When we think of the skeleton, it is most often as the only remaining evidence of a decaying body and a popular item for evoking screams on Halloween. When stripped of its muscle tendons and ligaments, there is no longer any real evidence of its function or of the complexity of the structures that make the smooth articulations possible which, nevertheless, often require the attention of joint specialists. Together, these articulations and the aforementioned soft tissues are jointly responsible for the complex movements that can be performed by a healthy musculoskeletal system.
Try rubbing an object along the rough bark of a tree and you will both hear and feel the effects of friction as the object attempts to overcome it. Imagine if such friction were to occur when flexing your knee or your elbow, affecting the bones that move against one another to complete these actions. This can occur and will often require joint specialists to rectify it.
Trauma to a knee or a hip can occur instantly. Often, it is the result of a sports injury or a road traffic accident. Alternatively, it can develop more gradually as a result of long-term wear and tear. In each case, the services of an orthopaedic surgeon are likely to be required to repair the damage. While many of these healthcare professionals may have chosen to restrict their attention to the repair of fractures and dislocations, a growing number are choosing to become joint specialists and focus on performing elective procedures, rather than treating trauma patients.
Osteoarthritis is a progressive disease in which the smooth cartilage that normally protects the articulating surface of bones, such as the femur and tibia in the knee or the humerus and ulna in the elbow, becomes eroded, exposing the bone beneath. When this occurs, movements create friction leading to pain and swelling which, over time, can result in a loss of mobility. While osteoarthritis was once a condition restricted to those in their late ‘60s and older, patients in their ‘50s and younger are now being referred to joint specialists for remedial surgery.
Treatment involves a procedure known as arthroscopy in which a part of one or both of the bones involved is replaced with a prosthesis which may be cemented in place or encouraged to fuse with the remaining healthy bone. Various combinations of metal, plastic, and ceramic are used for their construction – the choice being determined by cost, the extent of bone damage, and/or the preference of the surgeon. Either way, both partial and total replacements are exacting procedures that demand the particular expertise and experience of joint specialists, whether they are to be performed on a knee, hip, or shoulder.
The basic techniques for these procedures have been developed over several decades, as have the materials and the design of the various prostheses. One major advance has been the use of an arthroscope that, in some cases, allows a surgeon to employ a minimally invasive procedure that requires just three keyhole incisions.
Research into new treatments continues and, in time, it might be possible for joint specialists to replace damaged cartilage with healthy connective tissue grown from stem cells.