The earliest attempts by a German surgeon, named Themistocles Glück, to replace a joint damaged by tuberculosis with one made of ivory failed. For those who followed him, the journey to eventual success during the early 1960s lasted for close to a century. Today, tibiofemoral arthroplasty, or total knee replacement, is widely regarded as the jewel in the orthopaedic crown. Statistics indicate that, globally, around 2,6 million people undergo this operation each year, and its effects can be life-changing.
Worldwide, around 40% of those aged over 55 experience pain in this joint. For more than 50 million of these, the pain is disabling. Sadly, only those who live in the more technologically advanced societies are fortunate enough to have access to this type of remedial surgery. Current trends indicate that demand will increase and that the number of younger patients requiring knee replacement will account for much of that increase.
Except when it is essential, perhaps due to a severe injury to the joint, surgeons generally consider this procedure to be elective. Consequently, trauma cases must take precedence and this could mean joining a long waiting list. However, most medical aids provide cover for arthroplasty, so it is often possible to refer patients to a clinic that can admit them sooner. However, while pain management remains effective and mobility is not severely impaired, most surgeons will delay suggesting a knee replacement.
Those early failures by the pioneers of this procedure were not due to any lack of skill on the surgeons’ part. Instead, the problem arose due to the material used to manufacture the prosthetic components. They were either not strong enough or tended to lead to rejection in some patients. Stainless steel was the first durable and biocompatible material used for this purpose, joined later by titanium and its alloys. Following the invention of high-grade, durable plastics, most surgeons who undertake knee replacements now include a plastic spacer located between the metal surfaces of the tibial and femoral prostheses. The spacer facilitates smooth movement and serves to minimise wear on the artificial joint.
The invention of an instrument, known as an arthroscopic, has created an alternative approach to joint surgery. A video camera and light source mounted in a flexible tube enable surgeons to inspect a joint’s interior in detail through a tiny keyhole incision. While some surgeons continue to employ open surgery for this purpose, others, like those at the Life Wilgers Hospital in Pretoria, have gained the essential experience and skill required to offer suitable patients the option of a minimally invasive knee replacement procedure.