Orthopedic surgery or orthopedics ( alternative spelling orthopaedics) is the branch of

surgery Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

concerned with conditions involving the

musculoskeletal system The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their Muscular system, muscular and Human skeleton, skeletal systems. ...

. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal

trauma Trauma most often refers to: *Psychological trauma, in psychology and psychiatric medicine, refers to severe mental and emotional injury caused by distressing events *Traumatic injury, sudden physical injury caused by an external force, which doe ...

, spine diseases,

sports injuries Sports injuries occur during participation in sports or exercise in general. Globally, around 40% of individuals engage in some form of regular exercise or organized sports, with upwards of 60% of US high school students participating in one or ...

degenerative disease Degenerative disease is the result of a continuous process based on degenerative cell changes, affecting tissues or organs, which will increasingly deteriorate over time. In neurodegenerative diseases, cells of the central nervous system stop wo ...

s, infections,

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s and

congenital disorder A birth defect is an abnormal condition that is present at childbirth, birth, regardless of its cause. Birth defects may result in disability, disabilities that may be physical disability, physical, intellectual disability, intellectual, or dev ...

Etymology

Nicholas Andry Nicolas Andry de Bois-Regard (1658 – 13 May 1742) was a French physician and writer. He played a significant role in the early history of both parasitology and orthopedics, the name for which is taken from Andry's book ''Orthopédie''. Early li ...

coined the word in French as ', derived from the

Ancient Greek Ancient Greek (, ; ) includes the forms of the Greek language used in ancient Greece and the classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...

words ("correct", "straight") and ("child"), and published ''Orthopedie'' (translated as ''Orthopædia: Or the Art of Correcting and Preventing Deformities in Children'') in 1741. The word was assimilated into English as ''orthopædics''; the

ligature Ligature may refer to: Language * Ligature (writing), a combination of two or more letters into a single symbol (typography and calligraphy) * Ligature (grammar), a morpheme that links two words Medicine * Ligature (medicine), a piece of suture us ...

''æ'' was common in that era for ''ae'' in Greek- and Latin-based words. As the name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventually became the cornerstone of orthopedic practice.

Differences in spelling

As with many words derived with the "æ" ligature, simplification to either "ae" or just "e" is common, especially in North America. In the US, the majority of college, university, and residency programmes, and even the

American Academy of Orthopaedic Surgeons The American Academy of Orthopaedic Surgeons (AAOS) is an orthopedic organization. Founded at Northwestern University in 1933, as of 2015 AAOS had grown to include about 39,000 members.AAOMembersPage accessed June 27, 2015 The group provides ed ...

, still use the spelling with the digraph ae, though hospitals usually use the shortened form. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; "orthopaedics" is the normal spelling in the UK in line with other fields which retain "ae".

History

Early orthopedics

Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the

Middle Ages In the history of Europe, the Middle Ages or medieval period lasted approximately from the 5th to the late 15th centuries, similarly to the post-classical period of global history. It began with the fall of the Western Roman Empire and ...

, the injured were treated with bandages soaked in horses' blood, which dried to form a stiff, if unsanitary, splint. Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children.

Nicolas Andry Nicolas Andry de Bois-Regard (1658 – 13 May 1742) was a French physician and writer. He played a significant role in the early history of both parasitology and orthopedics, the name for which is taken from Andry's book ''Orthopédie''. Early li ...

, a professor of medicine at the

University of Paris The University of Paris (), known Metonymy, metonymically as the Sorbonne (), was the leading university in Paris, France, from 1150 to 1970, except for 1793–1806 during the French Revolution. Emerging around 1150 as a corporation associated wit ...

, coined the term in the first textbook written on the subject in 1741. He advocated the use of exercise, manipulation, and splinting to treat deformities in children. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles.

Jean-André Venel Jean-André Venel (28 May 1740 – 9 March 1791) was a Swiss surgeon and a pioneer in the field of orthopedics. Biography Venel was born on 28 May 1740 in Morges, Vaud, the son of Jean-François Venel, a barber surgeon and perruquier, and ...

established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. Advances made in surgical technique during the 18th century, such as

John Hunter John Hunter may refer to: Politics *John Hunter (British politician) (1724–1802), British Member of Parliament for Leominster * John Hunter (Canadian politician) (1909–1993), Canadian Liberal MP for Parkdale, 1949–1957 *Sir John Hunter ( ...

