The Miracle of Modern Knee Replacement Surgery
It is now more than 160 years since a German surgeon named Themistocles Glück first attempted the surgical procedure we now know as arthroplasty. In 1860, he tried the first knee replacement. However, despite his unquestionable skills, his choice of an ivory prosthesis led to subsequent failure. The material was insufficiently durable to support the patient’s weight under pressure, so his prosthesis collapsed within days. Nevertheless, Glück’s efforts spurred others to pursue this goal.
After limited successes with combinations of metal and acrylic, English orthopaedic surgeon John Charnley eventually developed a working artificial hinge joint composed of metal and polyethylene, in the early 1960s. The era of knee replacement began in earnest when Charnley’s colleague, Frank Gunston, developed a prosthesis consisting of two separate components for attachment to the femur and tibia.
Prosthetic joints serve mainly to rectify severe injuries or eliminate the pain, swelling, and reduced movement caused by osteoarthritis. Depending on the extent of the bone damage, a partial or total knee replacement can relieve the continuous pain and restore the patient’s mobility. For many patients, the outcome can be life changing.
Much of the improved performance of prosthetic joints can be attributed to advances in materials science. To improve the action of metal-on-metal joints, a plastic component inserted between their surfaces provided a smooth and virtually friction-free articulation. This addition alone has enabled the manufacture of prosthetic joints with the potential to continue working efficiently for decades.
The other groundbreaking advance now benefitting knee replacement patients relates to the surgical technique employed. Following the invention of the arthroscope and successive improvements in its performance, many surgeons have learned to adapt this formerly diagnostic aid to perform minimally invasive procedures. The arthroscopic approach can minimise the risk of excessive blood loss and infection that can often complicate open surgery and markedly reduce post-operative recovery times. That said, the procedure is more exacting than open surgery and requires additional training and extensive experience on the surgeon’s part. Consultants often reserve this approach for their younger patients.
A knee replacement requires a commitment by both the patient and the surgeon to ensure the best possible outcome. Based on its long record of success, the orthopaedic unit at the Life Wilgers Hospital in Pretoria has gained a reputation as a centre of excellence. It is also a referral destination of choice for both local and international patients in need of arthroplasty and other forms of orthopaedic surgery.