Some Remarkable Achievements of Bone Surgery Specialists
The specialised discipline of medicine, known as orthopaedics, has a surprisingly long history. In addition, it is a discipline that has been characterised by some pretty remarkable advances, particularly during the period that began in the early twentieth century. Although it was first given the name by which we now refer to this branch of medicine as recently as 1741, the origin of bone surgery and the specialists who practice it dates from a far earlier era. In fact, the first signs of man’s fledgling attempts in this field date back to the New Stone Age. Fossil evidence suggests that re-alignment of fractured limbs and traumatic amputations were already being performed.
Later archaeological evidence confirms the use of wooden splints by the physicians of ancient Egypt, as well as casts made from clay that appeared to be just as effective as plaster of Paris. At much the same time, the Greeks were steering orthopaedics into new territory by focusing on the correction of deformities, as well as injuries. They used traction, casts, and bandages to correct club feet, and also to immobilise fractured limbs. They even attempted to apply these techniques to help those with spinal irregularities, such as scoliosis. Though they were not actually performing bone surgery, the specialists of the time were laying the foundations for some of the techniques still employed in orthopaedics today.
With the dawn of the twentieth century came a new era in orthopaedic medicine, made possible by the invention of X-ray photography by Wilhelm Röntgen in 1895. The ability to visualise internal damage, rather than needing to deduce it by feel, led to improved diagnosis and, in turn, to more effective treatments. The new technology made it possible to spot signs of wear and tear, such as that resulting from osteoarthritis, although it would be some time before an effective corrective procedure was developed.
The combination of effective anaesthesia, infection control, antibiotics, and science has contributed to rapid advances in bone surgery, allowing the modern orthopaedic specialist to perform feats of which their predecessors could only dream. Complex fractures, for which the sole option would once have been to amputate a limb, can now be painstakingly reconstructed with the use of metal pins, plates, rods, and screws, allowing the treated limb to perform normally once again. The technique is known as open reduction and internal fixation (ORIF).
Just as Christiaan Barnard’s first successful heart transplant at Cape Town’s Groote Schuur Hospital in 1967 transformed the world of cardiac surgery, there have been major breakthroughs in orthopaedics that have also proved to be transformational. The advanced bone surgery undertaken by specialists today owes much of its success to an instrument known as an arthroscope, which was invented by a Japanese physician, named Masaki Watanabe in the early 60s. Inserted into a joint, it allowed surgeons a live view that was far-superior to an X-ray image, as the details of both bone and soft tissue were equally visible in situ.
Already invaluable, the instrument turned out to be more than just a diagnostic tool. In pursuit of ways to limit the trauma associated with bone surgery, specialists soon began to develop techniques to perform minimally-invasive procedures by means of tiny incisions, whilst guided by the real-time view relayed by an arthroscope. The use of so-called keyhole procedures reduces the risk of blood loss and infection while substantially reducing the time required for post-operative recovery.
While the value of this versatile instrument is undeniable, the orthopaedic equivalent of the cardiac transplant was not arthroscopy, but arthroplasty – the surgical replacement of all or part of a damaged joint with a manufactured substitute. The first successful attempt at this type of bone surgery was by a British specialist and researcher named John Charnley. His prosthesis consisted of a metal stem with a plastic cap, which he cemented to the shaft of the femur after removing the damaged femoral head to perform a partial hip replacement.
Today, materials, such as stainless steel, titanium, cobalt-chromium alloys, polypropylene, and ceramics, in various combinations, are serving to extend the life of prosthetic joints, as are alternative methods of securing them. At the same time, the use of the arthroscope is now offering the means for specialists in arthroplasty to perform the particular brand of bone surgery in a far-less invasive manner. Eliminating the need to expose the entire joint, arthroscopic replacements requiring no more than three tiny incisions, are often possible today.