How Technology Has Enabled Joint Surgeons to Achieve More
While the practice of something resembling the medical discipline known as orthopaedics can be traced back for thousands of years, for the vast majority of that time, it was limited to amputations, the reduction of fractures and dislocations, and attempts to straighten club feet and curvatures of the spine in children. In fact, even the name of this discipline, which is derived from the Greek for “straight child”, was only adopted during the late 18th century, when the prospect of specialised joint surgeons would still have been no more than wishful thinking.
In practice, knowledge regarding the structure of the musculoskeletal system, at that time, was quite extensive based on the dissections performed by anatomists. However, the prospect of conducting repairs to its complex articulating components continued to be restricted by the limited technology available. In fact, it was almost a century later before the first big breakthrough occurred. In 1890, for the first time, a professor in Berlin succeeded in transplanting an artificial knee joint. The professor is also accredited with coining the term “arthroplasty” to describe what, in time, was destined to become one of the most successful procedures ever undertaken by the joint surgeons of today.
Professor Glück went on to complete the first hip replacement during the following year. However, despite the fact that his surgical technique proved to be effective, the ivory he used to form the articulating surfaces turned out to be too brittle and resulted in them becoming damaged after just a few months of activity. Nevertheless, once the feasibility of joint replacement was established, subsequent advances in material science eventually led to the development of a number of stronger and more bio-compatible options for use in the manufacture of artificial joints.
Over the following few decades, the introduction of general anaesthesia and the invention of the X-ray machine presented early joint surgeons with valuable tools to protect patients from the pain of surgery and to provide visible evidence of the nature, the extent, and the precise location of any damage they might be called upon to repair. However, it was undoubtedly the invention of the arthroscope that was first responsible for many of the major advances in orthopaedic diagnostic and surgical techniques.
Although similar instruments were already in use as a means with which to investigate the internal condition of the lungs, bowel, bladder, and other body cavities, it was a Japanese physician who, in the early ‘60s, hit on the idea of adapting a cystoscope (used to examine the bladder) to view the interior of a joint directly. In doing so, he presented joint surgeons with a host of new opportunities. Firstly, the magnified view of the bones and surrounding soft tissues obtained by arthroscopy offers greater diagnostic value than an X-ray image. Even more significantly, that real-time view has since given them the means to avoid fully exposing a joint and, instead, to employ less-invasive techniques in which the scope is used to manage the actions of instruments inserted via tiny “keyhole” incisions.
Today, joint surgeons routinely perform arthroscopic procedures to repair a torn ligament or meniscus, to wash out loose fragments of bone and cartilage that may be causing pain, and in some cases, even to replace a damaged joint with an artificial one. Known as arthroplasty, those who now undergo these procedures enjoy the benefit of newly developed metals, plastics, and ceramic used to create a frictionless prosthesis that, in normal use, should continue to offer them pain-free mobility for a minimum of 10 years and often as much as twice that.
Other benefits to patients when their joint surgeons employ these minimally-invasive interventions include faster recovery times, and a lower risk of infection and excessive bleeding when compared to more radical options. However it may be performed, arthroplasty is invariably a life-changing experience for those who undergo it and is rated by the majority of these specialists to be their most successful surgical intervention to date.
That said, newer technologies are making inroads in other areas of medicine and could even be poised to supersede this current jewel in the orthopaedic crown. One such technology is stem cell therapy. Research into its use to promote the growth of new cartilage in damaged joints is proving very promising. Once perfected, this technology could see future joint specialists and surgeons relying on stem cell injections to treat many of their patients.