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Orthopedic Implants
Historical Milestones in Orthopaedic
Implant Development
Anesthetics
• Nitrous oxide
– Humphrey Davy, 1800
– Horace Wells, 1844
• Ether
– Crawford Long, 1842
– W.T.G. Morton, 1846
• Chloroform
– Sir James Simpson, 1847
Sir Joseph Lister
(1827-1912)
Visualization
• Wilhelm Konrad Roentgen (1845-1923)
• Discovery of x-rays: 1895
– Nobel Prize, 1901
• Fluoroscopy: Thomas A. Edison, 1896
• X-ray tube: William D. Coolidge, 1913
Suitable Materials
• Traditional Materials
– Gold, silver, lead, aluminum: too weak
– Iron, steel, copper, nickel, zinc: adverse response
• Stainless steel (18-8): 1926
• Vitallium: 1929
– Tantalum: 1936
• Titanium & its alloys
– Maurice Down, 1947
Pre-Implant Era War Experience
• Ollier (1870)
– Immobilization
– Plaster of Paris
• Friedrich (1898)
– Proved efficacy of debridement of dead tissue
– Earlier practice, empirically
Sir Robert Jones
(1857-1939)
War Experience
• Joseph Truetta
– Debridement/immobilization (1936)
– Laboratory studies of bone healing
– Blood flow in bone
Hansman’s
Bone Plate
(1886)
Bone
Ivory
Bone Suture Stabilization Inserts (Koenig, 1905)
Albin Lambotte
Forceps and Bone Plates (Lambotte)
Intra-articular Fracture Fixation
Constructs (Lambotte)
Lambotte Brass Plates & Screws
E.W. Heygroves (1916)
Sir William
Arbuthnot Lane
(1856-1942)
Stress Risers
Broken Lane Plates
William O’Neill
Sherman
ca. 1880
Sherman Plates
Lambotte screws
Metallic Internal Fixation
Roux-Lane
bent wire
Jacoel corrugated
steel staple
Schede-Brun
plain steel staple
Lambotte
spikes
Intuitively-Based
Fracture Fixation
Constructs
(ca. 1920)
Redundant
usage of
Lane
Plates
The Era of Disfavor
• 1920’s → 1950’s
• High incidence of bone destruction, delayed
union, non-union
• Confusion re: failure & corrosion of metals
• Confusion re: fracture healing biomechanics
Heygroves’ “Long Steel Strut” (1921)
Heygroves’ Splint
for
Gunshot Injuries
Burghard’s Screws
Marius N. Smith-Petersen
(1886-1953)
Decalcified Bone
Ferrule
Nicholas Senn
Intramedullary Nails
Küntscher, 1940
Küntscher’s
1st IM Nailing
Development
of Femoral
Intramedullary
Nailing
Kuntscher Kuntscher
KuntscherKuntscher & Maatz
Nails for Proximal Femur Fractures
Compression
Plating
(Danis, 1947)
Standardized
Instrumentation
Set
(AO, 1958)
Cornerstones of AO Technique
• “Technique of Internal Fixation of Fractures” (1965)
– Rigid compression to achieve primary bone union
– Use of austenitic stainless steel
– Pre-threading of screw holes
– Reduced-shear thread profile
– Dynamic compression plate (1973)
– AO Documentation Center (Berne)
Dynamic Compression Plate
(Müeller)
Standardized
Fracture
Documentation
(AO)
Articular Joint Reconstruction and Replacement
• Interpositional arthroplasty
– Chulmsky (1880’s: tin, zinc, silver, rubber, fascia)
– Jones (1895: gold foil)
Interpositional Cups (Pyrex)
Medullary Fixation
• Medullary fixation
– Gluck (1891)
• Ivory implants: hip, finger, thumb
• Experimented with cement fixation
Moore-Bohlman
Upper Femur
(1941)
Smith-Petersen
Vitallium Cups
Urist Cup
Metal
Judet
Austin-
Moore Thompson
THA
Precursors
McKee THA, circa 1940
McKee-Farrar
Total Hip
Prosthesis
Femoral Head Endoprostheses:
1939-1972
Development of
Early Devices for
Hip ArthroplastyMetallic Socket THA:
1956-1968
THA with Plastic or Ceramic Sockets: 1959-1970
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Orthopedic Implants