's research on

tendon A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...

healing and

Percival Pott Percivall Pott (6 January 1714, in London – 22 December 1788) was an English surgeon, one of the founders of orthopaedics, and the first scientist to demonstrate that cancer may be caused by an environmental carcinogen, namely chimney sweep ...

's work on spinal deformity steadily increased the range of new methods available for effective treatment. Robert Chessher, a pioneering British orthopedist, invented the double-inclined plane, used to treat lower-body bone fractures, in 1790. Antonius Mathijsen, a Dutch military surgeon, invented the

plaster of Paris Plaster is a building material used for the protective or decorative coating of walls and ceilings and for moulding and casting decorative elements. In English, "plaster" usually means a material used for the interiors of buildings, while "re ...

cast Cast may refer to: Music * Cast (band), an English alternative rock band * Cast (Mexican band), a progressive Mexican rock band * The Cast, a Scottish musical duo: Mairi Campbell and Dave Francis * ''Cast'', a 2012 album by Trespassers William ...

in 1851. Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. One of the first surgical procedures developed was percutaneous tenotomy. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. In the late 1800s and first decades of the 1900s, significant controversy arose about whether orthopedics should include surgical procedures at all.

Modern orthopedics

Examples of people who aided the development of modern orthopedic surgery were

Hugh Owen Thomas Hugh Owen Thomas (23 August 1834 – 6 January 1891) was a Welsh orthopaedic surgeon. He and his nephew Robert Jones have been called "the Fathers of orthopaedic surgery". Thomas was descended from a line of Welsh bone setters and placed grea ...

, a surgeon from

Wales Wales ( ) is a Countries of the United Kingdom, country that is part of the United Kingdom. It is bordered by the Irish Sea to the north and west, England to the England–Wales border, east, the Bristol Channel to the south, and the Celtic ...

, and his nephew, Robert Jones. Thomas became interested in orthopedics and bone-setting at a young age, and after establishing his own practice, went on to expand the field into the general treatment of fracture and other musculoskeletal problems. He advocated enforced rest as the best remedy for

fracture Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...

s and

tuberculosis Tuberculosis (TB), also known colloquially as the "white death", or historically as consumption, is a contagious disease usually caused by ''Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can al ...

, and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's maneuvere, an orthopedic investigation for fracture of the hip joint, the Thomas test, a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as a so-called "osteoclast" implement to break and reset bones. Thomas's work was not fully appreciated in his own lifetime. Only during the

First World War World War I or the First World War (28 July 1914 – 11 November 1918), also known as the Great War, was a World war, global conflict between two coalitions: the Allies of World War I, Allies (or Entente) and the Central Powers. Fighting to ...

did his techniques come to be used for injured soldiers on the

battle A battle is an occurrence of combat in warfare between opposing military units of any number or size. A war usually consists of multiple battles. In general, a battle is a military engagement that is well defined in duration, area, and force co ...

field. His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for the construction of the

Manchester Ship Canal The Manchester Ship Canal is a inland waterway in the North West England, North West of England linking Manchester to the Irish Sea. Starting at the River Mersey, Mersey Estuary at Eastham, Merseyside, Eastham, near Ellesmere Port, Cheshire, it ...

in 1888. He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. He had the medical personnel trained in fracture management. He personally managed 3,000 cases and performed 300 operations in his own hospital. This position enabled him to learn new techniques and improve the standard of fracture management. Physicians from around the world came to Jones' clinic to learn his techniques. Along with Alfred Tubby, Jones founded the British Orthopedic Society in 1894. During the First World War, Jones served as a Territorial Army surgeon. He observed that treatment of fractures both, at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. He was appointed Inspector of Military Orthopedics, with responsibility for 30,000 beds. The hospital in Ducane Road,

Hammersmith Hammersmith is a district of West London, England, southwest of Charing Cross. It is the administrative centre of the London Borough of Hammersmith and Fulham, and identified in the London Plan as one of 35 major centres in Greater London. It ...

