Long before modern operating rooms, surgeons faced a difficult problem: what to do when a joint was destroyed by disease or injury. In the late 19th century, conditions like tuberculosis could eat away at bone, leaving people with painful, useless limbs. The standard solution was often fusion (arthrodesis) or amputation. But a few bold surgeons began to wonder if they could replace the damaged joint instead.

One of these pioneers was German surgeon Themistocles Gluck. In 1890, he performed a wrist arthroplasty on a patient whose joint had been ravaged by tuberculosis. His solution was to carve a new joint out of ivory. Gluck chose ivory because it was biocompatible and relatively easy to shape. He also developed a cement, a mix of plaster of Paris and pumice, to secure his creations to the remaining bone. While not a shoulder replacement, his work laid crucial groundwork, proving that an artificial joint could be implanted in a human.

Just a few years later, French surgeon Jules-Émile Péan took the next logical step. In 1893, he was treating a 37-year-old man whose shoulder had also been destroyed by tuberculosis. Rather than simply removing the joint, Péan decided to build a new one.

His implant was innovative for its time. He crafted the ball of the shoulder joint from platinum and attached it to a rubber stem that went inside the humerus. A platinum cup lined with rubber was fixed to the shoulder blade to create the socket. Péan likely chose platinum for its resistance to corrosion inside the body, a problem that plagued surgeons using other metals.

Péan's surgery was partially successful. His patient regained some use of his arm, which was a remarkable outcome at the time. He could move his shoulder and was reportedly happy with the result. However, the victory was short-lived.

Two years after the surgery, the implant had to be removed. The primary culprit was infection, a constant threat in the pre-antibiotic era. The materials also posed a problem. The rubber components deteriorated, and the entire device eventually loosened. The challenges were immense: materials weren't durable enough, fixation techniques were rudimentary, and controlling infection was nearly impossible.

Despite the ultimate outcome, Péan's and Gluck's efforts were not failures. They were crucial first steps. They demonstrated that joint replacement was a viable concept, sparking the imagination of other surgeons and setting the stage for the advancements that would follow decades later.