person who invented the modern

A Short History of Hip Replacement Surgery

The hip replacement procedure is a procedure in which the hip joint is replaced using an implant made of synthetic material. It is the most effective option for cost-effective and secure method of joint replacement surgery. The first documented attempts at hip replacements, carried out in Germany employed ivory as a replacement for the head of the femur.

Artificial hips gained popularity in the 1930s. The joints made of artificial materials were made from chrome or steel. While they were superior to arthritis, there were several disadvantages. The main problem was that surfaces of the joint were not properly lubricated by the body. This caused the joints becoming loose and wearing, and the need for a replacement joint (also called revision procedures).

Teflon was utilized to make osteolysis-producing joints. They were in use for two years. Another significant problem was infection. Prior to the introduction of antibiotics, surgeries on the joints carried a high risk of infections. Even with antibiotics, infections can still be problematic. Such infections are not necessarily due to surgery, but they could also be the result of bacteria getting into the bloodstream during dental treatment.

John Charnley, Manchester Royal Infirmary's tribologist was the person who invented the modern artificial joint. His work was a complete leap over the earlier designs in the 1970s. The design of Charnley was comprised of three elements: (1) a metal (originally Stainless Steel), the femoral piece and (2) an Ultra-high molecular-weight polyethylene acetabular piece. Both were joined to the bone by (3) specific bone cement. Synovial fluid was utilized to lubricate the joint replacement, also known as Low Friction Arthroplasty.

Although the 22.25mm head of the femoral bone was an issue the design was suitable for patients that aren't sedentary. But, the substantial reduction in friction allowed for outstanding clinical outcomes. The Charnley Low Friction Arthroplasty design has been the most well-known around the globe for over 20 years, and has surpassed all other designs like McKee and Ring.

1960 witnessed 1960 saw Dr. San Baw, a Burmese orthopaedic surgeon, pioneer the use of ivory hip prostheses. He used them to replace fractures in the neck of the femur (or 'hip bones') and was the first doctor to use an ivory prosthesis to fix the fractured hip bone of Daw Punya, an 83-year-old Burmese Buddhist nun. The surgery was performed during the time of Dr. San Baw's appointment as chief of orthopeadic surgeons at Mandalay General Hospital, Manadalay in Burma. Dr San Baw performed more than 300 ivory hip replacements from the 1960s to 1980s.

He gave a talk titled "Ivory hip prostheses for ununited fractures of neck of femur' at the conference of the British Orthopeadic Association held in London in September 1969. An 88% success rate was noted in the reality that patients in Dr. San Baw's age range of 24 to 87 were able, in a few weeks in which they could walk, squat, and cycle and even play football, after their broken hip bones were replaced with ivory prostheses. In Burma the Dr. San Baw was a proponent of ivory in the 1960s 1970s and 1980s. This was before the rise of the illegal ivory trade. Furthermore, due to the mechanical, physical, chemical, and biological qualities of ivory it was observed that there was a better biological bonding between ivory to human tissue near ivory prostheses. A short excerpt from Dr. San Baw's paper that he gave at the British Orthopeadic Association's Conference in 1969, is published in Journal of Bone and Joint Surgery (British edition) January 1970.

Over the last 10 years there have been several improvements that have been made to the complete hip replacement process and prosthesis. Studies have shown that hip implants made from ceramic materials are significantly less likely to wear than those made of polyethylene. There is also a growing demand for metal-on-metal implant. Implants can be joined without the necessity of cement. The prosthesis is porous in order to allow bone to grow. It has been proven to reduce the requirement for revision of the acetabular portion. After more than 35 years of clinical experience surgeons still employ bone cement to fix the femoral parts.

There are many competing Minimally Invasive Surgery methods (MIS) that have been developed recently. They could result in lesser tissue damage and faster recovery. Implant manufacturers are also heavily marketing C.A.O.S. (Computer-Assisted Orthopedic Surgery) however its effectiveness is still largely unknown.

A different option to complete hip replacement (THR) is hip surface replacement (HSR) which is also known as hip resurfacing. Both THR and HSR a socket made of prosthetic material is put into the pelvis. THR is the process of amputation of the femur. A shank made of metal is placed into the bone. The shank is used to hold the ball which will be placed into the socket. Resurfacing ensures that the top of the femur does not get amputated. Instead, the outside surface of the ball is replaced with a cylindrical metal cap. Resurfacing is a solution to the THR issue of the shaft of metal separating from the femur. If a revision should be necessary, the bone is preserved through Resurfacing. The socket and ball have a larger diameter that more closely replicates the natural joint structure. This reduces the chance dislocations and enhances the range of motion. There's been no scientifically-proven clinical study to prove that today's CoCr metal-on-metal articulating surfaces possess the osteolytic effects on bone that previous polyethylene products had. Research conducted in England have demonstrated that hip resurfacing has 10-year success rates. This is based on age-matched subjects. In the United States, the first modern resurfacing device gained FDA approval in May of 2006 as well as 90,000 resurfacings have been performed world-wide.

Prior to undergoing hip replacement surgery patients must be aware of the various options. Hip surgeons have different surgical procedures and surgical outcomes. There are currently various incisions to reach your hip joint. The posterior approach, which is widely utilized by the majority of orthopedic surgeons, cuts off the gluteus maximus muscle from the muscle fibers in order to get to the hip joint. Other approaches access the hip through the side that is lateral. Contrary to the posterior and lateral methods, the anterior one uses a natural gap in the soft tissues to get to the hip joint. Its primary drawbacks is that it may cause harm to the lateral femoral cutaneous nerve, and it is not widely available for the general population because less surgeons have been educated to perform this procedure.

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