Orthopedic surgery

Orthopaedic surgery or orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system

Orthopaedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders

orthopedic surgeons have typically complet four years of undergraduate education and four years of medical school and earned either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. Subsequently, these medical school graduates undergo residency 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 3 to 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 are:

-Hand and upper extremity

-Shoulder and elbow

-Total joint reconstruction (arthroplasty)

-Pediatric orthopedics

-Foot and ankle surgery

-Spine surgery

-Orthopedic oncologist

-Surgical sports medicine

-Orthopedic trauma

-Hip and Knee surgery

-Osseointegration

These specialised areas of medicine are not exclusive to orthopedic surgery. For example, hand surgery is practiced by some plastic surgeons, and spine surgery is practiced by most neurosurgeons. Additionally, some aspects of foot and ankle surgery are also practiced by board-certified doctors of podiatric medicine (DPM). Some family practice physicians practice sports medicine, but their scope of practice is nonoperative.

After completion of specialty residency/registrar training, an orthopedic surgeon is then eligible for board certification by the Medical Specialties or the Osteopathic Association Bureau of Osteopathic Specialists. Certification by the Board of Orthopaedic Surgery or the Osteopathic Board of Orthopedic Surgery 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.

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.

Arthroscopy

The use of arthroscopic techniques has been particularly important for injured patients. Arthroscopy was pioneered in the early 1950s by Dr. Masaki Watanabe 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 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) or some other type of trauma. As well as the standard total knee replacement surgery, the uni-compartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, is a popular alternative

Joint replacements are available for other joints on a variable basis, most notably the hip, shoulder, elbow, wrist, ankle, spine, and finger joints.

In recent years, surface replacement of joints, in particular the hip joint, has become more popular amongst younger and more active patients. This type of operation delays the need for the more traditional and less bone-conserving total hip replacement, but carries significant risks of early failure from fracture and bone death.

One of the main problems 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 use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic chosen is usually ultra-high-molecular-weight polyethylene, which can also be altered in ways that may improve wear characteristics

Epidemiology

Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays

In a study of hospitalizations 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.