Joint Surgeons Employing New Technology to Improve Patient Outcomes
Long before the medical specialism known as orthopaedics receive this title, much of the attention of those physicians providing attention for patients with problems of the musculoskeletal system was devoted to reducing fractures and dislocations, or attempts to correct deformities of the spine in young children. Even the name eventually applied to this discipline during the mid-18th-century was derived from a pair of Greek words “orthos” and “paidios” meaning “straight and without deformity” and “child” respectively. Today, joint surgeons routinely perform feats which would have been considered as miracles by their professional predecessors.
Even as far back as the time of the ancient Egyptians, albeit rather primitive, simple splints and strapping were among the earliest attempts by physicians to develop technology aimed at assisting the healing of fractures. However, faced with the kind of challenges that the specialised joint surgeons of today tackle and overcome on a daily basis, such as the repair of complex fractures, even the most competent of Egyptian, Greek, or Roman physicians would have had no option but to resort to amputation – a procedure they had ample opportunity to perfect given their extensive experience of treating those injured in the frequent battles of the time.
Apart from those primitive splints, most of the technology available to joint surgeons today is of relatively recent origin. However, there is evidence that bandages hardened with albumen were used by early Arabian doctors as a simple means with which to immobilise fractures – a precursor of the more rigid casts prepared from plaster of Paris introduced in the early 1800s and more recently superseded by comfortable, padded casts made of fibreglass that are far easier to fit and to remove.
While such items have done much to simplify the tasks and increase the productivity of the general orthopaedist, despite the ongoing quest for new and improved tools and procedures, for those of the profession who chose to focus on damaged or diseased joints, advances have been somewhat less forthcoming. While being of immense value to medicine in general, the invention of the X-ray machine by William Conrad Rontgen in 1895 also marked a major turning point for joint surgeons, providing them with an internal view of the damage with which to supplement the findings of their physical examinations.
The first attempt at a hip replacement was that by the German Physician, Themistocles Gluck, when in 1891, he replaced the head of a damaged femur with one fashioned from ivory. Although it quickly became damaged, being insufficiently robust to support the patient’s weight, the foundations of arthroplasty had been laid. Just after the Second World War, an American named Austin Moore became the first to perform a successful hip arthroplasty by employing a metal prosthesis instead. Since then, successive advances in the science of materials have presented joint surgeons with many more options, including metal-on-metal, metal-on-plastic, and ceramic-on-ceramic prostheses.
While the transparent, negative images produced by X-rays can be highly informative to the trained eye, they require careful interpretation and may still fail to accurately reflect the findings of a surgical examination. The first attempts to use a device to take a peek inside the body date back to the BC era, but only in 1853 was the first functional endoscope used to examine the bladder and urinary tract (cystoscopy). Subsequent modifications led to new procedures, such as colonoscopy, bronchoscopy, and gastroscopy. Only in 1919, however, when Japanese Professor Kenji Takagi inserted a cystoscope into a knee joint, did arthroscopy subsequently become available to joint surgeons around the world.
No longer a simple, illuminated viewing tube, the modern arthroscope employs fibre-optic technology to illuminate the targeted area and relay images to a video camera, displaying them on a monitor screen. First used as a diagnostic tool providing far more detail than an X-ray, arthroscopy was quickly adapted to guide the actions of orthopaedic specialists, allowing them to perform less-invasive keyhole surgeries, initially for more basic procedures, but eventually extending to include knee and hip replacements. While such procedures demand great skill, avoiding the need to expose an entire joint reduces the risk of infection and excessive blood loss, as well as lessens recovery time.
While it took centuries to develop these major advances, today’s joint surgeons can look forward to more rapid progress. It is already possible to 3D-print prostheses and to use advanced imaging techniques to position them more accurately, while stem cell therapy is repairing damaged cartilage and reducing pain.