Orthopedic surgery or orthopedics is a branch of surgery that deals with disorders and conditions involving the musculoskeletal system. Orthopedic surgeons use surgical and non-surgical methods to treat musculoskeletal trauma, spinal diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos (“correct”, “straight”) and παιδίον paidion (“child”), and published Orthopedie (translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children) in 1741. 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.
Many developments in orthopedic surgery have resulted from experiences during wartime. On the battlefields of the Middle Ages, the injured were treated with bandages soaked in horses’ blood, which dried to form a stiff, if unsanitary, splint.
Jean-André Venel 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’s research on tendon healing and Percival Pott’s work on spinal deformity steadily increased the range of new methods available for effective treatment. Antonius Mathijsen, a Dutch military surgeon, invented the plaster of Paris cast 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.
Hugh Owen Thomas, a pioneer of modern orthopedic surgery
Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, 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 fractures and tuberculosis, 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 manoeuvre, 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 an osteoclast to break and reset bones.
The use of intramedullary rods to treat fractures of the femur and tibia 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 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 group in Seattle popularized intramedullary fixation without opening up the fracture.
External fixation of fractures was refined by American surgeons during the Vietnam War, but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia 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 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.
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.
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.
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.
Stem cell therapy is successfully used for large orthopedic procedures in terms of injuries of bone and joint fractures (bone fractures, damage to cartilage structures), osteoarthritis-damage to cartilage, injuries of ligaments and tendons, osteonecrosis of the femoral head… Stem cells are also used in bone regeneration and to ensure faster and better tissue healing.
Multiple preclinical stem cell studies have been performed and there is a growing interest in implementing this method of treatment.
Orthopedic subspecialization may include the following areas:
Orthopedists use surgical and rehabilitative health care methods related to the musculoskeletal system. Orthopedic doctors treat a wide variety of conditions, including but not limited to the following: bone fractures, muscle strains, joint or back pain, arthritis, carpal tunnel syndrome, injuries to tendons or ligaments, such as sprains, tendonitis, and ACL tears, limb abnormalities, such as clubfoot and bowlegs, bone cancer
In general, orthopedists are skilled in:
The orthopedist also works closely with other health professionals and often serves as an advisor to other physicians.
Injuries to the musculoskeletal system (bones, joints, muscles, ligaments, tendons) or conditions such as arthritis, osteoporosis take first place in visits to doctor’s offices.
The number of people who suffer from musculoskeletal injuries per year is 28.6 million – which is more than half of all injuries in one year.
Musculoskeletal disorders and injuries account for 137.6 million visits to physicians and hospital outpatient and emergency departments each year.
Doctors perform approximately 7.5 million musculoskeletal procedures each year.
Arthritis is the leading chronic condition of our body.
Back or spine injuries are the most common musculoskeletal injuries.
Sprains and fractures account for almost half of all musculoskeletal injuries.
More than 15.3 million visits to doctor’s offices were due to back problems in 1999. –
More than 10.1 million visits to doctor’s offices were due to knee problems in 1999. The knee is the anatomical site most commonly treated by orthopedic surgeons.
More than 5.9 million visits to doctor’s offices were due to shoulder problems in 1999. –
More than 5.3 million doctor visits were due to foot and ankle problems in 1999. year.
More than 2.4 million visits to doctors in office practice in 1999. was due to carpal tunnel syndrome. Of those visits, more than a million were performed by orthopedic surgeons.