Understanding the Role of the Joint Specialist
Archaeological evidence confirms that physicians have been successfully treating fractures of the long bones for thousands of years. The Greeks and Romans were also adept at correcting spinal deformities in children. However, in each case, their approach was to apply splinting and bracing techniques rather than attempting surgical interventions. By contrast, progress in addressing damage to the knee, hip, shoulder, and elbow was much slower. In practice, the first person who might qualify for the title of joint specialist made their debut in 1821, albeit with minimal success. On that occasion, Anthony White of London’s Westminster Hospital became the world’s first surgeon to attempt hip resurfacing.
White’s efforts spurred others to experiment further, using prostheses to replace damaged bone and cartilage. However, most failed to provide a long-term solution due largely to the limited durability of the prosthetic materials. Only in the late 1950s and early 1960s did Sir John Charnley, another British surgeon, perfect the procedure now known as frictionless hip arthroplasty, finally establishing the profession of joint specialist.
However, the specialism is not the exclusive province of the surgeon. Physicians also play a significant role in treating patients with conditions that result in swollen and painful joints. In most cases, a primary care doctor is the first point of contact for patients with arthritic conditions and will generally undertake their preliminary treatment. Typically, this will involve anti-inflammatory medication and may include referral to a physiotherapist. However, if a GP suspects some other form of musculoskeletal disease or an autoimmune condition, they might refer the case to another type of joint specialist – a rheumatologist.
That said, when prolonged joint pain and swelling no longer respond to painkillers or even corticosteroid injections and mobility is compromised, the most likely cause is osteoarthritis. The latter is a condition in which the protective layers of cartilage on the articulating surfaces of a joint become eroded, exposing the underlying bone to damage. Bone and cartilage fragments accumulate, making movement painful and increasingly difficult. At this point, surgery is generally the only option. Many orthopaedic surgeons undergo further training to become joint specialists, qualifying them to perform hip, knee, and shoulder replacements and other interventions to treat damaged or infected joints.
Arthroplasty (joint replacement) represents the pinnacle of achievement in the field of orthopaedics. In the US alone, more than a million people undergo a total hip or knee replacement every year. Osteoarthritis remains the most common reason to consult some form of joint specialist, and the orthopaedic department of the Life Wilgers Hospital in Pretoria remains the first choice of many referring physicians in South Africa and several overseas countries.