Saint Helena

The ultimate joint replacement challenge?

2021 was a time when I spent some very happy months as the orthopaedic surgeon in residence & interim CMO (Chief Medical Officer) on the isolated British dependancy of St. Helena. The island is one of the most remote places on earth. Napoleon Bonaparte was exiled there after his defeat at the Battle of Waterloo and it is home to the world's oldest terrestrial creature - Jonathan the giant tortoise. 

St. Helena is also where you will find 'Jacob's Ladder' which is a construct of 699 steps. This is a Grade 1 listed structure & every year there is a timed run up to the top, with competitors coming from around the world to take part. The current record is just under 5 minutes & 17 seconds. Thinking about this is a reminder of something important. The wonderful Jonathan, who I had the privilege of meeting, doesn't let the fact that he is the oldest land-based being on the planet stop him from getting about. To him mobility matters, allowing life to still be enjoyed to the full despite having been born before Queen Victoria's coronation in 1838. Then we have the other extreme of mobility, with those who punish themselves in the attempt to climb 699 demanding steps in record time.

Everyone's need for mobility is different, because everyone is unique. When joint replacement began it was essentially a 'pain relief procedure'. Now we are so much better placed to deliver on a broader range of expectations. At the extremes of demand on prosthesis we see sports persons returning to competitive activity. At the other end of the spectrum we see more modest requirements, reflecting the realities of advancing years. Irrespective, loss of mobility impacts hugely on quality of life & the mission of the orthopaedic surgeon is to improve things for patients. 

It was a great privilege to be able to assist some of the resident's of St Helena with joint replacement procedures while I was there, perhaps the most remote hip & knee replacements in the world. Thinking about such things it's amazing to reflect that Jonathan would have been a "young giant tortoise about town" when Themistocles Glück was proposing joint arthroplasty in the late 1800's. My philosophy is that small & remote communities are deserving of the finest of orthopaedic service & commitment & it was great to see my service to the St. Helena community acknowledged in the reference below. My intention is to bring the same philosophy of care to Forster, Taree, & the surrounding areas of NSW.

Michael 'out & about' with Jonathan

St. Helena Government Reference.pdf
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