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Historical Overview of Hip Arthroplasty

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Historical Overview of Hip Arthroplasty Orthopedic Reviews 2021; volume 13:8773 Historical overview of hip archeologists who found signs of this arthroplasty: From humble pathology in Homo Neanderthalensis skele - Correspondence: Dan-Viorel Nistor, “Iuliu tons. 1,2 Also, skeletons from ancient Britain Haţieganu” University of Medicine and beginnings to a high-tech and medieval times 3,4 were found with signs Pharmacy, Calea Manastur Street, nr. 38-40, future of hip arthritis. In those times, the orthope - sc.2, ap.20, Cluj Napoca, Romania. Tel.: +40.752171202. dic treatment was the only one available, E-mail: [email protected] Nicolae Ciprian Bota, Dan-Viorel Nistor, surgery for arthritis being yet to be devel - oped. Naturally, patients could ambulate Sergiu Caterev, Adrian Todor Key words: Total hip arthroplasty, direct ante - with the use of a cane and crutches, eventu - rior approach, hip replacement, history, histor - Department of Orthopedics, ally becoming permanently immobilized in ical approach. Traumatology and Pediatric bed. No more innovations in degenerative Orthopedics, “Iuliu Haţieganu” hip disease were developed until modern Contributions: NCB, DVN and AT were University of Medicine and Pharmacy, times. More recently, at the beginning of the responsible for the conception and the design th of the study. All authors contributed in data Cluj-Napoca, Romania 18 century, surgeons used to excise the collection and manuscript preparation. All femoral head, basically performing the authors gave their approval for publishing of excision hip arthroplasty. At the time, this this final version. All authors had equal con - was groundbreaking surgery, especially in tributions. an age when limb amputation was common. Abstract The first surgeon to report such an operation Conflict of interest: The authors declare no potential conflict of interest. Surgery of the arthritic hip was not an was Henry Park (1744-1831) in Liverpool, United Kingdom. He told to his mentor easy task in the previous centuries, lots of Funding: None. operations being followed very closely by Percival Pott (1717-1788) that after “total complications and failures. Nowadays, hip extirpation of articulation” he hoped to Ethics approval: Not needed. 2 arthroplasty is considered “the operation of obtain a cure by “callus” formation. In that the century”. This review follows the evolu - period, the “callus” term was a general con - Consent to publication: Not required. tion of surgery on the arthritic hip, with cept which referred either to a proper bony Availability of data and materials: Available in emphasis on arthroplasty. Acknowledging callus or a fibrous nonunion. th the text. the history of this operation, one can better Across Europe, the 18 century was very violent, many wars and conflicts rang - prepare its evolution and future directions Received for publication: 2 July 2020. of research. The final chapter briefly ing from Ireland and Scotland all the way to Revision received: 14 November 2020. describes the current trends and future per - the Black Sea and Caucasus. The introduc - Accepted for publication: 25 February 2021. spectives. tion of military conscription and the spread - ing of firearms meant that more people This work is licensed under a Creative were subjected to high energy trauma and Commons Attribution NonCommercial 4.0 License (CC BY-NC 4.0). Introduction many surgeons who practiced alongside an army were very fond of amputations and ©Copyright: the Author(s), 2021 Throughout history, patients with ortho - limb disarticulations. But some surgeons, Licensee PAGEPress, Italy pedic disorders were called “cripples” since who were horrified by the idea of invalidity Orthopedic Reviews 2021;13:8773 this kind of pathology, which concerned the and life-threatening surgery in a time when doi:10.4081/or.2021.8773 musculoskeletal anatomy and function, was procedures were performed without anes - poorly understood. This meant that condi - thesia or any regard to asepsis and antisep - tions like trauma, degenerative joint disease sis, were happy to adopt the principle of and infection had poor outcomes, usually limb conservation. Among those, the 59 patients, in which only 39 survived. He putting the patient at risk for death, major Prussian surgeon Johann Ulrich Bilguer presented his results in 1876 at the handicap and crippling deformity. (1720-1796) who wrote in 1761 “ De mem - International Medical Congress in During its evolution, hip surgery brorum amputatione rarissime adminis - Philadelphia and then across Europe on dif - 6 focused on three major aspects: approach tranda” advocating for limb sparing proce - ferent occasions during lectures. Although and anatomy, trauma and joint replacement. dures, with minimum tissue excision and in the United States this technique was well Often, hip trauma that required surgical lower amputation rates amongst surgeons. received, the European surgeons, like treatment needed proper surgical approach - Unfortunately, due to the speed of