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By the 18th century, scientific knowledge of skeletal structure was sufficiently advanced to allow the development of the precursors to the modern hip implant. Excision arthroplasty (removal of the affected parts of the joint, to be replaced by scar tissue) was well known, though not in widespread use due to the popularity of amputation, which was particularly common among sailors and soldiers. Prior to the invention of modern anesthetics, a premium was unsurprisingly placed on speed of the operation.
The first successful reported excision hip arthroplasty was performed in 1821 by Anthony White, a surgeon at London’s Westminster Hospital. That was followed in 1826 by the first recorded hip osteotomy, performed in Philadelphia by John Rhea Barton. Barton’s patient was able to walk with a cane after the operation, but within 6 years had lost all mobility. Nonetheless, Barton’s procedure was significant for his recognition that gentle movement was required to help redevelop mobility after a procedure.
The development of general anesthetic and modern standards of surgical sterility in the 19th century paved the way for modern joint replacement.
The Berlin physician Themistocles Glück is widely credited with performing the first total joint replacement. In 1890 Glück successfully replaced a 17-year-old girl’s damaged knee with an ivory prosthesis. He also developed the first ball-and-socket hip replacement (also made of ivory, a material he had settled on after experimenting with alternatives such as aluminum, wood, and glass) and experimented widely with methods of adhering implants to existing bone. He designed artificial versions of most major joints in the human body, including the wrist and knee.