The Classic: Ankylosis: Arthroplasty—Clinical and Experimental

Abstract

Figure: Dr. John B. Murphy is shown. Reprinted with courtesy from Davis LJB. JB Murphy: Stormy Petrel of Surgery. New York, NY: G.P. Putnam's Sons; 1938.This month we republish abridged sections from Dr. John B. Murphy's article, “Ankylosis: Arthroplasty-Clinical and Experimental,” published in 1905 [6]. Dr. Murphy, quite a controversial figure in his time [3], made many innovations in many surgical fields. Dr. Murphy was born in Appleton, Wisconsin in 1857, to a farming family who had immigrated from Ireland [3, 8]. He graduated from high school, having been sufficiently accomplished he taught some of the courses [7]. He apprenticed with a local surgeon, and in 1878 at the age of 21 entered Rush Medical College [3]. His mentor, Dr. Christian Fenger, encouraged him to go abroad, which he did for a period of two years beginning September, 1881 [3]. He visited London and Paris on his way to Vienna, Berlin, and Heidelberg, spending time with Billroth, Schröder, and Arnold in those three centers. He returned to Chicago in the spring of 1884 to a private practice and became a professor of surgery at Rush Medical College and the Northwestern Medical College. His accomplishments and prominence were such that he became Chief of the Editorial Staff of Surgery, Gynecology, and Obstetrics, then President of the American Medical Association in 1911. Dr. Murphy was a founder of the American College of Surgeons and honored by membership in The Royal College of Surgeons of England and receiving a Knighthood in the Order of St. Gregory. He died of heart disease in 1916. The article we republish in an abridged version outlines the embryological basis for joint development and the experimental and clinical basis for joint reformation using various forms of arthroplasty in stiff or ankylosed joints. Based on the manner of joint formation embryologically, Murphy explained the development of a “hygroma”—a space with “acquired endothelial lined sacs.” Such spaces provided the rationale for arthroplasty, and he, as others he cites, recognized the importance of interposing various materials to facilitate such formation. These materials included skin, fascia, muscle, periosteum, and adipose tissue. However, he noted Chlumsky experimented with artificial materials such as “plates of celluloid, silver, zinc and rubber, cambric, and layers of colloidion” while Hubscher used magnesium foil. “Interposition arthroplasty” was common well into the mid 20th century. Campbell described various forms of the procedure, and noted that prepared animal membranes, including chromacized pig's bladder, were no longer in general use in 1939 [2]. By that time metals, including Vitallium as advocated by Smith-Petersen for hip interposition arthroplasty [11], had become more widely accepted. All authors, up to and including Murphy, recognized the importance of the aftercare, including passive and active motion, and occasionally forced manipulation. For the time, the outcomes were sometimes remarkably effective compared to the disability of the stiff joint, although we have no idea as to the success rates since series were virtually never reported and failures rarely. The concept, though, remains current for many uses: the carpometacarpal joint [10], following resection of the distal ulna [4], temporomandibular joint [5], elbow [9], shoulder [1], and other joints.