Aims

The aim of this study was to identify the origin and development of the threshold for surgical intervention, highlight the consequences of residual displacement, and justify the importance of accurate measurement.

Orthopaedic surgeons use a variety of instruments to help correct, treat, and heal bone disease. The development of these instruments mirrors the history of orthopaedic surgery. The history of bonesetting, the treatment and replacement of joints, and of those who performed these techniques, appears to originate deep in antiquity. Changing ideas within medicine and surgery over the last 200 years have shaped the discovery and evolution of orthopaedic instruments and of the bonesetters themselves. Advances have led to the use of computers as instruments in the navigational guidance of arthroplasty surgery, the use of robotics, the development of cordless drills and improvements in the design of blades to cut bone. Yet some of the old instruments remain; plaster of Paris bandages, the Thomas Splint, Liston’s bonecutter, Gigli’s saw, bone nibblers and Macewan’s osteotomes are still in use. This paper presents a historical review of bonesetters and examines how orthopaedic instruments have evolved from antiquity to the 21st century

The ankle joint offers adverse conditions to any prosthetic replacement: high loads on small surfaces, only vague landmarks for the insertion, complex and individually very different functional anatomy. Despite these obstacles many excellent short- and some long-term results have been published, giving little way to a learning curve. This contrasts with our own experiences over at all 29 years now: 24 % failures of cemented two-component EP’s after 14,6 (6,1–21,2) years (n=67) and 8,7 % failures of uncemented tri-component EP’s after 3,7 (0,6–7,6) years (n=92). We analyze and explain special problems and typical failures by a brief historical review of ankle joint replacement: as a logical sequence of various concepts, each of them basing on the knowledge of preceding insufficiencies. The general concern of the functionally useful, but limited mobility after the implantation will be discussed, also on the basis of own early and medium-term results: ROM ranging on average from 26° for TPR-(n=35) and 29° for New Jersey LCS-(n=30) up to 35° for S. T. A. R.-prostheses (n=12). Possible solutions of problems will be considered, respecting assumed causalities. Basing on the literature and own earlier investigations, especially the long-term results will be compared critically. The incertitude of an exact implantation has been partly compensated by the actual „meniscal“ concept of tricomponent prostheses. It should be favourable for their fixation to the bone and moreover reduce polyethylene-wear. But – as before – the discrepancy of high loads on a small area threatens the durability of ankle joint prostheses. Prosthetic replacement has become indispensable in the treatment of painfully destructed ankle joints, but it demands a careful and critical indication

This study presents an historical review of the treatment of talipes equino-varus during the last centuries. The aim of the study was to show how knowledge about the pathogenesis and the progress of new techniques in orthopaedic surgery (plaster of Paris, anaesthesiology, asepsis, antisepsis) have influenced the treatment of this disease during the centuries. This investigation is based on a study of the library of the German Orthopaedic and Science Museum that has more than 3000 historical books and theses from the middle of the 19th century to the present time. In the 18th and 19th century there were different theories about the pathogenesis of clubfoot. For example, Paré was of the opinion that secondary forces were responsible for the deformity. Camper and Wolff were convinced that intrauterine pressure on the extremities was the reason for pes equinovarus. Little, Stromeyer and Delpech believed that shortening of the muscles was the origin. The pathogenesis of the clubfoot is still obscure. The concept of therapy with redression and retention during the first month has not changed since Hippocrates. However, the techniques of redression and retention have changed during the decades. Machines and rural instruments were used for redression until the end of the 19th century (Lorenz, Thomas). Retention was improved by the development of new splints (Arceo, Venel, Scarpa). The introduction of plaster of Paris (Mathysen) in the treatment of the clubfoot led to a further improvement of retention in early treatment. A new era began with asepsis and anaesthesia. These techniques allowed progress in the operative therapy of the tendons. The open and subcutaneous tenotomy was developed by Delpech, Dieffenbach, and Stromeyer. In spite of the operative possibilities, we conclude that conservative treatment still has a major role in the concept of treatment for equinovarus

Substantial healthcare resources have been devoted to computer navigation and patient-specific instrumentation systems that improve the reproducibility with which neutral mechanical alignment can be achieved following total knee replacement (TKR). This choice of alignment is based on the long-held tenet that the alignment of the limb post-operatively should be within 3° of a neutral mechanical axis. Several recent studies have demonstrated no significant difference in survivorship when comparing well aligned versus malaligned TKRs. Our aim was to review the anatomical alignment of the knee, the historical and contemporary data on a neutral mechanical axis in TKR, and the feasibility of kinematically-aligned TKRs.

Review of the literature suggests that a neutral mechanical axis remains the optimal guide to alignment.

Cite this article: Bone Joint J 2014;96-B:857–62.