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Biographical entry Howse, Alan Justin Greenway (1929 - 2012)

FRCS 1962; MB BS Lond 1955; DObst RCOG 1956.

13 May 1929
Stanmore, Middlesex
27 December 2012
Orthopaedic surgeon


A J G Howse was an orthopaedic surgeon at the Central Middlesex Hospital who became the foremost authority on acute and chronic injuries affecting ballet dancers. He was a consultant to the Royal Ballet School and the Royal Ballet Company. His other interest of note was in the development of a modified Charnley type of hip replacement, which had a larger diameter prosthetic femoral head and a snap fit into the polyethylene socket. The aim was to reduce the incidence of dislocation, a recognised complication of the Charnley prosthesis because of its small diameter femoral head. Although the implant was called the 'Howse hip', Justin readily and perhaps modestly admitted that the name arose because it was manufactured by the Howse Surgical Manufacturing Company, a totally independent body.

Alan Justin Greenway Howse was born in Stanmore, Middlesex, on 13 May 1929. He was the son of Henry, an engineer, and Elizabeth, and the grandson of Sir Henry Greenway Howse, president of the Royal College of Surgeons (between 1901 and 1903), who is remembered for his introduction of antiseptic Listerian surgery to Guy's Hospital.

Justin Howse was educated at Uppingham School. From there he entered the Middlesex Hospital Medical School shortly after the Second World War. Little is known about his time there, except to say that he qualified MB BS and that his recreation almost certainly included dinghy sailing, in view of his subsequent sailing attainments.

After qualifying and completing pre-registration house appointments, Justin decided to embark on a career in gynaecology, but this was short lived. As a result of his attachment to the various surgical specialties as part of his basic surgical training, his interest swung firmly towards orthopaedics. He gained his English FRCS in 1962, and was appointed as a consultant orthopaedic surgeon to the Central Middlesex Hospital and St Vincent's Orthopaedic Hospital, Eastcote, Middlesex, in 1966. He also became a fellow of the British Orthopaedic Association.

His interest in the injuries and strains sustained during ballet developed soon after, which led him to become an orthopaedic consultant to the Royal Ballet Company and its school. This extended to similar links with the English National Ballet and the Royal Academy of Dance. In 1980 he founded the Remedial Dance Clinic in Harley Street. Justin favoured a multidisciplinary approach to injuries, emphasising the importance of physiotherapy and alterations to the dance technique, which he suggested in collaboration with the teachers and leaders of the ballet schools and companies. He considered that strains and to some extent injuries occurred through faulty dance technique. This orthopaedic and physiotherapy collaboration has now become standard practise in the ballet world largely through his pioneering work.

As his experience and reputation grew in this specialised field he joined the British Association for Performing Arts Medicine in 1984, extending their involvement to include ballet. He subsequently became a trustee of that body. In 1990 he was co-founder with Allan Ryan of the International Association for Dance Medicine and Science, and was appointed its president. He was presented with the Association's life-time service award in 2010. As a mark of his contribution to the performing arts world he was made an honorary member of the Royal Society of Musicians of Great Britain in 2009.

Justin Howse also had a wider interest in sports injuries akin to the physical stresses and trauma of ballet dancers. He became a consultant to the Surrey County Cricket Club and the Badminton Association of England. In 2004 he was elected an honorary fellow of the Institute of Sports and Exercise Medicine. It is interesting to note that he had almost certainly started as a student at Middlesex in 1948 during the Olympic year when the athletes clinic was opened, the first of its kind. He could well have been influenced by or involved in the athletes clinic during his time as a junior doctor.

Justin Howse's other major area of expertise was in total hip replacement (THR). He developed an engineering approach to joint replacement. From the early days of THR, in the late 1960s, he built up a large series of cemented Howse implants, which survived well and he presented these results internationally, including giving papers at the American Academy of Orthopaedic Surgeons.

Outside surgery, Justin was a practical man, being a DIY expert. The family comment was 'a carpenter by trade, a carpenter by hobby!' He was also a talented sailor, finding time to compete for a number of years in the national championships of the Ajax 23 keel boat class which, with his son as crew, he won for three years. Interestingly, Justin was also a rally driver in the 1950s and 1960s, winning a number of prizes. He was also a qualified teacher of Scottish Highland dancing.

He met his future wife Sherley Fawkner at the Middlesex, where she was a nursing sister. They married in 1953. Justin Howse died on 27 December 2012, at the age of 82. His wife survived him, together with their son and three daughters.

Michael Edgar

Sources used to compile this entry: [The Telegraph 3 February 2013; The Times 30 January 2013; BMJ 2013 346 2048].

The Royal College of Surgeons of England