Joint Replacement Over the Years

There is a significant portion of the world population currently suffering from joint problems like osteoarthritis of the knee, which require joint replacement. Joint replacement primarily involves the knee and the hip. Let us look at the evolution of Joint Replacement surgery over the years.

Evolution of Total Hip Replacement: Development of Hip implants began quite a long time ago. In 1821, Anthony White, who was a surgeon at London’s Westminster Hospital, carried out the first successful hip Arthroplasty, which was followed by the first recorded Osteotomy in 1826, which was carried out by John Rhea Barton in Philadelphia. The first total joint replacement procedure was carried out in 1890 by Themistocles Glück.

The first ball-and-socket hip replacement made of ivory was also developed by Glück. Glück’s implants had short-term success but infection led to their eventual failure. There was widespread experimentation in the first half of the 20th century involving resurfacing techniques and partial hip replacement, with prostheses made of materials like rubber, ivory, acrylic, glass, metal etc. The modern hip replacement was made possible with Sir John Charnley’s invention of a device consisting of a plastic acetabular cup and a metal femoral component, in 1962.

Evolution of Total Knee Replacement:  Total knee replacement has a long history. Back in the 19th century, skin, fascia, muscle, fat and even pig bladder were used during knee arthroplasty. Following similar hip replacement designs, molds fitted to the femoral condyles were first used as artificial implants in the 1940s. The tibial replacement was tried out in the next decade but both designs suffered from issues like loosening and continuous pain. In the 1950s, combined femoral and tibial articular surface came into the picture as simple hinges, but suffered from high failure rates as the implants could not match knee motion complexities.

That the femoral condyles roll and glide on the tibia with many instant points of rotation, with the knee not doing single axis rotation like a hinge, was an important discovery made by Gunston in 1971. Due to kinematics that was better than hinged implants, Gunston’s polycentric knee replacement enjoyed some initial success, but insufficient fixation of a prosthesis to bone led to its failure. In 1973 at the Hospital for Special Surgery, Insall designed the Total Condylar prosthesis. Reproduction of normal knee motion was not the objective of this prosthesis that focussed on mechanics. A prosthesis with kinematics which were more natural was developed later on.

Joint Replacement Surgery Today: The last two decades have seen great advancements in Joint Replacement surgery. Till two decades ago, total knee replacement was a procedure that was greatly dreaded by patients due to the long recovery time and hospital stay, the trauma involved, medication, side effects, and the uncertain results. But all that has changed today with the great advancements that have contributed to modern total knee replacement. One such advancement is the ‘Zero Technique’ invented by Dr. Vikram Shah of Shalby Hospitals, Ahmedabad. This painless procedure has revolutionized Total Knee Replacement (TKR) surgery and offers faster recovery with multiple benefits like minimum surgery time, hospital stay, medication, side effects, exposure etc.

Provided one goes to the right professionals, modern Joint Replacement surgery can help patients reverse about 20 years of their lives and get back their youth in terms of mobility and self-reliance, with minimal distress to them and their loved ones.

By:

Dr. Bharat Gajjar

Director, Outpatient Services

Shalby Hospitals, Ahmedabad

+ 91 99240 73400/ 91 79 40203154/155