facilitate the accurate implantation of prosthetic
components.
His long-term follow-up studies of clinical results in
various populations of patients, such as those who are young, elderly,
or obese and those who have diabetes, psoriasis, or poliomyelitis,
are the gold standard against which all future results will be compared.
John Insall was an acknowledged master surgeon. His clinical
skills were complemented by his equally strong ability to teach
others by both word and example. Some sixty surgeons, many now world-renowned
themselves, served as his fellows. They formed the Insall Club in
his honor and meet annually to share experiences and promote research in
knee arthroplasty techniques.
His lectures were classics, and he served frequently as the keynote
speaker at national meetings. He was an annual fixture, for example,
at Seth Greenwald’s Current Concepts Meeting in Orlando,
Larry Dorr’s Master Techniques in Los Angeles, and, of
course, the ISK meeting in New York City. He adopted Leo Whiteside’s
technique of video presentation in lieu of slides, delivering messages
that were clear, precise, and, when appropriate, entertaining.
Both in public and in private, John Insall was a kind and good
person; he was a gentleman and a role model for his colleagues and
his friends. An avid reader, he could converse on virtually any
topic. If he disagreed with you, he would not become argumentative,
but his silence spoke volumes.
He loved golf and was a student of the game. If your swing was
off, he could tell you why, but he never offered advice unless asked.
As one might expect, his own swing was controlled and graceful, and
his short game was played with surgical precision.
His academic demands made him a world traveler. He profited from
these opportunities to educate himself about the local culture,
frequenting museums and historical sites. His boundless energy took him
on many a long walk to experience the environs of a new city and
partake of the local cuisine.
In May 1999, the orthopaedic community was shocked to learn that
John had metastatic lung cancer. We were not surprised, however,
at the strength and dignity that he showed over the next eighteen months.
Never complaining, he remained optimistic and as active as possible.
In his last year, John returned to the seaside in Connecticut
with his beloved wife, Mary. There, when able, he walked the beach,
read voraciously, and bonded with his young grandson, John. He still enjoyed
a "proper meal" with a "proper wine" and offered
wise counsel to his students to the end.
He is survived by his wife, Mary V.; his daughter, Amanda; his
son, John H.; his grandson, John E.; and countless friends, students,
and grateful patients throughout the world.