Definition and Facts

• According to the Surgery Encyclopedia, "Arthroplasty is surgery performed to relieve pain and restore range of motion by realigning or reconstructing a dysfunctional joint." Approximately 713,000 arthroplasty procedures are performed on an annual basis, which include 297,000 hip and 362,000 knee surgeries. Under the age of 45, the men outnumber women in needing this surgery, whereas, women lead men older than 45.
  
  

Early History

• The first arthroplasty was performed in 1821, by Anthony White, in London at the Westminister Hospital. Czech surgeon Vitezlav Chlumsky experimented with many types of materials for the arthroplasty, which were mostly unsuccessful. In 1891, a professor from Berlin, Themistocles Glück came up with the idea of an ivory ball and socket affixed by nickel plated screws. The first successful arthroplasty, in the United States, was performed by Jules E. Pean, in 1893.
  
  

Resection Arthroplasty

• Resection arthroplasty is a procedure in which an incision is made and excess bone is removed to improve motion and stability. In 1904, the Keller resection arthroplasty laid the groundwork for future procedures and is studied regularly. Keller's study primarily focused on bunions, however, expanding to include arthritis and MTP joints. The next advancement, the Hoffman procedure in 1912, used metatarsal head resection through a single plantar curved incision. In 1967, silicone implants became part of resection arthroplasty, to maintain stability and relieve pain.
  
  

Interpositional Arthroplasty

• Interpostional arthroplasty involves the reshaping bones of the joint and placing a piece of material between the two to keep them from rubbing together. In the early 1900s, JB Murphy and Erich Lexer proposed the idea of joint replacement. William Steven Baer, in 1919, took it a step further and studied the use of pig bladders in joint replacement. Royal Whitman, in 1924, described in detail his surgical procedure in Annals of Surgery, furthering the study of interpositional arthroplasty.
  
  

Joint Replacement

• Joint replacement is also a major procedure within arthroplasty. The first type, in major use in the 1940s, was the mold arthroplasty. The procedure used many types of material before settling with stainless steel. In the 1950s, hemiarthroplasty developed in which the ball of the joint was the only portion replaced. The beginning of the era of total knee replacements was in 1968.
  
  

Current Trends and Uses

• Today, arthroplasty is used in total knee and hip replacements, shoulder and ankle joint issues, and rheumatoid arthritis treatment. The trend in knee and hip replacements is increased durability and longevity. Younger patients are requiring increased mobility. Future improvements include the trabecular metal, less invasive operative techniques and computer-assisted navigation.