Thoughts Relating to the San Baw Lecture on Orthopaedic Innovation at the University of Pennsylvania

By Myint Zan

ON 20 March 2025, Penn Orthopaedics at the University of Pennsylvania in the United States hosted the annual San Baw, MD, GM ‘58 Honorary Lecture in Orthopaedic Innovation featuring Dr Arnold-Peter C Weiss from the Medical University of South Carolina (MUSC), who was the honorary speaker.

A brief bio-data of Dr San Baw and the youngest person (at the age of 13) to be inserted with an ivory hip prosthesis: Daw Than Htay

Dr San Baw (29 June1922-7 December 1984) was my late fa­ther.

In January 1960, my late fa­ther first used an ivory prosthesis to replace the fractured thigh bone of an 83-year-old Burmese Bud­dhist nun, Daw Punya. He had to go to an ivory carver in the city of Mandalay to sculpt an ivory hip prosthesis. After his return from the University of Pennsylvania, do­ing his post-graduate studies for 3 1/2 years, my father was posted as Head of the Department of Ortho­paedic Surgery at Mandalay Gen­eral Hospital from November 1958 to June 1975. And he was posted as chief of orthopaedic surgery at Rangoon (now Yangon) General Hospital from June 1975 until his retirement in October 1980. From 1960 to 1980, Dr San Baw and his junior colleagues operated upon and inserted ivory hip prosthe­ses to replace the fractured thigh bones of patients whose ages ranged from 13 to 87. Definitely one, if not two, persons who Dr San Baw inserted ivory hip prostheses are still alive as of mid-April 2025. On or about December 1969, a per­son from a village near Mandalay at the age of about thirteen was inserted with an ivory hip prosthe­ses by my late father and his junior colleagues in an operation which lasted for about four hours (as told to me by the patient herself). The patient’s name is Daw Than Htay (born around November 1956). Up till about mid-2021, she lived in a village about a hundred and fifty miles from Mandalay. She currently lives in a monastery in Mandalay. Sometime in 2024, an X Ray was taken of her left hip (about 55 years after her inser­tion of the ivory prosthesis), and even though the prosthesis was broken, there has been a creeping substitution or ‘biological bonding’ between bone and ivory, the 2024 X-rays show.

Abstract of Presentation at Brit­ish Orthopaedic Conference in 1969 and Master of Medical Sci­ence thesis at the University of Pennsylvania in 1957

My late father was invited by the British Orthopaedic Associ­ation to deliver his research on ivory hip prostheses at the an­nual conference of the British Orthopaedic Association (BOA) in London, which was held from September 23 to 27, 1969. But only an abstract of my father’s presentation was published in the Journal of Bone and Joint Sur­gery (British volume), Volume 59 B. When I wrote to the BOA some­time around 2019, they stated that they do not have the full paper any more with them. It is ironic that a paper that was presented to the BOA in 1969 is not on record with the BOA but a Master of Medical Science (Orthopaedics) thesis presented to the Department of Orthopaedic Surgery at the then Graduate School of Medicine of the University of Pennsylvania by my late father in late 1957 is in the repository of the University of Pennsylvania library.

No killing of elephants in Burma when ivory prostheses were be­ing used for the non-reunion of the femoral head

In the context of Burma from the 1960s to the early 1990s, ivory was a cheaper material to use as implants or prostheses to replace fractured thigh bones. Starting from 1959 in Mandalay, Dr San Baw studied the physical, me­chanical, chemical and biologi­cal properties of ivory for about a year before he inserted it as a replacement on the 83-year-old Burmese Buddhist nun Daw Pu­nya in January 1960. He consulted a physics professor and a zoology professor when investigating the physical, mechanical and biolog­ical properties of ivory. It must be emphasized that when my fa­ther was using ivory to replace hip fractures from the 1960s to early 1980s, there was no (no) killing of elephants. Only when elephants died say carrying logs after living their natural lives, was the ivory extracted from the elephants. Indeed, about ten years after Dr San Baw passed away in December 1984, his jun­ior colleagues continued to use ivory prostheses as hip implants. One such patient, now deceased, Daw (Mrs, honorific) Than Than (May 1923-May 2023) (a different person from Daw Than Htay mentioned above) had a fall and fractured her left hip sometime after 1990. Professor U Meik, a junior colleague of Dr San Baw, an orthopaedic surgeon in Mandalay, used an ivory hip prosthesis in the early 1990s as a hip replacement for Daw Than Than. In October 2014, the elderly lady broke her right hip, and another orthopaedic surgeon replaced it with a metal hip prosthesis

