As knowledge of the musculoskeletal system has improved, together with advances in technology and surgical techniques, the combined effect of these developments has seen a change in the role played by the orthopaedic specialist. At one time, the main focus of these healthcare professionals would have been largely divided between treating traumatic injuries involving bones and the associated soft tissues, and attempting to correct skeletal deformities, such as curvature of the spine, also known as scoliosis. However, for many of those who have chosen to specialise in this branch of medicine, this has since changed.
The change began during the early ‘60s when the work of Sir John Charnley at Britain’s Manchester Royal Infirmary earned him the title of “father of the modern total hip arthroplasty” (THA). The procedure involved the replacement, by this innovative orthopaedic specialist, of a diseased hip joint with a prosthesis consisting of a polyethylene acetabular component and a metal femoral stem – the latter being secured to the shaft of the femur with acrylic bone cement. Although there had been previous attempts at hip replacements, Charnley’s proved to be the most durable and the design of his prosthesis is, in principle, little different from those in use today.
Before the successful treatment of tuberculosis and the development of an effective vaccine, TB was frequently the cause of bone degeneration and it was mainly this manifestation of the disease which, during the experimental years, led to the first attempts by a number of orthopaedic specialists to replace the affected joints. Today, life expectancy has increased quite markedly and it is no longer TB, but the long-term effects of osteoarthritis, that is responsible for the growing waiting list of patients who are now in need of either a hip or a knee replacement.
Although it is a progressive disease, the progress pf osteoarthritis tends to be relatively slow. Traditionally, therefore, it was only those patients in their mid-60s and older who, when no longer able to obtain relief from the pain and swelling when treated with analgesics and steroids, reached the point at which only surgery at the hands of an experienced orthopaedic specialist would have the potential to restore their mobility. In recent years, this too has changed.
Whether it is a secondary effect of the growing incidence of obesity and the resulting increased pressure on the joints, or due to some other factor, osteoarthritis and its complications are now frequently seen in much younger subjects. The result is that many patients in their 50s or even younger are now joining the elderly on the waiting lists of those orthopaedic specialists whose area of expertise is arthroplasty.
The procedures are most commonly performed on the hip and knee, but other joints, such as the shoulders, can also be successfully replaced. Depending on the extent of the damage, either both articulating surfaces may be replaced or just one, resulting in either a total or partial joint replacement.
Arthroplasty is widely seen by members of the profession as the most successful intervention in the history of the discipline. Each year, many thousands of patients worldwide will owe their restored, pain-free mobility to the knowledge and surgical skills of an orthopaedic specialist.