Joint Replacement Specialists

Jan 8, 2019 | Articles

From Bonesetters to Joint Replacement Specialists

The history of orthopaedics is a long and colourful journey marked by slow but significant advances. Although it began with simple, intuitive treatments, over the centuries, these have been added to and transformed by experience and research to provide the foundations for a specialised and complex discipline of modern medicine. It is feasible that fractures may have been treated as early as the New Stone Age, but there is definite evidence of the use of primitive splints by the ancient Egyptians – almost five thousand years before the first joint replacements by modern-day specialists.

What the Egyptians devised, the Greeks improved upon to provide the basis for many of the procedures still in use by orthopaedic surgeons today. Texts by notable physicians of the time, such as Hippocrates, make it clear that they understood the importance of the reduction and accurate alignment of fractures, as well as the use of traction and counter-traction. Furthermore, they were skilled in the treatment of dislocations and, in fact, the original procedure developed by Hippocrates for the reduction of an anterior shoulder dislocation is still in use today. In addition to the treatment of traumatic injuries, the Greeks also tackled the treatment of skeletal deformities, such as clubfoot. Although it is a far cry from the work of today’s joint replacement specialists, the accomplishments of the Greeks and later the Romans were no less outstanding in their time.

The fall of the Roman Empire was followed by a millennium in which medicine saw little progress – largely due to the Church’s ban on the study of human anatomy by dissection. Nevertheless, the need to repair fractures and dislocations continued and, in the absence of physicians, that need was often met by monks and nuns. In time, they were joined by others who lacked any formal medical training and who became known simply as bonesetters. Sometimes, entire families took on the role of informal, self-taught healers, often earning a sound reputation for success. In practice, the joint replacement specialists of today might not exist had it not been for the Apothecaries Act of 1815. This crucial piece of legislation made it mandatory for surgeons, like physicians, to undergo formal training in medical schools.

Of benefit, not just to orthopaedics, but to surgery in general, the development of anaesthesia and aseptic procedures contributed to both the success and the reputation of surgeons. However, it was probably the invention of the X-ray machine that gave the biggest boost to orthopaedics. Later, the arthroscope proved to be of even greater value to joint replacement specialists.

Unlike the tasks of the general orthopaedic surgeon, in which the focus is largely on the treatment of traumatic injuries to or deformities of the musculoskeletal system, arthroplasty tends to be an elective procedure undertaken when the action of a joint is compromised by illness, such as osteoarthritis. The erosion of protective cartilage leads to friction and damage to the heads of the articulating bones. The damage is progressive, eventually resulting in pain that can no longer be relieved by painkillers or steroids, and loss of mobility.

At this point, the only option remaining to the patient is for a joint replacement specialist to remove the head of one or both of the damaged bones and to replace them with suitable prostheses.