Ideal xenograft or a perfect bone substitute?-A retrospective review and analysis of the historical concept of ivory implants in orthopaedics.

PURPOSE: Surgical treatment of fractures has evolved with the development of anaesthesia in 1846. Experiments with different implants both organic and non-organic had led to introduction of sometimes extremely peculiar materials coming from different species like ox bone or elephant's ivory. The aim of this article is to present not widely known concept of ivory use in bone surgery that set its foot in the history of orthopaedics and laid foundations for orthobiologic reconstructions. METHODS: Retrospective analysis of articles and books published between 1846 and 2017 that describe various examples of ivory application in the treatment of fresh fractures, non-unions and reconstruction of joints. RESULTS: Our research shows that ivory to the surgical world was introduced by Friedrich Dieffenbach, founder of the modern plastic surgery. It was also used with different rate of success by many of the famous surgeons of the nineteenth and twentieth century to include Trendelenburg, Billroth, Volkmann, Paget and Hey Groves. Ivory was immensely popular in bone surgery and became material of choice demonstrating amazing biological properties and very low rate of infections. CONCLUSION: Ivory has served well in successful treatment of various orthopaedic conditions for over 100 years. In this article, we are using history as a stepping stone to examine material that is not rejected by the body and promotes bony healing without increased infection or other complications. It is worth considering further analysis of historically acquired specimens for further development of materials for further orthopaedic fracture and reconstructive techniques.

Surgical Nasal Implants: Indications and Risks.

Rhinoplasty often requires the use of grafting material, and the goal of the specific graft dictates the ideal characteristics of the material to be used. An ideal material would be biologically inert, resistant to infection, noncarcinogenic, nondegradable, widely available, cost-effective, readily modifiable, and easily removable, have compatible biomechanical characteristics, retain physical properties over time, and not migrate. Unfortunately, no material currently in existence meets all of these criteria. In modern rhinoplasty, autologous grafts are the gold standard against which all other nasal implants are measured and offer the safest long-term results for most patients. They are easily manipulated, have inherent stability and biomechanical characteristics similar to the native nasal framework, and confer minimal risk of complications. Modern homologous and alloplastic materials have gained considerable support in recent years because they are readily available in endless quantity, do not require a second surgical site for harvest, and are generally considered safe if most circumstances, but they confer additional risk and have biomechanical characteristics different from that of the native nasal framework. To address some of these issues, we provide a contemporary review of autologous, homologous, and alloplastic materials commonly used in rhinoplasty surgery.

Spines of Steel: A Case of Surgical Enthusiasm in Cold War America.

Just as the prevalence of scoliosis began to decline precipitously after World War II, American orthopedic surgeon Dr. Paul R. Harrington devised a new, invasive surgical system whereby implantable prosthetic metal rods and hooks were used to straighten curved backs. By the 1970s, "Harrington rods" had become the gold standard of surgical scoliosis care in the United States, replacing more conventional methods of exercise, bracing, and casting. This article situates the success of Harrington rods within a much larger and historically longer debate about why, when compared to those in other nations, American surgeons appear to be "more aggressive" and "knife-happy." Using Harrington's papers and correspondence, I argue that patients played a vital role in the rise of spinal surgery. As such, this article examines not only how surgical enthusiasm has been historically measured, defined, and morally evaluated, but also how scoliosis became classified as a debility in need of surgical management.

Inspiration and application in the evolution of biomaterials.

Biomaterials, traditionally defined as materials used in medical devices, have been used since antiquity, but recently their degree of sophistication has increased significantly. Biomaterials made today are routinely information rich and incorporate biologically active components derived from nature. In the future, biomaterials will assume an even greater role in medicine and will find use in a wide variety of non-medical applications through biologically inspired design and incorporation of dynamic behaviour.

[History of vertebral body replacement]. / Geschichte des Wirbelkörperersatzes.

BACKGROUND: Vertebral body replacement after corpectomy is nowadays a standard procedure in spinal surgery. OBJECTIVE: Description of the developmental process of vertebral body replacement. METHOD: Historical description of the innovations in vertebral body replacement. RESULTS: The first serious attempts to perform vertebral body replacement were initiated approximately 50 years ago. Over several decades spinal surgeons used bone grafts, polymethyl methacrylate, titanium and glass-ceramics containing apatite and wollastonite. Known vertebral surgeons, including Scoville, Polster, Kaneda and Harms, to name but a few, were involved in the continuous development of vertebral body replacement. CONCLUSION: Many different expandable and non-expandable implants are now available and both types of implant can still be justified. This article describes the historical development of these implants and shows how this innovational process has significantly increased the therapy options for surgeons.

Progress in musculoskeletal oncology from 1922 - 2012.

