How Knee Replacement Surgery has Changed Over the Years
In 1968, an English surgeon named Frank Gunston completed the world’s first successful total knee replacement. However, previously, surgeons worldwide had been attempting to perfect this procedure for more than a century. In the early 1860s, a German named Themistocles Glück was the first to try this tricky orthopaedic intervention, but he met with repeated failures. Since Gunston’s initial success, ongoing research has led to massive improvements in hip, knee, and shoulder arthroplasty.
Those early failures were not due to poor technique. Surgeons were generally successful in achieving their goal of implanting a prosthetic joint. In practice, the design of the prostheses and the materials used in their manufacture caused those early attempts at knee replacement to fail. Glück’s historic attempt utilised an ivory implant cemented into the bone. However, the material was insufficiently durable to be effective, and the procedure often resulted in severe infections. Later, he tried using a hinged joint made of iron. Unfortunately, this new implant also developed unforeseen problems. Nevertheless, his pioneering groundwork established proof of concept, prompting others to pursue the continuing quest for improved designs and more effective materials.
The process involves replacing the articulating surfaces of one or more of the three bones that form the joint. Initially, most knee replacements relied on metal components. Stainless steel, titanium, and various alloys remain popular because they are biocompatible and don’t cause adverse reactions when implanted. However, the introduction of plastics was the most significant breakthrough in this field. Metal-on-plastic joints behave more like natural ones, allowing the articulating surfaces to move freely by minimising much of the friction associated with metal-on-metal prostheses.
How Knee Replacements Have Evolved
The extent of this intervention has also changed over the years. Today, patients have the option of a partial procedure, in which only the femoral or tibial head is replaced, or a total knee replacement where both of these and, sometimes, the patellar surface are all renewed. In addition, there has been a breakthrough in the surgical approach itself. While not suitable for everyone, many younger or fitter patients may now be eligible to undergo a minimally invasive procedure. Instead of exposing the entire joint, the surgeon makes several small incisions. These accommodate the necessary instruments and an arthroscope to illuminate the joint’s interior and transmit a magnified video image to a monitor to guide the surgeon’s actions.
Knee replacement surgery is now regarded as among the most successful orthopaedic interventions ever. The orthopaedic unit at the Life Wilgers Hospital in Pretoria has earned the status of a national and international referral centre, specialising in arthroplasty and arthroscopy. Please click here to learn more about Dr Jan De Vos and his team. You can also contact us for any enquiries.