History of joint replacement is quite interesting. Earliest method for treating arthritis was interposition arthroplasty using soft and flexible materials.
But these substances lacked strengths and were not rigid enough to support.
Metal and glass were tried next in the form of condylar shapes attached to one of the joint. These provided some amount of success but joint apposition was not perfect and neither were kinematics of the joint.
Modern day joint replacement began in the early 1960s. This was hallmarked by introduction of cemented metal-polyethylene components for the hip. Later Gunston used this technique in the knee also.
Charnley prop0sed following principles of arthroplasty which are still valid today.
These include
- Rigid fixation of the component to the bone
- Resurfacing of both joint surfaces
- Use of materials with low friction and wear.
Following this there was a great rise in joint replacement surgery.
In the 1970s, there was a rapid expansion in the number of total joint joint replacement surgeries.
After Charnley, there are number of other designs which have been introduced successfully.
In the next decade, there was development of more sophisticated instrumentation. Also, uncemented components with porous coatings intended for indefinite fixation were introduced. Certain uncemented designs of hip stem, acetabular component, and femoral component of the knee have shown survivorship values superior to those of cemented components.
At present, a number of designs of hips, knees, and other joints have greater than 90% survivorship at 10 years.
Today’s hip and knee systems offer a large variety of sizes and modular augments to deal with virtually every situation encountered in primary and revision surgery.
The instrumentation systems are elaborate, usually well engineered, and often too complex, but they allow the surgeon to achieve accurate component placement and limb alignment.
Future
The main limitations of total hip and knee replacements are excessive wear of the ultra-high molecular weight polyethylene (UHMWPE) and loosening.
Gamma-irradiation and storage in an inert atmosphere, as well as enhanced cross-linking and stabilization to minimize subsequent oxidation, have resulted in reduced wear rates.
Other modalities are being investigated too. Like ceramic-on-ceramic and metal-on-metal produce minimal wear debris.
With improvement in technology further, much greater durability can be expected.
Use of computer modeling for designing the prostheses has improved the knee prosthesis as well.
New advancement would bring better and durable designs especially for younger patients.
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