How the Role of the Orthopaedic Surgeon Has Evolved
Although the adjective “orthopaedic”, as used to describe the activities of certain specialised surgeons today, has its origins in the Greek language, it was not coined until the late 16th century. Even then, the type of activity it was used to describe was quite different to that with which the term would eventually be associated. In fact, procedures similar to some of those carried out today appear to predate the medicine of both the ancient Greeks and Romans, and even that of the Egyptians before them.
Fossil evidence suggests that the primitive healers of the New Stone Age may have engaged in traumatic amputations. Also, the discovery of fractured limbs, in which the union of bones had obviously been carefully aligned, indicates an understanding of the reduction process. Other evidence of the early attempts to repair broken limbs suggests that, perhaps as early as 2000BC, the Shoshone Indians used rawhide soaked in water to immobilise fractures, while the Aborigines of Southern Australia used casts prepared from clay for the same purpose. Dating back to around 300BC, the first known use of wooden splints appears to have been by the ancient Egyptians, while a carving found on a tomb confirms that they also made use of crutches.
That said, it was the Greek physician Hippocrates who laid many of the foundations upon which today’s orthopaedic surgeons rely. For instance, he described methods for the treatment of fractures, including traction, and emphasised the importance of precise alignment. He also recognised spinal deformities, and even devised a means with which to correct them using a special extension bench. The efforts of another Greek, named Galen, who was employed by the Romans to treat gladiators, served to greatly extend our knowledge of the musculoskeletal system. Widely considered to be the father of sports medicine, Galen’s study of spinal deformities led to the differentiation and naming of the conditions we know as scoliosis, kyphosis and lordosis. Following the decline and eventual fall of the Roman Empire, there was little or no significant progress in any field of medicine for the better part of a thousand years.
The term orthopaedic, as applied to the surgeons of today, is a composite of two Greek words – orthos and paidios. Together, their literal translation is “straight child”, thus implying the absence of any deformity. Derived from “Orthopaedia”, the title of a book published some years earlier during the European Renaissance by a professor of medicine at the University of Paris, together with the anatomical knowledge provided by the likes of the artist Leonardo da Vinci; it marked the start of a new era for this specialised branch of medicine. Later, the contributions of Lister, Pasteur and Koch, regarding the principles and the importance of antisepsis, would greatly extend both the scope and the reliability of surgical procedures in general.
Since those early days, advances in technology and anatomical knowledge have served to revolutionise the former role of the “bone doctor”. No longer limited to the repair of fractured limbs and the manipulation of dislocated shoulders and fingers, such advances have given the orthopaedic surgeons of today the ability to actually replace joints that have been damaged by injury, disease or old age with tough and efficient prosthetics. Known as arthroplasty, its procedures can often be life changing. They provide a means with which to finally alleviate the pain and restore lost mobility for millions of people whose hip or knee joints have been damaged by injury, or by osteoarthritis and similar illnesses.
This too was an advance marked by humble beginnings and early failures, as researchers experimented with different materials to develop a sufficiently durable and functional artificial joint. Today, however, both the prostheses and the surgical techniques used for their insertion have been thoroughly tried and tested with millions of patients worldwide now living pain-free and mobile, once again, following successful arthroplasty.
These procedures are, of course, available to patients in South Africa, and one of the country’s foremost orthopaedic surgeons is to be found at the private clinic known as Pretoria Hip, Knee and Shoulder Surgeons in Lynwood Ridge. Under the direction of Dr Jan De Vos, the unit has gained recognition both locally and internationally for its exceptional record of success and quality of care.