The Dual Role for a Centre Providing General Orthopaedics in Pretoria
In addition to providing the services of a general orthopaedics centre, a private practice in the Pretoria area has gained recognition both in South Africa and overseas, for its expertise in the field of arthroplasty. Elective surgeries, such as hip and knee replacements, now form the major focus of the practice. These are backed by the use of arthroscopic procedures for diagnostic purposes, and for keyhole surgery where this is seen as an appropriate option. In practice, the clinic’s transition from a primary role of addressing trauma cases, to a centre that now specialises in the implantation of prosthetic joints, to a large extent, tends to parallel the evolution of the discipline itself.
As is the case with so many aspects of modern medicine, the treatment of bone disorders has its origins in ancient Greece. Literature dating from this period, much of which can be attributed to Hippocrates, contains numerous references to methods for the treatment of fractures. Also, this early physician is accredited with devising a procedure to reduce a dislocated shoulder joint.
The Greeks, however, were by no means the only nation to contribute to the development of general orthopaedics; practice of splinting, for instance, seems to have originated with the ancient Egyptians. They also employed a mixture similar to plaster of Paris to immobilise fractured limbs. Perhaps even more remarkable are the 16th century records made by Spanish explorers chronicling the reduction of fractures and the use of fir branches for intramedullary fixation, in which the branch was inserted into the central cavity of a fractured bone to support it.
Such knowledge provided an alternative to amputation, a common approach to treating serious fractures in medieval Europe. It also led to the emergence of a new, albeit self-taught, group of healers known as bonesetters. Consisting mainly of monks and nuns at first, the practice was soon adopted by others, and often developed into a family business, passed on to successive generations. Although many were highly skilled, they were universally branded as “quacks” by trained physicians, yet continued to operate in Britain, well into the 19th century. At which time, they were required by an act of parliament to undergo formal training similar to that given to physicians.
Although the term orthopaedics, as applied to the general treatment of fractures and the correction of skeletal defects in children, was coined about a century earlier, it was only with this act that it became recognised as a medical discipline. That transformation would, in time, make the development of facilities such as those operated by leading Pretoria hip, knee and shoulder surgeon, Dr Jan De Vos possible.
The last 125 years or so have resulted in a number of important advances in this field, as well as in the role formerly played by the bonesetters. The pioneering work of the German surgeon Themistocles Glück, who in 1891 presented a paper at an international conference on the use of ivory to replace the heads of femurs damaged by tuberculosis, laid the foundations of modern arthroplasty. Even though ivory proved to be insufficiently durable and meant that his implants were short-lived, the new and improved materials and techniques subsequently developed by those prompted to follow his lead have since overcome this problem. Today, these advances have served to position the procedure known as THA, or total hip arthroplasty, among the most valuable and successful surgical interventions conducted within this specialist discipline.
Dr De Vos’s practice has gained the status of a centre of excellence and has become a preferred choice for arthroplasty that enjoys numerous referrals from sources both in South Africa and beyond its borders. That said, however, the general orthopaedic services available from the Pretoria practice are no less remarkable. This is an area within the discipline that has seen some impressive advances of its own. For instance, the use of tissue culture to propagate chondrocytes and create sufficient hyaline cartilage for autologous transplants in cases of articular damage offers a valuable alternative to prostheses in younger patients. Likewise, flexible nailing of long-bone fractures in children employs tiny alloy nails, inserted percutaneously via a tiny incision, in order to provide stable fixation that is more readily managed than a plaster spica, and also allows earlier discharge. Based on current research, in future, we could even see gene therapy playing a significant role in aiding fracture repair.