, became the model for both British and American military orthopedic hospitals. His advocacy of the use of

Thomas splint A traction splint most commonly refers to a splinting device that uses straps attaching over the pelvis or hip as an anchor, a metal rod(s) to mimic normal bone stability and limb length, and a mechanical device to apply traction (used in an at ...

for the initial treatment of femoral fractures reduced mortality of open fractures of the femur from 87% to less than 8% in the period from 1916 to 1918. The use of

intramedullary rod An intramedullary rod, also known as an intramedullary nail (IM nail) or inter-locking nail or Küntscher nail (without proximal or distal fixation), is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat ...

s to treat fractures of the femur and

tibia The tibia (; : tibiae or tibias), also known as the shinbone or shankbone, is the larger, stronger, and anterior (frontal) of the two Leg bones, bones in the leg below the knee in vertebrates (the other being the fibula, behind and to the outsi ...

was pioneered by Gerhard Küntscher of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during

World War II World War II or the Second World War (1 September 1939 – 2 September 1945) was a World war, global conflict between two coalitions: the Allies of World War II, Allies and the Axis powers. World War II by country, Nearly all of the wo ...

and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. Traction was the standard method of treating thigh bone fractures until the late 1970s, though, when the

Harborview Medical Center Harborview Medical Center is a public hospital located in the First Hill neighborhood of Seattle, Washington, United States. It is owned by King County and managed by UW Medicine. Overview Harborview Medical Center is the designated Disast ...

group in Seattle popularized intramedullary fixation without opening up the fracture. Hip replacement Image 3684-PH

The modern total

hip replacement Hip replacement is a surgery, surgical procedure in which the hip joint is replaced by a prosthetic implant (medicine), implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) repl ...

was pioneered by Sir

John Charnley Sir John Charnley, (29 August 1911 – 5 August 1982) was an English Orthopedic surgery, orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the wo ...

, expert in

tribology Tribology is the science and engineering of understanding friction, lubrication and wear phenomena for interacting surfaces in relative Motion (physics), motion. It is highly interdisciplinary, drawing on many academic fields, including physics, c ...

at Wrightington Hospital, in England in the 1960s. He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a

stainless steel Stainless steel, also known as inox, corrosion-resistant steel (CRES), or rustless steel, is an iron-based alloy that contains chromium, making it resistant to rust and corrosion. Stainless steel's resistance to corrosion comes from its chromi ...

, one-piece femoral stem and head, and a

polyethylene Polyethylene or polythene (abbreviated PE; IUPAC name polyethene or poly(methylene)) is the most commonly produced plastic. It is a polymer, primarily used for packaging (plastic bags, plastic films, geomembranes and containers including bott ...

acetabular component, both of which were fixed to the bone using PMMA (acrylic)

bone cement Bone cements have been used very successfully to anchor artificial joints (hip joints, knee joints, shoulder and elbow joints) for more than half a century. Artificial joints (referred to as prostheses) are anchored with bone cement. The bone cem ...

. For over two decades, the Charnley low-friction arthroplasty and its derivative designs were the most-used systems in the world. This formed the basis for all modern hip implants. The

Exeter Exeter ( ) is a City status in the United Kingdom, cathedral city and the county town of Devon in South West England. It is situated on the River Exe, approximately northeast of Plymouth and southwest of Bristol. In Roman Britain, Exeter w ...

hip replacement system (with a slightly different stem geometry) was developed at the same time. Since Charnley, improvements have been continuous in the design and technique of

joint replacement Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pai ...

(arthroplasty) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant. Knee replacements, using similar technology, were started by McIntosh in

rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects synovial joint, joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and h ...

patients and later by Gunston and Marmor for

osteoarthritis Osteoarthritis is a type of degenerative joint disease that results from breakdown of articular cartilage, joint cartilage and underlying bone. A form of arthritis, it is believed to be the fourth leading cause of disability in the world, affect ...

in the 1970s, developed by

John Insall John Nevil Insall (1930–2000) was a pioneering English orthopaedic surgeon who contributed extensively to the advancement of orthopedic surgery and total knee replacement surgery. Insall designed four models of widely used systems, including ...

in New York using a fixed bearing system, and by Frederick Buechel and Michael Pappas using a mobile bearing system. External fixation of fractures was refined by American surgeons during the

Vietnam War The Vietnam War (1 November 1955 – 30 April 1975) was an armed conflict in Vietnam, Laos, and Cambodia fought between North Vietnam (Democratic Republic of Vietnam) and South Vietnam (Republic of Vietnam) and their allies. North Vietnam w ...

