What Is Orthopaedic Surgery?

Introduction

Orthopaedic surgery (or orthopaedics) is the branch of medicine that deals with the skeletal system. It aims to manage and/or treat physical traumas, injuries, musculoskeletal issues, tumours and other congenital disorders that affect the bones. This may involve orthopaedic surgery, which is used to correct bone deformities and realign broken bones.

The importance of orthopaedic health and medicine

Orthopaedic health concerns the musculoskeletal system and its normal functions. This includes your bones, joints, muscles, and connective tissues, which all have crucial roles in locomotive functions (movement) alongside the nervous system. The symptoms of orthopaedic health conditions often include:

• Limited mobility
• Pain whilst moving
• Inflammation in the joints
• Reduced ability to work

Given the significant impact that orthopaedic conditions can have on your day-to-day life and well-being, it’s important to learn about common orthopaedic conditions and how they can be managed and treated.

The basics of orthopaedics

History

The term orthopaedics was first coined in 1741 by the French surgeon Nicolas Andry de Bois-Regard. The term is formed from the Greek orthos (meaning alignment or straight) and paideia (relating to children). He used to describe procedures used to correct and prevent spinal deformities in children.

The origins of orthopaedic surgery

Orthopaedics is said to have originated in ancient Egypt and spread over time to European countries and, later, to America. Initially, orthopaedics was used to correct bone deformities in children. However, its use later expanded to treating adult patients too. By the 18th century, exercises and splints were being used for deformities treatment in the feet and spine.

Evolution of orthopaedic techniques and practices

One of the first orthopaedic surgery techniques to be developed was the osteotomy, which is used to shorten or increase the length of a bone or to realign it. The Hippocratic Corpus (a collection of ancient medical works) includes some information about the prevalent osteotomy practices at that time. Then, an osteotomy was used to treat new traumatic fractures.

After Hippocrates developed the Hippocratic Scamnum device, bones could be realigned too. From this point until the sixteenth century, bone deformities were treated via deliberate closed fracturing, called ‘osteoclasis’. 

Orthopaedic surgery today

Overview of the musculoskeletal system 

The musculoskeletal system is also called the locomotor system as it responsible for our movement. It is composed of muscles, bones and connective tissue. Our bones provide structural support and makes all our movements possible. Skeletal muscles have a major role in bone and joint movements. Muscles are attached to bones by tendons and receive the nerve and blood supply.

Common orthopaedic conditions

Arthritis

Arthritis causes acute (short-term) or chronic inflammation and swelling in the joints. This may develop due to advancing age, obesity, trauma, autoimmune disorders, or gene mutations. There are several types of arthritis, including:

• Osteoarthritis
• Septic arthritis
• Inflammatory arthritis
• Post-traumatic arthritis

Bone fractures

A bone fracture is a type of bone break. Bones are rigid structures that protect our internal organs and give shape to our body, but they can break under excessive force.

Causes of fracture include:

• Trauma
• Osteoporosis
• Overuse may cause fractures in old age

The role of orthopaedic surgeons

Orthopaedic surgeons treat a wide range of musculoskeletal conditions. These conditions may be present from birth or the result of trauma. If doctors deem non-surgical methods inappropriate for a certain injury, orthopaedic surgeons will examine, diagnose and treat the patient using appropriate surgical methods. 

Types of orthopaedic procedures

Joint replacement surgery

A joint is a point of contact between two bones. Joints are made of bones and connective tissue. A joint is where two or more bones come together, like the knee, hip, ankle and shoulder. They are made of bones and connective tissue and are vital for movement and mobility. 

Pain, swelling or reduced joint mobility is seen in arthritis, trauma, and sports injuries. In cases where joint pain cannot be managed using medication, joint replacements are advised to improve movement. 

Three types of replacement joints are available:

• immovable
• slightly movable
• mobile

Joints can also be classified based on their type of connective tissue, which can be fibrous, cartilaginous, or synovial.

During a joint replacement surgery, the orthopaedic surgeon removes the damaged joint and replaces either part or all of it with an artificial part. Artificial joints can be made of: 

• Metal alloys of steel, cobalt-chromium, or titanium
• Strong plastic
• Ceramic 

Arthroscopy

Arthroscopy is a minimally invasive surgical procedure used to diagnose joint problems or improve a surgeon’s visibility during surgery. It uses an arthroscope - a lens attached to a small tube. During an arthroscopy, a small keyhole incision is made, through which the arthroscope is inserted. Once inserted, the scope can be manoeuvred to examine, diagnose and treat the joint disturbance.

