Like heeding a “Don’t Tread On Me” flag, surgeons were properly
menaced by the thought of chronic infection in any joint wherein they
contemplated implant surgery. Decades passed after Péan removed his
platinum and rubber shoulder implant; the only implants being inserted
were metal plates and screws in the occasional fracture patient, although
scientists had never established which metal alloy was best indicated for
human application. However, in the early decades of the 20th century,
surgeons were awakening to the ravages of joint arthritis, particularly of
the hip and knee. Although the incidence of TB was decreasing with
improved living conditions and the emphasis on fresh air, X-rays were
allowing doctors to see arthritis with their own eyes as never before.
Every joint in the human body shares several characteristics: at least
two connecting bones, a joint capsule which functions as a membrane that
encompasses the lubricating fluid, stabilizing ligaments that hold the joint
together, and most miraculously, articular cartilage. The cartilage
simultaneously provides a cushion and a smooth, gliding surface that
enables painless motion—providing that the cartilage is healthy. Articular
cartilage is the slipperiest material in the world, although with age it
begins to lose its astounding properties. When a physician tells someone
they have arthritis of a joint, the implication is that the cartilage is
diseased, either through “wear and tear” degeneration, or alternatively,
through an auto-immune process (like rheumatoid arthritis) wherein the
body’s immune system attacks and destroys the articular cartilage. In
either case, once the cartilage is worn or destroyed, arthritis (literally,
“inflammation of a joint”) results in pain, stiffness, progressive loss of
motion, formation of bony outcroppings on the bone ends, loose
cartilaginous bodies floating in the joint, and, oftentimes, deformation of
the joint. Prior to 1895, physicians could only examine a patient through
direct observation, but “X-ray vision” empowered practitioners to
visualize arthritis, and start thinking about not just treating TB infections,
but to start thinking about surgically treating arthritis.
Marius Smith-Petersen (1886–1953) spent his entire professional career in
Boston, operating at the Massachusetts General Hospital until his death at