, but a major contribution was made by

Gavril Abramovich Ilizarov Gavriil Abramovich Ilizarov (; 15 June 1921 – 24 July 1992) was a Soviet physician, known for inventing the Ilizarov apparatus for lengthening limb bones and for the method of surgery named after him, the Ilizarov surgery. Life and work Iliza ...

in the

USSR The Union of Soviet Socialist Republics. (USSR), commonly known as the Soviet Union, was a List of former transcontinental countries#Since 1700, transcontinental country that spanned much of Eurasia from 1922 until Dissolution of the Soviet ...

. He was sent, without much orthopedic training, to look after injured Russian soldiers in

Siberia Siberia ( ; , ) is an extensive geographical region comprising all of North Asia, from the Ural Mountains in the west to the Pacific Ocean in the east. It has formed a part of the sovereign territory of Russia and its predecessor states ...

in the 1950s. With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures. With the help of the local bicycle shop, he devised ring external fixators tensioned like the spokes of a bicycle. With this equipment, he achieved healing, realignment, and lengthening to a degree unheard of elsewhere. His

Ilizarov apparatus In medicine, the Ilizarov apparatus is a type of external fixation apparatus used in orthopedic surgery to lengthen or to reshape the damaged bones of an arm or a leg; used as a limb-sparing techniques, limb-sparing technique for treating comple ...

is still used today as one of the distraction osteogenesis methods. Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. On the other hand, since the emergence of the opioid epidemic, orthopedic surgeons have been identified as one of the highest prescribers of opioid medications. Decreasing prescription of opioids while still providing adequate pain control is a development in orthopedic surgery.

Training

In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school and earned either a

Doctor of Medicine A Doctor of Medicine (abbreviated MD, from the Latin language, Latin ) is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the ''MD'' denotes a professional degree of ph ...

(MD) or

Doctor of Osteopathic Medicine Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become li ...

(DO) degree. Subsequently, these medical school graduates undergo

residency Residency may refer to: * Artist-in-residence, a program to sponsor the residence and work of visual artists, writers, musicians, etc. * Concert residency, a series of concerts performed at one venue * Domicile (law), the act of establishing or m ...

training in orthopedic surgery. The five-year residency is a categorical orthopedic surgery training. Selection for residency training in orthopedic surgery is very competitive. Roughly 700 physicians complete orthopedic residency training per year in the United States. About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups. Around 20,400 actively practicing orthopedic surgeons and residents are in the United States. According to the latest Occupational Outlook Handbook (2011–2012) published by the

United States Department of Labor The United States Department of Labor (DOL) is one of the executive departments of the U.S. federal government. It is responsible for the administration of federal laws governing occupational safety and health, wage and hour standards, unemp ...

, 3–4% of all practicing physicians are orthopedic surgeons. Many orthopedic surgeons elect to do further training, or fellowships, after completing their residency training. Fellowship training in an orthopedic sub-specialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the United States are: *

Foot and ankle surgery Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of col ...

* Hand and upper extremities * Hip and knee surgery * Orthopedic oncologist * Orthopedic trauma *

Osseointegration Osseointegration (from Latin " bony" and "to make whole") is the direct structural and functional connection between living bone and the surface of a load-bearing artificial implant ("load-bearing" as defined by Albrektsson et al. in 1981). ...

* Pediatric orthopedics * Shoulder and elbow *

Spine Spine or spinal may refer to: Science Biology * Spinal column, also known as the backbone * Dendritic spine, a small membranous protrusion from a neuron's dendrite * Thorns, spines, and prickles, needle-like structures in plants * Spine (zoology), ...

surgery * Surgical sports medicine * Total joint reconstruction (

arthroplasty Arthroplasty (literally " e-orming of joint") is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that ...

) These specialized areas of medicine are not exclusive to orthopedic surgery. For example,

hand surgery Hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity (commonly from the tip of the hand to the shoulder), American Society for Surgery of the Hand. Retriev ...

is practiced by some plastic surgeons, and spine surgery is practiced by most

neurosurgeons Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system including the brain, ...