Spinal fusion surgery

Spinal fusion is a surgical procedure used to treat issues with the spinal column and tissues. It is commonly used to correct defects in the small bones of the spine using bone grafts. Various methods of spinal fusion are used to address spinal deformities in patients as required.

Spinal fusion may help relieve symptoms of:

• Degenerative disc disease
• Spondylosis
• Scoliosis
• Fractured vertebra
• Tumours

Musculoskeletal conditions treated with orthopaedic surgery

Arthritis

Arthritis causes inflammation in the joints, for example, the knee or elbow. Arthritis also occurs as a symptom of other existing conditions. There are several types of arthritis.

Osteoarthritis

Osteoarthritis the most common type of arthritis, and is also known as degenerative joint disease or wear and tear arthritis. Risk factors for osteoarthritis include joint injury or overuse, diabetes, old age, or being overweight. It is more common among women than men.

The main symptoms of osteoarthritis are pain, swelling, stiffness, and trouble moving the affected joint. Early diagnosis can help in managing the condition. Management of osteoarthritis includes non-steroidal anti-inflammatory drugs, joint replacement surgery and maintaining a healthy weight.

Rheumatoid arthritis

This is an Autoimmune condition which results in joint inflammation. Thus a combination of genetic and environmental factors are responsible for this condition. Rheumatoid arthritis is a chronic condition and can lead to joint deformities and loss of function over time if not adequately managed.

Fractures

A fracture is a broken bone which may range from a crack to loss of complete continuity of the bone. The treatment of bone fractures depends on whether the fracture is open or closed and the pattern of the break. Break patterns include:

• Stable fracture: The broken ends are barely out of place
• Open (compound) fracture: The skin may be pierced by the bone and the bone may or may not be visible in the wound
• Transverse fracture: This fracture has a horizontal fracture line
• Oblique fracture: Has an angled pattern
• Comminuted fracture: In this type of fracture, the bone shatters into three or more pieces

Depending on the type and severity of the fracture, it may be immobilised to reduce pain and prevent further injury. In severe cases, or where stability cannot be achieved with conservative methods, surgery may be required. Surgical options include inserting pins, screws, plates, or rods to stabilise the fractured bones and promote proper healing.

Soft tissue injuries

Soft tissue structures related to bone are cartilage, synovium, tendon, ligaments and bursa. Types of soft tissue injuries include:

• Bruises or contusions
• Sprain
• Tendonitis
• Stress injuries

Summary of orthopaedic techniques

Non-surgical approaches

The non-surgical treatment approaches in orthopaedics include:

• Physiotherapy 
• Orthotic devices 
• Anti-inflammatory medications and other pharmacological interventions 
• Lifestyle modifications like weight management and daily activity adjustments 

Surgical interventions

• Joint replacement surgery
• Fracture fixation surgeries
• Arthroscopy
• Spinal surgeries

Rehabilitation and recovery

Post-surgical care

Physical therapy

Physical therapy begins soon after the surgery to prevent complications and optimise healing. The primary goal of post-surgical physical therapy is to restore the joint’s range of motion and improve its strength and flexibility. Your surgeon and/or therapist will create a personalised treatment plan for you. 

Rehabilitation programs

Rehabilitation programs can help patients with:

• Pain management
• Strengthening the muscles supporting the affected joint(s)
• Train in daily activities
• Avoiding re-injury

The future of orthopaedic surgery

Robotics in orthopaedics

Robotic-assisted orthopaedic surgeries offer new levels of precision in orthopaedic surgeries used to replace joints, insert screws or pins, and treat bone or soft tissue injuries. They are made possible by combining surgical techniques with robotic engineering.

The robotic systems used in orthopaedic surgery include:

• Open or closed platform
• Active, semi-active, or passive 
• Image-based or imageless

Research and innovations

Digital medicine is the application of machine learning, big data analytics, or artificial intelligence to improve patient outcomes. Orthopaedic digital medicine techniques include clinical computer-aided design, mechanical simulation of musculoskeletal systems, 3D visualisation, finite element technology, surgical navigation and robot-assisted technology, and medical image processing.²

Potential breakthroughs

The recent innovations and ongoing research in orthopaedics focus on delivering customised support to the patient.

This includes:

• Biologics and regenerative medicine
• Robotics and navigation
• Nanotechnology
• 3D printing
• Virtual reality (VR) and augmented reality (AR)
• Smart implants and wearables

Summary

This article provides a concise overview of orthopaedic surgery, which focuses on the musculoskeletal system and its various components. This article also provided insights into the diverse range of conditions that can be treated with orthopaedic surgery, and how treatments such as joint replacements and fracture fixations, can help restore joint function and alleviate patients’ pain.