Since 1922 surgical approaches toward limb salvage in bone and soft tissue tumours have been documented. There is the famous "Umkippplastik" of Sauerbruch, the "Tikhoff-Linberg" inter-scapulo-thoracic resection or in 1943 a metallic tumour prosthesis for the hip joint in the United States (Moore, Bohlman). Since 1960 acrylic prostheses and metallic prosthesis with bone cement have been in use. Cement-free implants and the first modular ceramic prostheses were implanted in the 1970s in Vienna. At the same time successful chemotherapy in bone sarcomas was introduced by Gerald Rosen and Norman Jaffe. This was mainly the decade of custom-made prostheses. In the 1980s modular tumour prostheses with cone connection to be adopted to the needs of the patient were built intra-operatively. Since 1981 biannual international meetings (ISOLS) have pushed forward the field of bone tumour treatment to allow also tumour resection in wide borders for spine and pelvic tumours. New hope for resistant tumours could be monoclonal antibodies or even dendritic cell therapy.

Limb amputations from the ancient times to the present.

Amputations, or the removal of limbs at different levels, have been performed since the ancient times. The first reports of amputations originate from the ancient ruins in Egypt, where primitive prosthetic toes were found in the tombs of the Pharaohs. In Europe, during the period of ancient Greece and Rome, various examples of amputations were described on amphoras and mosaics. During the middle ages, the body was marginalized and replaced by the worship of human spirituality. As a result reports of amputations from that time period are scarce. True development of amputation and prosthetic techniques took place during the Renaissance and centuries that followed. Present-day indications for amputation are similar to those utilized in the ancient times. The greatest development of limb amputation techniques and prosthetic methods began in the 20th century and continues to this day. Despite the development of new techniques in prosthetics, many solutions have their roots in designs originating in the ancient times and differ only in their structural design.

Surgical correction of pectus excavatum. How did we get here? Where are we going?

The currently applied techniques recommended for the repair of pectus excavatum anomalies are discussed, set against a historical review of early clinical studies and surgical interventions. The issues of the future direction pectus excavatum surgery may take are analyzed in detail, with the reviewer expressing reservations in connection with the recent trend to closed repair and concern over the potential for serious complications associated with the application of this technique.

Adoption of new technology in sports medicine: case studies of the Gore-Tex prosthetic ligament and of thermal capsulorrhaphy.

Evaluation of new technology in sports medicine is supposed to promote improvements in the care of patients. It is also supposed to prohibit technology that can harm patients. This evaluation process is not perfect and at times can promote technology that not only does not help patients but may harm them. Two examples of new sports medicine technology that were widely adopted but eventually abandoned are thermal capsulorrhaphy for treatment of shoulder instability and the Gore-Tex prosthetic ligament (W. L. Gore & Associates, Flagstaff, AZ) for patients with anterior cruciate ligament deficiency. On analysis of the quick adoption of these 2 failed procedures, certain recommendations are apparent for improvement of the evaluation process. There must be a sound rationale behind any new technology, basic science research into the theory of the medical technology, and demonstrated improvements in animal models and clinical studies that are prospective cohort studies or randomized controlled trials, and finally, there must be careful follow-up and postmarket surveillance.

Overview of disc arthroplasty-past, present and future.

Degenerative disc disease is one of the most frequent spinal disorders. The anatomy and the biomechanics of the intervertebral disc are very complex, and the pathomechanics of its degeneration are poorly understood. Despite this complexity and uncertainty, great advances have been made in the field of disc replacement technology, with promising results. Difficulties are continuously being encountered, but careful analysis of the results and intensive research and development will assist in countering these problems. There are approximately 40 clinical reports in the literature describing various aspects of randomised controlled trials involving intervertebral disc arthroplasty. However, the majority of these publications do not provide reliable information, in that they give only interim results and/or the results from just one of the many centres in multicentre studies. Such publications must be interpreted with caution, since they do not always represent the results of the whole study population and may hence be underpowered. We identified six randomised controlled trials that compared the final clinical outcomes of disc arthroplasty and spinal fusion. The present systematic review attempts to give an overview of the current status of disc arthroplasty.

[From natural growth to artificial composition: the use of artificial materials in endoprosthetics from a cultural-historical perspective]. / Verwendung von Fremdmaterialien in der Endoprothetik: Ein medizinhistorischer Beitrag.

The use of artifical materials in joint replacement is not self-evident. A paradigm change can be observed. Beginning in the 18th century orthopedic surgery became possible because of a change of the idea of man. Natural growth was seen as ideal solution in orthopedic surgery until the 19th century. Yet in the aftermath the point of view changed to a more technical determined approach. Until the middle of the 20th century the terms "efficieny" and "ability" became more and more important. Joint replacement with artificial materials was generally accepted and led to an enormous accelaration in the development of new materials and surgical techniques.

[History of implant-free anterior cruciate ligament reconstruction]. / Geschichte des implantatfreien Kreuzbandersatzes.

