Knee joint

General Patient Information

History of orthopaedics

The history of orthopaedics is long and extremely interesting. Resourceful doctors have made all kinds of experimental attempts to alleviate the problem of joint pain:
  • 400 B.C. Hippocrates of Kos undertook a search for suitable methods to heal joint pain or improve the quality of life for patients who suffered from severe pain and restriction of limb movement.
  • 1797 Barton divided a stiff hip joint to remediate an obstructive malposition.
  • 1821 White performed the first excision arthroplasty. This type of intervention involved the resection (removal) of the femoral head; the residual stump was placed into the remaining hip socket.
  • 1826 Barton, an American surgeon, made the first attempt to remediate a hip ankylosis (stiffening of the hip joint) by dividing the bone (intertrochanteric osteotomy). He divided the hip stem with a simple saw and provoked the formation of a false joint by keeping the leg in motion.
  • 1840 Carnochon placed a wooden board into a diseased joint to improve the function of a stiffened hip.
  • 1871 Helferich was the first surgeon to achieve the permanent remobilisation of ossified joints by pushing muscles between the separated bone fragments. He thus established the basis for the method of arthroplasty that was dominated by the surgical techniques of Payr until after World War Two (1946).
  • 1890/1891 Gluck, a professor of surgery in Berlin, implanted his first knee hinge prostheses made of ivory in 3 patients. The foreign material was rejected by the recipient organism. Moreover, the mechanical resilience of the material was very low.
  • 1903 Debet replaced the femoral head with a head made of ivory.
  • 1906 Hoffa, Hübscher and others used silver, magnesium and zinc as materials; ivory was also frequently used. Still others used celluloid (a plastic compound) and gutta-percha (a rubber-like material) which, however, caused irritation and joint stiffening.
  • 1907 E. Lexer transplanted complete cadaveric knees. The grafts were not accepted by the recipient organism. Due to the rejection reaction, doctors renounced the use of foreign material in the years that followed.
  • 1917 Smith-Peterson for the first time used a mould arthroplasty for the hip joint: a glass mould is placed without fixation between the hip socket and the femoral head. Glass was soon superseded by Plexiglas, Viscaloid and Bakelite. In 1938, an alloy of CoCrMo (cobalt-chromium-molybdenum) was used.
  • 1926 Hey-Groves preferred bone pegs instead of screws. He removed the loose femoral head and locked it with an ivory peg or replaced it with an ivory prosthesis, whereas Robert Jones wrapped the stump in a gold foil.
  • 1938 Wiles designed the first clinically viable total endoprosthesis of the hip joint, fixing the hip socket with screws and anchoring the femoral component in the femoral neck with a bolt. The total endoprosthesis was made of stainless steel. Wiles reported a bilaterally treated case with satisfactory function after 13 years.
  • 1940 Bohlmann and Moore used special endoprostheses made of CoCrMo alloys. McKee developed a metal-metal total endoprosthesis. He published the clinical results eleven years later.
  • 1942 Austin T. Moore described the case of an overweight man with a recurrent osteoclastoma (a tumour in the long bone) at the upper end of the femur. He replaced the entire upper section of the bone with a one-foot long synthetic resin prosthesis featuring a round head and loops for muscle fixation.
  • 1950 Adams and Lange used mounted rather than embedded caps. Wagner and Freeman improved this type of arthroplasty in several steps over a number of years without developing a new prosthesis of their own. Their idea was to replace the articulating joint surfaces of the hip socket or femoral head by permanently implanted endoprostheses. This advancement by Freeman and Wagner eventually facilitated the development of the hip endoprostheses as we use them today.
    1950 The Judet brothers were the first to use Plexiglas for their femoral prosthesis.
  • 1954 Thompson and Moore used metal (CoCrMo, cobalt-chromium-molybdenum) for their first femoral neck prosthesis.
  • 1959/60 Sir John Charnley introduced methyl methacrylate (PMMA) as bone cement into hip endoprosthetics. He advocated polyethylene (UHMWPE, HDPE) as a sliding surface component.
  • 1969 Mittelmeier developed the supporting-fin endoprosthesis for cement-free anchorage.
  • 1969/70 The previously used straight stem shape was replaced by the bent “banana stem”. The banana stem was developed by Prof. M. Müller in cooperation with Robert Mathys Sr.
  • 1974 Morscher advocated the iso-elastic stem according to Robert Mathys Sr., the metal-reinforced elastic artificial prosthetic stem.
  • 1976 Prof. M. E. Müller and Robert Mathys Sr. initiated the development of the straight-stem prosthesis.
  • 1980 Zweymüller used a titanium alloy for his prosthetic stem which was fixated with a distal press-fit anchoring. This titanium stem comprises a broad range of stems and is offered with a conical screw-on cup with polyethylene inlay.
  • 1982 Mittelmeier and Harms introduced the first conical screw-on cup with polyethylene inlay.
  • 1983 Spotorno developed an elastic expansion cup and a proximal stem anchorage.

Although the development of endoprosthetics has made great progress over the last 50 years, medical professionals and the industry are continuing their relentless research and development work in order to further improve the systems in the next 50 years as well – always with the aim to restore the patients’ quality of life.

Robert Mathys Senior, 1946

Robert Mathys Senior, 1946

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