Joint degenerative pathologies

Abstract

During the twentieth century, the development of orthopaedic surgery led to a more solid definition of the orthopaedist's boundaries and competences. It started at the beginning of the 1900 from Alessandro Codivilla's intuition, and his stating that the orthopaedist had to deal with the diseases of the musculoskeletal system [1]. However, the main pathologies involving orthopaedists in the first few years of last century were the congenital and childhood ones, those resulting from poliomyelitis, and the bone complications of tuberculosis. Later on, the treatment of degenerative diseases focused mainly on the treatment of coxoarthritis, among which the worth mentioning are consequences of congenital dysplasias, and knee arthritis. Up until the 1960s, arthritis surgery mainly consisted of osteotomies, with the aim of modifying the axes and the load areas of the joint cartilage, and arthrodeses, which inevitably led to poor functional results in large joints, even though it acted directly upon the cause of the arthritic pain. In 1962, Sir John Charnley described his hip prosthesis, thus changing the approach to degenerative surgery for ever [2]. In parallel, only after several attempts, John Insall improved the knee prosthesis with a condylar design in the 1970s [3]. Interestingly, in about a decade the approach to the treatment of coxoarthritis changed completely in the records of the national congress of the Italian Society of Orthopaedics and Traumatology (SIOT). In the 49th Congress in 1964 on the surgical treatment of coxoarthritis, osteotomies, arthrodeses, and many interventions on the soft parts were the pillars of the orthopaedist's cultural background, while more modern therapies such as acetabuloplasties and arthroplasties were only beginning to develop. In 1969, many orthopaedists already reported on their experience in prosthetic implants, and the scientific community was split between “conservatives and prosthesisizers”. Since then, the development of more and more sophisticated prosthetic implants has characterized orthopaedic surgery, which nowadays faces the issue of revision surgery and complication management [4]. Another innovation in the treatment of degenerative conditions has certainly been the implementation of arthroscopic techniques of the large joints, which has been widely considered as a technological innovation of the last few years, even though a 1912 contribution from Severin Nordentoft has just been found: At the 41st congress of the German Surgery Society in Berlin he presented his contribution on laparoscopy, cystoscopy, and knee endoscopy, followed after a few years by Takagi (from Japan), and Bircher (from Switzerland), who mainly concentrated on joint endoscopy [5]. Finally, the last few years have seen a growing interest in new treatment approaches towards degenerative arthritis, through the implementation of bioengineering in surgery, in particular with studies on osteocartilage transplants, mesenchymal cells, biomaterials, and growth factors.