Most recent articles on anterior cruciate ligament (ACL) reconstruction focus on anatomic tunnel placement, but reviewing the early history of ACL reconstruction it can be seen that at the beginning of the 20th century Ernest Hey-Groves had already pointed out the importance of anatomic placement of the tunnels. Palmer even developed a femoral drill guide for precise anatomic placing of the tunnel before World War II. The possibility of graft fixation without any fixation material is also not new and was described as early as 1967 by Brückner from Rostock. Many techniques in ACL reconstruction with non-anatomic placement and high failure rates could have been avoided if surgeons had been aware of what the early pioneers in this important field of orthopedic surgery had already described.

Education in prosthetic and orthotic training: Looking back 50 years and moving forward.

There is a long history of prosthetic and orthotic services helping to mitigate the impact of physical impairment by restoring function, and enabling and equipping the user. The training of health professionals who design, fit, and maintain prosthetic and orthotic devices has evolved over the centuries, reflecting an increase in knowledge, technology, understanding, and social attitudes in each era. Improvements in pedagogical thinking and biomechanical understanding, as well as the advent of new integrated technologies, have driven the profession over the past 50 years to modernize, evolve training and service delivery models in line with new attitudes toward clients, and search for new ways to improve users' quality of life. In this narrative review, the authors examined the evolution of prosthetic and orthotic education, the impact of changing educational techniques and technologies, and the impact of the International Society for Prosthetics and Orthotics in that process. Through conversations with experts and review of peer-reviewed literature, accreditation documents, and the International Society for Prosthetics and Orthotics records and databases, the authors identified three areas of change in prosthetics and orthotics education over the past 50 years: (1) prosthetic/orthotic curriculum content, (2) pedagogy and course delivery, and (3) internships/residencies. This narrative review is a snapshot of a growing profession and we can only speculate where the next 50 years will lead us as we strive to serve patients, ever placing their needs and aspirations at the center of this professional service.

Biomaterials and biocompatibility: An historical overview.

This review focuses on the characteristics and applications of biomaterials through the ages, ranging from the prehistoric times to the beginning of the era of modern medicine, which has been arbitrarily set to the middle of the 19th century, when aseptic procedures, antiseptic substances and modern anesthetics were developed. After a brief discussion on the definition of "biomaterial" from an historical point of view and a short introduction on the general history of surgery and dentistry, each material or class of materials will be presented with references listed in chronological order and, where possible, with their real, scientifically demonstrated effects on biological tissues. Particular attention has been given to references that are nowadays considered spurious or affected by translation errors or other kinds of biases.

History of Integral Fixation for Anterior Lumbar Interbody Fusion (ALIF): The Hartshill Horseshoe.

OBJECTIVE: Anterior lumbar interbody fusion (ALIF) is a common spinal fusion option for different spinal pathologies. In the early years, implant migrations/expulsions were potential complications of ALIFs due to the lack of integral fixation. We present a historical vignette on the inception and development of the first stand-alone ALIF (SA-ALIF) implant-the Hartshill Horseshoe (HH). METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic search was carried out for 3 online databases focusing on implant development for ALIF, refining the search to before 1995. A personal communication with the original patent holders of the HH was used due to the lack of formal publication of the HH during its early years. RESULTS: Since 1932, the idea of anterior lumbar fusion was proposed and was carried out in 1933 using a tibial peg. Autografts were first reported in 1936 as interbody spacers for ALIF. Since then, bone grafts were commonly used for ALIF. However, ALIFs were not commonly performed due to variable reported outcomes. A pilot study in 1971 reported the use titanium mesh blocks as interbody implants in 6 patients. No articles reporting the use of integral fixation for SA-ALIF implants were found before the development of the HH in 1984. CONCLUSIONS: The HH was the first synthetic SA-ALIF implant developed. Since the HH, multiple SA-ALIF implants have been designed. The benefits of integral fixation in a SA-ALIF device include immediate implant stability, ability to reduce and correct deformity postimplantation, prevention of implant migration, and increased implant-bony endplate contact for early osseointegration.

Barber-Surgeons in Military Surgery and Occupational Health in Finland, 1324-1944.

Barber-surgeons have existed as a medical profession in multiple countries for centuries. This article outlines the exciting history of the barber-surgeons in Finland, focusing on a time frame covering over 600 years, from the Middle Ages until the last barber-surgeon in Finland finished his practice during the Second World War. The barber-surgeons were the first healthcare professionals who focused on the healthcare of soldiers during times of both peace and war. They were able to treat wounds, conduct minor and even major surgeries and perform amputations. The development of the profession and the education and skills of the barber-surgeons are summed up and illuminated. New genealogical sources are also reviewed to profile the barber-surgeons as men, married and of multinational origin. This review summarizes the history of the profession, who the barber-surgeons in Finland were and where they came from. It concludes by noting that the barber-surgeons had a remarkable impact on the development of the professions of surgeons and physicians as well as on the development of occupational healthcare as a whole. However, these impacts are not sufficiently appreciated today.