Knee Replacement – Once a Miracle, Now a Routine Procedure
Unfortunately, most of us only become aware of the continuous wear and tear to which we subject our joints when they fail us. The adult body has 206 bones and 360 joints. Many of the latter are immobile, and we tend to remain unaware of them. However, others, such as the shoulders, elbows, wrists, hips, ankles, and knees are essential for movement and, if damaged, could leave us severely disabled. Fortunately, knee replacements and similar procedures performed on other joints are now helping many patients with diseased or damaged joints avoid such disabilities and retain their independence.
At one time, the best one could expect when afflicted with a painful and swollen joint was a course of painkillers and physiotherapy. For some, this may have sufficed, but many would reach the point where the medication no longer provided relief and their mobility was compromised. However, pioneering work performed in 1860 by a German surgeon named Themistocles Glück provided the foundation that made possible the world’s first successful knee replacement in 1968.
Much of the delay in developing a successful procedure was due to the materials used to create the prosthetic joint. Some, such as Glück’s ivory prosthesis, were simply not strong enough, while the metal alternatives used initially were not biocompatible, leading to short-term failures. Today, artificial joints are manufactured from a combination of various metal and plastic components or, more recently, ceramics. Since the ‘70s, a succession of new and improved materials has positioned knee replacement as one of the most successful orthopaedic interventions of all time.
Apart from physical injuries to the joint, the most common reason a patient might require a prosthetic joint is a degenerative condition known as osteoarthritis. The disease mainly affects weight-bearing joints and causes a breakdown of the protective cartilage layer coating the articulating surfaces. As a result, the underlying bone is exposed to frictional forces causing splintering and subsequent swelling and pain. The condition is progressive, and when palliative treatments fail, surgery will be necessary. A knee replacement may be partial or total, depending on the extent of the damage. The latter option involves removing the damaged sections of the femur and tibia and replacing them with prosthetic parts made from cobalt-chromium alloy or titanium, separated by a spacer of tough polyethylene.
The procedure is technically known as femorotibial arthroplasty and should be undertaken only by an appropriately qualified and experienced surgeon. The orthopaedic unit of the Life Wilgers Hospital in Pretoria is hailed locally and internationally as a centre of excellence for shoulder, hip, and knee replacement.