The Tools and Tasks of the Bone and Joint Specialist
Orthopaedics is the name given to the branch of medicine practised by the bone and joint specialist, and its origins are rooted in the distant past. Since early humans first fashioned tools and, in particular, their primitive weapons, they became increasingly prone to fractures and dislocations that, without appropriate treatment, would frequently have been fatal or at best, resulted in lifelong disability. Archaeological evidence confirms that the use of splints dates back to the Ancient Egyptian era and even earlier, while the Greeks and the Romans were responsible for some progress, including attempts to correct spinal deformities in children. In fact, it was from a Greek phrase meaning “straight child” that the term orthopaedics was eventually coined.
More significant advances by the physicians of the time stem from the treatment of soldiers wounded in battle. Later, with the invention of the plaster of Paris cast in the mid-1800s, although still focused mainly on childhood deformities, orthopaedic practices began to evolve, and by the end of the 19th century, the first surgical procedure designed to help treat such deformities was attempted. Today, bone and joint specialists are generally known as orthopaedic surgeons and surgical procedures account for about half of their therapeutic activities.
Their responsibilities can be conveniently categorised as being either trauma-related or elective, and it is quite common for an orthopaedic surgeon to specialise in either one or the other of these categories, while some may choose to divide their time between the two. More importantly, the ongoing development of new and improved equipment and advanced surgical techniques has served to benefit both the patients and the bone and joint specialists within each of these spheres.
While those in other branches of medicine had been making use of an instrument that would eventually become known as an endoscope in order to examine the pharynx, urinary tract, and rectum since 1805, it was more than a century later when a Japanese professor first used such a device to examine the internal structure of a joint. In doing so, Professor Kenji Takagi laid the foundation for the development of the modern arthroscope, a tool that made a diagnostic procedure known as arthroscopy possible.
A modern arthroscope consists of a narrow tube containing a system of magnifying lenses through which light is transmitted via optical fibres. Light passing down the tube illuminates the interior of the joint, and images of the bones and surrounding tissue are captured by a video camera, enabling bone and joint specialists to view them in real time and in full colour on a monitor screen. In an alternative mode, the camera is omitted and the observer views the magnified image directly through an eyepiece. Already a vast improvement on the traditional X-ray image in terms of the detail provided, arthroscopy has long since graduated from its diagnostic role to form the basis for a number of minimally-invasive surgical procedures now widely used to treat several common forms of joint disorder.
The technique allows the bone and joint specialists of today to avoid the need to fully expose the joint with the attendant increased risk of infection and excessive blood loss, as well as reducing the patient’s recovery time. A tiny incision is sufficient to accommodate the scope with which the surgeon can observe his actions while a second or third incision of the same size may then be used to provide the entry route for whatever surgical instruments he or she may require.
Amongst the most common reasons for the use of this type of “keyhole surgery” by bone and joint specialists today, is to repair or resect a torn meniscus either in the knee or the shoulder. It may also be used to remove the synovium when it is inflamed and could potentially cause further damage, to repair a torn ligament, and to aspirate loose fragments of bone or cartilage that might cause pain and impede the subject’s movement.
Innovative and versatile though it may be, arthroscopy does have its limits, and the undisputed jewel in the crown of modern orthopaedics simply has to be arthroplasty. The term refers to the partial or total replacement of a painful, malfunctioning joint with a prosthesis fashioned from metal, plastic, or ceramic, or some combination of these materials. Routinely used to repair hips, knees, and shoulders damaged by osteoarthritis, arthroplasty is one of the most successful orthopaedic procedures, enabling bone and joint specialists to perform life-changing interventions.