Arthroplasty for the production of motion, in certain joints and under certain conditions, has taken its place in surgery as a definite procedure. Surely this is the case in Germany, Italy, and America, and to a lesser degree in France, but it cannot yet be said to have gained a foothold in England. Indeed, most English writers seem to be antagonistic to it, but, as only one hundred and forty arthroplasties of all joints have been done in England (Groves, 1924), perhaps a greater experience may change this point of view.
Arthroplasty for ankylosis of the jaw is an operative procedure as permanent and exact as is the operation of appendectomy. I myself have had forty-three operations of arthroplasty of the jaw with but a single failure. That one should not have been attempted, as it was a synostosis of the entire upper and lower jaw in a baby weighing but four pounds at one year of age. I have no hesitancy whatever in promising a cure in ankylosis of the jaw, subject only to the unforeseen happenings to which any operation is prone.
[See FIG in Source PDF] To my mind, next to the jaw, arthroplasty of the hip has made the greatest strides, and is well on its way of taking its place as a recognized surgical procedure. I believe that arthroplasty of the hip for gonorrheal arthritis is not only a proper procedure, but it almost assures the patient of good motion in the hip with "all the advantages thereunto appertaining". I should not hesitate to recommend such a procedure to any patient applying for relief.
The results of arthroplasty in traumatic ankylosis of the hip are very gratifying.
Our prognosis in septic infection of the hip should be far more guarded, and we should attempt the operation only after the most careful scrutiny of the case, and always with a certain mental reservation. It is difficult to tell what changes have been made in the human body by the previous continuous suppuration. Here we are dealing with latent fire.
In tuberculous arthritis caution should be our motto. Opinion generally is against an arthroplasty. In some adults, apparently cured but with exacerbation of fluid in the joint and its consequent disability, good results may be obtained. In arthritis deformans, almost never!