Although the modern medical degree was only introduced during the nineteenth century, medicine has been practised in various forms for several millennia. Initially, medical knowledge and skills were simply passed from physicians directly to their apprentices and it was only in the early thirteenth century that Oxford University introduced a formal curriculum of medical studies. By contrast, surgery, unlike that performed by hip and other specialised surgeons of today, was conducted exclusively by laymen with no formal training in medicine, until as recently as the early nineteenth century. That said, the subsequent advances in the many different surgical fields that exist today have been prolific.
One of the specialised fields that have been transformed by technological advances is orthopaedics – the diagnosis and treatment of conditions that affect the musculoskeletal system. While the early days of the profession were devoted almost exclusively to the repair of fractures and the correction of spinal deformities, modern hip surgeons provide clear evidence of the extent to which orthopaedic interventions have evolved.
The articulation between the acetabular fossa and the head of the femur, better known as the hip joint, is the mechanism that allows the back and forth movement of the leg and its partial rotation. It has to be sufficiently strong to support the full weight of the torso, plus any items that might be carried by its owner. Over the course of several decades, this joint is subjected to constant, heavy wear and it is only the layer of cartilage covering each articulating surface that prevents the bones of the joint from damage that might necessitate the services of a hip surgeon.
The cartilage acts as a lubricant rather like the Teflon coating on a frying pan, allowing the bones to glide smoothly over one another. When that coating becomes worn and the bone surfaces meet, they can become chipped and cracked, resulting in pain and swelling. The most common explanation for the cartilage layers becoming worn is the condition known as osteoarthritis. While the pain and swelling can be managed with medication, it may require the attention of a specialist hip surgeon at a later stage.
Thanks to more than a century of progress, it is now possible to replace the damaged parts of a joint with a prosthesis. Known as arthroscopy, not only do these joint replacements alleviate the pain and swelling but they also serve to restore normal mobility in the treated joint. A carefully executed total hip arthroplasty (THA) can continue to serve a patient for 20 years or more and is considered by the orthopaedic fraternity to be the most effective form of intervention available to the hip surgeons of today.
Today’s specialists owe this ability to the efforts of surgical pioneers such as the German Professor Themistocles Glück who, in 1891, became the first person to attempt a hip replacement. Although his ivory prostheses quickly collapsed due to wear and tear, he blazed a trail which others of his profession were quick to follow. The development of tougher, bio-compatible materials and new surgical techniques led eventually to the development of the Exeter Hip Stem. By 2010 more than one million patients had been successfully fitted with this remarkable device.
Named after the English university town in which it was developed, the prosthesis was the product of a cooperation between the orthopaedic surgeon, Mr Robin Ling, and the engineering graduate, Dr Clive Lee. Characterised by its double taper and highly polished surface, it is implanted into the shaft of the femur and secured by acrylic bone cement. This enables the implant to self-tighten while allowing a little movement. Today, hip surgeons employ prostheses made from a variety of different materials including exotic metals and ceramics, but the basic design of these implants has remained largely unaltered.
One thing that has changed considerably, however, is the technique of implantation and, for this, one must give credit to a Japanese professor, Kenji Takagi. In 1919, Takagi became the first surgeon to use a modified cystoscope to examine the internal structure of a knee joint. Subsequent improvements led to the creation of a dedicated arthroscope with fibre optics to provide illumination while transmitting full-colour video images to a monitor.
Innovative hip and knee surgeons have since leveraged arthroscopy to develop a minimally invasive technique for performing joint replacements that avoids the risks involved when totally exposing the interior of a joint.
If you wish to learn more about this specialised field or wish to make an appointment with Dr Jan de Vos, contact us at 012 807 0335 or send an email to firstname.lastname@example.org.