. Additionally,

foot and ankle surgery Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of col ...

is also practiced by doctors of

podiatric medicine Podiatry ( ), also know as podiatric medicine and surgery ( ), is a branch of medicine devoted to the study, diagnosis, and treatment of disorders of the foot, ankle and lower limb. The healthcare professional is known as a podiatrist. The US ...

(DPM) in the United States. Some

family practice Family medicine is a medical specialty that provides continuing and comprehensive health care for the individual and family across all ages, genders, diseases, and parts of the body. The specialist, who is usually a primary care physician, is ...

physicians practice

sports medicine Sports medicine is a branch of medicine that deals with physical fitness and the treatment and prevention of injuries related to sports and exercise. Although most sports teams have employed team physicians for many years, it is only since the ...

, but their scope of practice is nonoperative. After completion of specialty residency or registrar training, an orthopedic surgeon is then eligible for board certification by the

American Board of Medical Specialties The American Board of Medical Specialties (ABMS) is a non-profit organization established in 1933 which represents 24 broad areas of specialty medicine. ABMS is the largest and most widely recognized physician-led specialty certification organi ...

or the

American Osteopathic Association Bureau of Osteopathic Specialists Established in 1939, the American Osteopathic Association's (AOA) Bureau of Osteopathic Specialists (BOS) is the supervisory body for the AOA's 16 Specialty Certifying Boards in the United States. The BOS establishes and enforces policy for board ...

. Certification by the American Board of Orthopedic Surgery or the

American Osteopathic Board of Orthopedic Surgery The American Osteopathic Board of Orthopedic Surgery (AOBOS) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (DO) and non-osteopathic (MD and equivalent) physicians who specialize in the medical ...

means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board. The process requires successful completion of a standardized written examination followed by an oral examination focused on the surgeon's clinical and surgical performance over a 6-month period. In Canada, the certifying organization is the

Royal College of Physicians and Surgeons of Canada The Royal College of Physicians and Surgeons of Canada () is a regulatory college which acts as a national, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada. The ...

; in Australia and New Zealand, it is the

Royal Australasian College of Surgeons The Royal Australasian College of Surgeons (RACS) is the leading advocate for surgical standards, professionalism and surgical education in Australia and New Zealand. Known by its common acronym RACS, it is a not-for-profit organisation, supp ...

. In the United States, specialists in hand surgery and orthopedic sports medicine may obtain a certificate of added qualifications in addition to their board primary certification by successfully completing a separate standardized examination. No additional certification process exists for the other subspecialties.

Practice

$X ray internal fixation leg fracture$ According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are: # Knee

arthroscopy Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the j ...

and meniscectomy # Shoulder

and decompression #

Carpal tunnel In the human body, the carpal tunnel or carpal canal is a flattened body cavity on the flexor ( palmar/volar) side of the wrist, bounded by the carpal bones and flexor retinaculum. It forms the passageway that transmits the median nerve and the ...

release # Knee

and chondroplasty # Removal of support implant # Knee

and

anterior cruciate ligament reconstruction Anterior cruciate ligament reconstruction (ACL reconstruction) is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from ...

Knee replacement Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. ...

# Repair of femoral neck

# Repair of trochanteric fracture # Debridement of skin/

muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...

bone A bone is a rigid organ that constitutes part of the skeleton in most vertebrate animals. Bones protect the various other organs of the body, produce red and white blood cells, store minerals, provide structure and support for the body, ...

/ fracture # Knee arthroscopy repair of both menisci #

Hip replacement Hip replacement is a surgery, surgical procedure in which the hip joint is replaced by a prosthetic implant (medicine), implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) repl ...

# Shoulder arthroscopy/distal

clavicle The clavicle, collarbone, or keybone is a slender, S-shaped long bone approximately long that serves as a strut between the scapula, shoulder blade and the sternum (breastbone). There are two clavicles, one on each side of the body. The clavic ...

excision # Repair of rotator cuff tendon # Repair fracture of

radius In classical geometry, a radius (: radii or radiuses) of a circle or sphere is any of the line segments from its Centre (geometry), center to its perimeter, and in more modern usage, it is also their length. The radius of a regular polygon is th ...

ulna The ulna or ulnar bone (: ulnae or ulnas) is a long bone in the forearm stretching from the elbow to the wrist. It is on the same side of the forearm as the little finger, running parallel to the Radius (bone), radius, the forearm's other long ...

