Orthopedic (sometimes spelled orthopedic) surgery is an operation performed by a medical specialist such as an orthopedist or orthopedic surgeon, who is trained to assess and treat problems that develop in the bones, joints, and ligaments of the human body.
Orthopedic surgery addresses and attempts to correct problems that arise in the skeleton and its attachments, the ligaments and tendons. It may also include some problems of the nervous system, such as those that arise from injury of the spine. These problems can occur at birth, through injury, or as the result of aging. They may be acute, as in an accident or injury, or chronic, as in many problems related to aging.
Orthopedics comes from two Greek words, ortho , meaning straight, and pais , meaning child. Originally, orthopedic surgeons treated skeletal deformities in children, using braces to straighten the child's bones. With the development of anesthesia and an understanding of the importance of aseptic technique in surgery, orthopedic surgeons extended their role to include surgery involving the bones and related nerves and connective tissue.
The terms orthopedic surgeon and orthopedist are used interchangeably today to indicate a medical doctor with special training and certification in orthopedics.
Many orthopedic surgeons maintain a general practice, while some specialize in one particular aspect of orthopedics such as hand surgery , joint replacements, or disorders of the spine. Orthopedists treat both acute and chronic disorders. Some orthopedic surgeons specialize in trauma medicine and can be found in emergency rooms and trauma centers, treating injuries. Others find their work overlapping with plastic surgeons, geriatric specialists, pediatricians, or podiatrists (foot care specialists). A rapidly growing area of orthopedics is sports medicine, and many sports medicine doctors are board certified in orthopedic surgery.
The American Academy of Orthopedic Surgeons reports that in 2003, there are 15,853 active fellows, 1,829 resident members, and 2,240 candidate members, for a total of 19,922 orthopedic surgeons in the United States.
The range of treatments provided by orthopedists is extensive. They include procedures such as traction , amputation , hand reconstruction, spinal fusion , and joint replacements. They also treat strains and sprains, broken bones, and dislocations. Some specific procedures performed by orthopedic surgeons are listed as separate entries in this book, including arthroplasty , arthroscopic surgery , bone grafting , fasciotomy , fracture repair , kneecap removal , and traction.
In general, orthopedists are employed by hospitals, medical centers, trauma centers, or free-standing surgical centers where they work closely with a surgical team , including an anesthesiologist and surgical nurse. Orthopedic surgery can be performed under general, regional, or local anesthesia.
Much of the work of an orthopedic surgeon involves adding foreign material to the body in the form of screws, wires, pins, tongs, and prosthetics to hold damaged bones in their proper alignment or to replace damaged bone or connective tissue. Great improvements have been made in the development of artificial limbs and joints, and in the materials available to repair damage to bones and connective tissue. As developments occur in the fields of metallurgy and plastics, changes will take place in orthopedic surgery that will allow surgeons to more nearly duplicate the natural functions of bones, joints, and ligaments, and to more accurately restore damaged parts to their original ranges of motion.
Persons are usually referred to an orthopedic surgeon by a primary care physician, emergency room physician, or other doctor. Prior to any surgery, candidates undergo extensive testing to determine appropriate corrective procedures. Tests may include x rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), myelograms, diagnostic arthroplasty, and blood tests. The orthopedist will determine the history of the disorder and any treatments that were previously tried. A period of rest to the injured part may be recommended before surgery is undertaken.
Surgical candidates undergo standard blood and urine tests before surgery and, for major procedures, may be given an electrocardiogram or other diagnostic tests prior to the operation. Individuals may choose to donate some of their own blood to be held in reserve for their use in major surgery such as knee replacement , during which heavy bleeding is common.
Rehabilitation from orthopedic injuries can require long periods of time. Rehabilitation is usually physically and mentally taxing. Orthopedic surgeons will work closely with physical therapists to ensure that patients receive treatment that will enhance the range of motion and return function to all affected body parts.
As with any surgery, there is always the risk of excessive bleeding, infection, and allergic reaction to anesthesia. Risks specifically associated with orthopedic surgery include inflammation at the site where foreign materials (pins, prostheses, or wires) are introduced into the body, infection as the result of surgery, and damage to nerves or to the spinal cord.
Thousands of people have successful orthopedic surgery each year to recover from injuries or to restore lost function. The degree of success in individual recoveries depends on an individual's age and general health, the medical problem being treated, and a person's willingness to comply with rehabilitative therapy after the surgery.