an ampu - Volkmann and Calot kept a conservative es and implants, which led to the continuous tation and its lower technical demand, approach. Later, in the 1940’s, excision of need of research and innovation. Park’s operation and Bilguer’s principles the femoral head was popularized by The purpose of this paper is to describe failed to echo into the surgical world. Gathorne Robert Girdlestone (1881-1950) the evolution of hip surgery and hip arthro - The breakthrough was in 1821, when from Oxford in patients suffering from plasty by understanding the key moments in Anthony White from London (1782-1849) tuberculosis and joint infection. Girdlestone their history. was credited with the first excision arthro - was a man of deep religious beliefs and his plasty on a 9-year-old patient with hip approach to this operation was somewhat tuberculosis, according to The Lancet jour - biblical, as in his own words “If thine 5 Early aspects of hip surgery nal. Lewis Sayre, later in 1854, was a great femoral head offend thee, pluck it out and promoter of hip resection for infection and cast it from thee” . Even today, some sur - The earliest data regarding degenerative tuberculosis ( “morbus coxarius” as he geons use this procedure as a final resort in hip disease came from paleontologists and called it). Subsequently, he operated up to a failed total hip arthroplasty. [Orthopedic Reviews 2021; 13:8773] [page 19 ] Review he graduated medicine from Leipzig and osteoarthritis surgery, that was not referring Osteotomy, interposition and Berlin. Later he took part as a military to hip fusion. He described his operation as fusion: early techniques for joint physician in Romanian War of a “mechanical adaptation of a hip joint dis - salvage Independence (1877-1878) and Serbian- abled by injury or disease to the essential Bulgarian War of 1885-1886 where he saw requirements of locomotion…”. In this type In 1826, John Rhea Barton from different kinds of bone trauma. In this peri - of surgery, the patient needs to sacrifice Philadelphia (1794-1871) performed the od Gluck used screws and steel plates to either stability or mobility for the sake of a first osteotomy on an ankylosed hip. 7 He provide an early form of ORIF (open reduc - pain free limb. performed an intertrochanteric osteotomy tion and internal fixation) on a fractured A major breakthrough in hip arthroplas - without anesthesia in seven minutes. femur and replaced the malignant bit of a ty was made by Marius Smith-Petersen Twenty days later, he mobilized the limb in mandible with a steel plate. Although he’s (1886-1953) from Boston who in 1923 order to create a pseudarthrosis. Three usage of artificial joints spanned not only to described the mold interposition arthroplas - months later, the patient was walking using hip, but also shoulder, knee and ankle, his ty with a synthetic material (glass). He a cane. Through this operation, Barton also results were darkened on a long term by noticed that glass was a material that was provided the first evidence that motion infection. Most of his work was not pub - very well tolerated by the human body and could prevent fracture healing and bone for - lished due to a conflict with his chief sur - while he was operating on a patient who had mation. At the time, this kind of treatment geon, Proff. Von Bergmann. a piece of glass in his back, Petersen noticed had a mortality rate of about 50%, unac - At the beginning of 20 th century, the that a fibrous membrane was present around ceptable by today’s standards. Although road to modern arthroplasty was paved by it. Therefore, he concluded that glass, mold - popularized by McMurray in the 1930’s, John Benjamin Murphy from Chicago ed on the femoral head could stimulate the and later by the biomechanical studies of (1857-1916) who studied the anatomy and formation of that fibrous membrane and Pauwels in the 50’s and Bombelli in 1983, evolution of the disease and named it alleviate pain, thus improving mobility and the indications for proximal femur osteoto - “malum coxae senilis”. He noticed the range of motion. In his own words, it will my shifted from adult degenerative condi - presence of osteophytes around the joint “guide nature’s repair” of the joint. During tions to young and adolescent septic hip and advocated for their removal only, with - surgery, the mold was inserted through an sequelae. In adults, the operation failed to out addressing the joint surfaces of the anterior approach, developed by Smith- properly address the hip joint and the femur and acetabulum. He described this Petersen in 1917. First glass implants were afflicted joint surfaces, but rather to merely procedure as “hip cheilectomy”. In his used in 1932 and although promising at change the loading biomechanics and slow patients, Murphy noticed that after the first, they soon started to shatter. During down the degenerative processes, with only removal of the osteophytes, their range of revision surgeries, Smith-Petersen was slight alleviation of pain and other symp - motion and pain somewhat improved, but in excited about the presence of the fibrous toms.
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