Cover Story in Clinical Ortho­paedics Journal of Dr San Baw’s work and Inaugural San Baw Lecture in Orthopaedic Inno­vation

In August 2017, Clinical Or­thopaedics Journal published the case of the only person in the world then over the age of nine­ty years who had an ivory pros­thesis in her left hip and metal prostheses in her right hip, with photos of X-rays. On the cover of the Journal, the photos of ivory hip prostheses that yours truly sent to the Journal were ‘touched up’ and displayed.

In December 2017, I contrib­uted funds to the Department of Orthopaedic Surgery at the Ray­mond and Ruth Perelman School of Medicine at the University of Pennsylvania to establish an annu­al Lecture in perpetuity in my fa­ther’s name: ‘San Baw, MD. GM’58 Honorary Lecture in Orthopaedic Innovation’.

On 29 November 2018, Dr Bartek Szostakowski, a Polish orthopaedic surgeon at the Ma­ria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology in Warsaw, Poland, gave the inaugural ‘San Baw, Honorary Lecture in Orthopaedic Innova­tion’ titled ‘Dr San Baw, a forgot­ten innovator in orthopaedic bio­logic reconstruction’. I also gave a presentation, ‘Dr San Baw: A Son’s Tribute to an Ivory Prince’. From 2022 to 2025, there have been four San Baw Lectures in Ortho­paedic innovation that were held at the University of Pennsylvania in honour of Dr San Baw. After the two inaugural Lectures by me and Dr Bartek, Dr L Scott Levin, Chair of Orthopaedic Surgery at Penn, stated that ‘San Baw was an inno­vative, compassionate physician who pioneered techniques in hip arthroplasty ... We are delighted to perpetuate the legacy of this remarkable orthopaedic surgeon’.

Scant domestic and internation­al recognition in relation to Dr San Baw’s contributions

Sir John Charnley (29 August 1911-5 August 1982), a British or­thopaedic surgeon, was recog­nised as the founder of modern hip replacement (total hip arthroplas­ty) and, in layperson’s terms, one of the leading pioneers of metal hip prostheses. When he passed away in 1982, there was a short obituary of him in the New York Times. (26 August 1982, Section B, page 12). In 1990, British orthopaedic surgeon William Waugh (17 Feb­ruary 1922-21 May 1998) published a biography of Sir John, titled John Charnley [:] The Man and the Hip (Springer-Verlag).

The next year in 1983, anoth­er pioneer of vitallium hip pros­theses, an American orthopaedic surgeon, Dr Frederick Thompson (1907-April 12,1983), passed away. The New York Times also pub­lished a longer obituary on its 15 April 1983 issue (Section D at page 18). But when Dr San Baw passed away just over 1 ½ years after Dr Frederick Thompson and just over 2 years after Sir John Charnley did, forget the New York Times, not even local Burmese and Eng­lish language newspapers carried the news.

But I should say that about 10 of the newspapers in the Unit­ed States did carry a news item under various headings, includ­ing ‘Ivory replaces metal in bone transplants’ written by journalist Albert E Kaff (1920-October 2011) in January and February 1970 is­sues. After my father passed away, I saw three handwritten letters ad­dressed to my father, ‘Dr San Baw, Mandalay General Hospital, Man­dalay, Burma’. The letters all came from the United States asking my father’s advice for their orthopae­dic problems. One of the corre­spondents attached a cutting of a news item under the above title from the San Bernardino Coun­ty Sun newspaper of 31 January 1970. Albert E Kaff was reporting on the ‘Lecture Dr San Baw at the British Orthopaedic Association in London in September 1969’, the UPI report by Albert E Kaff might have reached the Editors’ desk of the New York Times in early 1970, they might not have published it.

