**4. The past: a brief history of replacement arthroplasties**

Knowledge of the past is important to understand how we arrived at the present way of performing arthroplasty, in addition to making it possible to understand the directions of this surgery in the future. Although today, it is strongly linked to the activity of the implants and medical equipment industry, in the early days the first arthroplasties emerged thanks to the creativity and perseverance of important names in orthopedic surgery.

Modern days of replacement arthroplasty date back to the 1960s, with the development of "low friction arthroplasty," which reduced the wear sustained by artificial hip joints over time and provided more predictable outcomes. From the first femoral head attachments fashioned from ivory to current technologies, we can take this point in history as a milestone for the emergence of current models manufactured by the modern prosthetic industry (**Figure 2**).

However, without the first steps in any scientific endeavor, future steps are impossible. The nineteenth century brought three major technical advances that revolutionized surgery: Joseph Lister's aseptic technique, the discovery of anesthesia, and the discovery of X-Ray. Before the nineteenth century, people with severe joint problems and walking difficulties were called "cripples." There was not much to do, just the use of herbs to relieve pain and walking aids such as canes and crutches. In the eighteenth century, some surgeons dared to perform joint surgery to try to relieve the pain of these patients, but with poor results. Henry Park (1744–1831) in Liverpool, United Kingdom, was the first surgeon to report an operation with excision of the femoral head, basically performing an excisional arthroplasty. Later, in the 1940s, femoral head excision was popularized by Gathorne Robert Girdlestone (1881–1950) from Oxford in patients suffering from tuberculosis [4].

Later, surgeons began to consider using different types of materials or biological interposition tissues, developing the interposition arthroplasty without success.

It was only in the nineteenth century, with the use of aseptic surgery, anesthesia, and x-rays that the first attempts at joint reconstruction with prostheses began to become

**Figure 2.**

*Timeline of the evolution of arthroplasties.*

viable. In 1891, Themistocles Gluck from Berlin developed a ball and socket joint made from ivory that was fixed to the bone with nickel-plated screws. French surgeon Pierre Delbet (1861–925) used a rubber prosthesis for replacing the femoral head in 1919. In 1927, the British surgeon Ernest W. Hey-Groves (1872–1944) used ivory. In 1948, the Judet brothers, Robert (1901–1980) and Jean (1905–1995) used an acrylic prosthesis.

In 1940, Austin Moore implanted the first Vitallium prosthesis to replace the proximal femur. Modifications were made to preserve the proper neck angle and the stem was fenestrated in subsequent years. In the 1950s, Thompson developed his hemiarthroplasty for femoral neck fractures. Initially, it was operated without cement fixation, but with practice, it changed to a cemented procedure. This phase was marked by the pioneering spirit of great names in orthopedics at the time, who sought a solution to the problem of joint reconstruction. However, the results were still unsatisfactory. These were abandoned when Sir John Charnley defined modern hip arthroplasty [4, 5].

John Charnley developed the concept of "low friction arthroplasty" based on three principles: the idea of low friction torque arthroplasty, the use of acrylic cement and the introduction of high-density polyethylene as a bearing material. Low friction arthroplasty is the principle used until today, although with evolutions and small modifications, in all current prostheses. So we can say that Charnley's paper "Anchorage of the femoral head Prosthesis to the Shaft of the Femur", from 1960, was the birth of the current era of arthroplasties [4–7].

After Charnley, the realization of hip arthroplasties began to have promising clinical results, which led this surgery to become a routine practice and led to production on an industrial scale, contributing to the birth of the current implant industry. The success obtained in the hip encouraged other surgeons to seek similar solutions for other joints in the human body.

The evolution of knee arthroplasties follows a sequence very similar to that of the hip, with the first attempts to perform resection or interposition arthroplasties most of the time unsuccessful. The history of total knee arthroplasties made great progress

#### *Introductory Chapter: Past, Present, and Future of Joint Reconstructive Surgery DOI: http://dx.doi.org/10.5772/intechopen.109545*

with the application of the "low friction arthroplasty" principle and the launch of the "total Condylar" model created by John Insall in the 1970s. From then on, there were successful and replicable results, which made possible the flourishing of the modern knee implant industry [8].

In a similar way and practically at the same time, Charles Neer improved his model of hemiarthroplasty created in the 50s for the treatment of fractures of the proximal humerus and launched in the 70s a model of total prosthesis with a component for the glenoid, indicated for cases of shoulder osteoarthritis [9].

The ankle was the last joint in the lower limb where total joint replacement was attempted, and therefore, it is the least developed. The mobile bearing system for the ankle first used by Pappas and Buechel appears to have become widely accepted by orthopedic manufacturers as an accurate solution for replicating the biomechanics of the ankle.