Abnormal results from orthopedic surgery include persistent pain, swelling, redness, drainage or bleeding in the surgical area, surgical wound infection resulting in slow healing, and incomplete restoration of pre-surgical function.
Morbidity and mortality rates
Mortality from orthopedic surgical procedures is not common. The most common causes for mortality are adverse reactions to anesthetic agents or drugs used to control pain, post-surgical clot formation in the veins, and post-surgical heart attacks or strokes.
For the removal of diseased, non-functional, or non-vital tissue, there is no alternative to orthopedic surgery. Alternatives to orthopedic surgery depend on the condition being treated. Medications, acupuncture, or hypnosis are used to relieve pain. Radiation is an occasional alternative for shrinking growths. Chemotherapy may be used to treat bone cancer. Some foreign bodies may remain in the body without harm.
Bland, K. I., W. G. Cioffi, and M. G. Sarr. Practice of General Surgery. Philadelphia: Saunders, 2001.
Canale, S. T. Campbell's Operative Orthopedics. St. Louis: Mosby, 2003.
Schwartz, S. I., J. E. Fischer, F. C. Spencer, G. T. Shires, and J. M. Daly. Principles of Surgery, 7th Edition. New York: McGraw Hill, 1998.
Townsend, C., K. L. Mattox, R. D. Beauchamp, B. M. Evers, and D. C. Sabiston. Sabiston's Review of Surgery, 3rd Edition. Philadelphia: Saunders, 2001.
Caprini, J. A., J. I. Arcelus, D. Maksimovic, C. J. Glase, J. G. Sarayba, and K. Hathaway. "Thrombosis Prophylaxis in Orthopedic Surgery: Current Clinical Considerations." Journal of the Southern Orthopedic Association 11, no.4 (2002): 190–196.
O'Brien, J. G. "Orthopedic Surgery: A New Frontier." Mayo Clinic Proceedings 78, no.3 (2003): 275–277.
Ribbans, W. J. "Orthopedic Care in Haemophilia." Hospital Medicine 64, no.2 (2003): 68–69.
Showstack, J. "Improving Quality of Care in Orthopedic Surgery." Arthritis and Rheumatism 48, no.2 (2003): 289–290.
American Academy of Orthopedic Surgeons. 6300 North River Road Rosemont, IL 60018-4262. (847) 823-7186 or (800) 346-2267. http://www.aaos.org/wordhtml/home2.htm .
American College of Sports Medicine. 401 West Michigan Street, Indianapolis, IN 46202-3233 (Mailing Address: P.O. Box 1440, Indianapolis, IN 46206-1440). (317) 637-9200, Fax: (317) 634-7817. http://www.acsm.org .
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL 60611. (312) 202-5000. http://www.facs.org/ .
American Society for Bone and Mineral Research 2025 M Street, NW, Suite 800, Washington, DC 20036-3309. (202) 367-1161. http://www.asbmr.org/ .
Orthopedic Trauma Association. 6300 N. River Road, Suite 727, Rosemont, IL 60018-4226. (847) 698-1631. http://www.ota.org/links.htm .
American Osteopathic Association. [cited April 7, 2003] http://www.aoa-net.org/Certification/orthopedsurg.htm .
Brigham and Woman's Hospital (Harvard University School of Medicine). [cited April 7, 2003] <http://splweb.bwh.harvard.edu:8000/pages/projects/ortho/ortho.ht l> .
Martindale's Health Science Guide, 2003. [cited April 7, 2003] http://www-sci.lib.uci.edu/HSG/MedicalSurgery.html .
Thomas Jefferson University Hospital. [cited April 7, 2003] http://www.jeffersonhospital.org/e3front.dll?durki=4529 .
University of Maryland College of Medicine. [cited April 7, 2003] http://www.umm.edu/surg-ortho/ .
L. Fleming Fallon, Jr, MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Orthopedic surgery is performed by a physician with specialized training in orthopedic surgery. It is most commonly performed in operating room of a hospital. Very minor procedures such as setting a broken bone may be performed in a professional office or an emergency room of a hospital.
QUESTIONS TO ASK THE DOCTOR
- What tests will be performed prior to surgery?
- How will the procedure affect daily activities after recovery?
- Where will the surgery be performed?
- What form of anesthesia will be used?
- What will be the resulting appearance and level of function after surgery?
- Is the surgeon board certified by the American Academy of Orthopedic Surgeons?
- How many similar procedures has the surgeon performed?
- What is the surgeon's complication rate?