Ivory prostheses sample and prosthetic work being done ‘in Malaysia’: A correction

Still, smidgens (so to speak) of recognition somewhat belatedly came. There is a display (since when I do not know) of a sample of ivory prosthesis in the Museum of Surgery in Edinburgh, Scotland, Great Britain. I was not aware of the display at the museum until a former student wrote to me in 2017 about it. Ms Teo Ju-li, a Malaysian student, was then studying for her Master of Laws (LLM) at the Uni­versity of Edinburgh, and she visit­ed the Museum. She saw the ivory prosthesis on display and wrote to me about it. At my request, an official of the Museum sent me a photo of the ivory hip prosthesis on display at the Museum of Surgery. It wrongly and briefly stated that it was from ‘Malaysia’. I sent a few documents concerning my late father, and the museum personnel kindly changed it to QUOTE ‘Bur­ma (1970). Dr San Baw first used an ivory prosthesis on a Burmese Buddhist nun in 1960. Over 300 prostheses were used in 20 years with 90 per cent success, where patients were able to walk, squat and play football.’ UNQUOTE

The ‘mistake’ of Malaysia for Burma/Myanmar is made not only by the Museum of Surgery in Edinburgh. In a 90-second brief in­troduction of my late father in the 5th San Baw Honorary Lecture in Orthopaedic Innovation on March 20, 2025 (as indicated above), the introducer correctly stated that Dr San Baw worked at MGH (Manda­lay General Hospital) and RGH (Rangoon General Hospital). But in the video link provided to me, where the Lecture was recorded, it was stated that these were the two medical hospitals in ‘Malaysia’ (not Burma) or Myanmar. I should say, though, that in the pamphlet distributed before and during the Lecture, the information regard­ing my father and Burmese back­ground is correctly stated.

A Malaysian patient and Aus­tralian colleagues of Dr San Baw

As it was, Dr San Baw has had some Malaysian and Australian connections as well. From Janu­ary to June 1976, on a World Health Organization (WHO) Fellowship, he visited orthopaedic centres in Malaysia, Singapore, Australia and Hong Kong. He was in Malaysia in January 1976, visiting the Depart­ment of Orthopaedic Surgery at the University of Malaya Hospital. The then Head of the Department of Orthopaedic Surgery at the Uni­versity of Malaya (UM) Hospital, the late Professor Dr Subrama­niam, personally told me in 1990 that Dr San Baw treated the then Malaysian kid who had extra shin bone (infantile pseudarthrosis of the tibia) with his own technique. Incidentally even though BOA only published a 311word abstract of my father’s presentation in the Journal of Bone and Joint Sur­gery (British volume) (JBJS) in 1970 it did publish in full Dr San Baw’s article ‘The Transarticular graft for infantile pseudarthrosis of the tibia: A New Technique’ in Volume 57 (1975) of the above journal. Again, it is ironic that 14 case studies over a period of eight years on infantile pseudarthrosis were published in full in JBJS in 1975, but 100-plus studies on the insertion of ivory prostheses over a period of nine years were pub­lished only in abstract form five years earlier in 1970. But as the late Dr Subramaniam told me, a non-Burmese Malaysian boy (as he then was) in 1976 was also the beneficiary of my father’s innova­tive technique and compassion.

During his 1976 visit, Dr San Baw spent about two to three months in Australia visiting or­thopaedic centres in Brisbane, Sydney, Melbourne, Adelaide and Perth. I am in contact with only one Australian orthopaedic surgeon whom my father met in Australia and who, between 1976 and 2018, has visited Burma/ Myanmar about 16 times. He is Emeritus Clinical Professor in Or­thopaedics, Dr Robert Bauze of the University of Adelaide. It was in Australia, I understand, that Dr San Baw was called ‘ivory prince’.

Expression of thanks to Austral­ian Colleagues, to Dr Bartek and Dr San Baw’s junior colleagues

I am grateful to Professor Bauze for his many visits to Bur­ma/Myanmar and his assistance in facilitating Burmese orthopae­dists and other medical doctors to get their training in Australia and for the Australian health aid projects in Myanmar. I am also grateful to Dr Bartek, as stated above, for re-introducing, reviving the ‘forgotten innovator’ Dr San Baw’s contributions to orthopae­dics. Also, my thanks to former junior colleagues of Dr San Baw, Dr (Bobby) Sein Lwin (Florida), Professor Dr Kyaw Myint Naing (Yangon) My father Dr San Baw had in a small corner of the world assiduously and devotedly worked for the welfare of several hundred patients and had trained Burmese orthopaedic surgeons with dedica­tion and compassion.