Laminectomy A laminectomy is a surgical procedure that removes a portion of a vertebra called the Lamina of the vertebral arch, lamina, which is the roof of the spinal canal. It is a major spine operation with residual scar tissue and may result in postla ...

# Repair of ankle fracture (bimalleolar type) # Shoulder arthroscopy and

debridement Debridement is the medical removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. Removal may be surgical, mechanical, chemical, autolytic (self-digestion), or by maggot therapy. In ...

# Lumbar

spinal fusion Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by Orthopedic surgery#Practice, orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine ...

# Repair fracture of the distal part of radius # Low back

intervertebral disc An intervertebral disc (British English), also spelled intervertebral disk (American English), lies between adjacent vertebrae in the vertebral column. Each disc forms a fibrocartilaginous joint (a symphysis), to allow slight movement of the ver ...

surgery # Incise finger tendon sheath # Repair of ankle fracture (

fibula The fibula (: fibulae or fibulas) or calf bone is a leg bone on the lateral side of the tibia, to which it is connected above and below. It is the smaller of the two bones and, in proportion to its length, the most slender of all the long bones. ...

) # Repair of femoral shaft fracture # Repair of trochanteric fracture A typical schedule for a practicing orthopedic surgeon involves 50–55 hours of work per week divided among clinic, surgery, various administrative duties, and possibly teaching and/or research if in an academic setting. According to the American Association of Medical Colleges in 2021, the average work week of an orthopedic surgeon was 57 hours. This is a very low estimation however, as research derived from a 2013 survey of orthopedic surgeons who self identified as "highly successful" due to their prominent positions in the field indicated average work weeks of 70 hours or more.

Arthroscopy

The use of arthroscopic techniques has been particularly important for injured patients.

Arthroscopy Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the j ...

was pioneered in the early 1950s by

Masaki Watanabe Masaki Watanabe (渡辺正毅, 1911 – 15 October 1995) was a Japanese orthopedic surgeon, sometimes called the "founder of modern arthroscopy". Watanabe developed the first practical arthroscope. Watanabe was born in Nagano and graduated ...

of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Arthroscopy allows patients to recover from the surgery in a matter of days, rather than the weeks to months required by conventional, "open" surgery; it is a very popular technique. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and is often combined with meniscectomy or chondroplasty. The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically.

Arthroplasty

Arthroplasty is an orthopedic surgery where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by

osteotomy An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment. It is sometimes performed to correct a hallux valgus, or to straighten a bone that has healed crookedly following a fracture. It i ...

or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis (

rheumasurgery Rheumatology () is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, c ...

) or some other type of trauma. As well as the standard total knee replacement surgery, the unicompartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, may be performed, but it bears a significant risk of revision surgery. Joint replacements are used for other joints, most commonly the

hip In vertebrate anatomy, the hip, or coxaLatin ''coxa'' was used by Celsus in the sense "hip", but by Pliny the Elder in the sense "hip bone" (Diab, p 77) (: ''coxae'') in medical terminology, refers to either an anatomical region or a joint on t ...

shoulder The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder m ...

. A post-surgical concern with joint replacements is wear of the bearing surfaces of components. This can lead to damage to the surrounding bone and contribute to eventual failure of the implant. The plastic chosen is usually ultra-high-molecular-weight

, which can also be altered in ways that may improve wear characteristics. The risk of revision surgery has also been shown to be associated with surgeon volume.

Epidemiology

Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased in the U.S., from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays. In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Spinal fusion was one of the five most common OR procedures performed in every age group except infants younger than 1 year and adults 85 years and older. Laminectomy was common among adults aged 18–84 years. Knee arthroplasty and hip replacement were in the top five OR procedures for adults aged 45 years and older.

References

Quality assurance Accreditation in healthcare Medical tourism

External links

* {{DEFAULTSORT:Orthopedic Surgery Surgical specialties