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Orthopedic surgery
A fracture of the lower cervical vertebrae, one of the conditions treated by orthopedic surgeons and neurosurgeons
MeSHD019637
Orthopedic surgeon
Orthopaedic surgeons performing open reduction and internal fixation (ORIF) of a femural shaft structure
Occupation
Names
Occupation type
Specialty
Activity sectors
Medicine, Surgery
Description
Education required
Fields of
employment
Hospitals, Clinics

Orthopedic surgery or orthopedics (alternative spelling orthopaedics) is the branch of surgery concerned with conditions involving the musculoskeletal system.[1] Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors and congenital disorders.

Etymology

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Further information: International scientific vocabulary and List of Greek morphemes used in English

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[2]) in 1741. The word was assimilated into English as orthopædics; the ligature 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.[citation needed]

Differences in spelling

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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, 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".[citation needed]

History

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Early orthopedics

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Many developments in orthopedic surgery have resulted from experiences during wartime.[3] 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.[citation needed]

Originally, the term orthopedics meant the correcting of musculoskeletal deformities in children.[4] Nicolas Andry, a professor of medicine at the University of Paris, 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.[5]

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.[citation needed]

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. Robert Chessher, a pioneering British orthopedist, invented the double-inclined plane, used to treat lower-body bone fractures, in 1790.[6] 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.[citation needed]

Modern orthopedics

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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.[7] 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 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.[citation needed]

Thomas's work was not fully appreciated in his own lifetime. Only during the First World War did his techniques come to be used for injured soldiers on the battlefield. 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 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.[8] 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, became the model for both British and American military orthopedic hospitals. His advocacy of the use of Thomas splint 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.[9]

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.

X-ray of a hip replacement

The modern total hip replacement was pioneered by Sir John Charnley, expert in tribology at Wrightington Hospital, in England in the 1960s.[10] He found that joint surfaces could be replaced by implants cemented to the bone. His design consisted of a stainless steel, one-piece femoral stem and head, and a polyethylene acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement. 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 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 (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 patients and later by Gunston and Marmor for osteoarthritis in the 1970s, developed by John Insall in New York using a fixed bearing system, and by Frederick Buechel and Michael Pappas using a mobile bearing system.[11]

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.[12]

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.[13][14] Decreasing prescription of opioids while still providing adequate pain control is a development in orthopedic surgery.[14][15][16]

Training

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This image, taken in September 2006, shows extensive repair work to the right acetabulum six years after it was carried out (2000). The onset of arthritis, a bone/joint disease, has made further joint damage visible.

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 (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 and residents are in the United States.[17] According to the latest Occupational Outlook Handbook (2011–2012) published by the United States Department of Labor, 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:

These specialized 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, foot and ankle surgery is also practiced by doctors of podiatric medicine (DPM) in the United States. Some family practice physicians practice sports medicine, 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 or the American Osteopathic Association Bureau of Osteopathic Specialists. Certification by the American Board of Orthopedic Surgery or the American Osteopathic Board of Orthopedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board.[18][19] 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; in Australia and New Zealand, it is the Royal Australasian College of Surgeons.

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

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Radiography to identify eventual bone fractures after a knee injury
Orthopedic implants to repair fractures to the radius and ulna. Note the visible break in the ulna. (right forearm)
Anterior and lateral view x-rays of fractured left leg with internal fixation after surgery

According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are:[20]

  1. Knee arthroscopy and meniscectomy
  2. Shoulder arthroscopy and decompression
  3. Carpal tunnel release
  4. Knee arthroscopy and chondroplasty
  5. Removal of support implant
  6. Knee arthroscopy and anterior cruciate ligament reconstruction
  7. Knee replacement
  8. Repair of femoral neck fracture
  9. Repair of trochanteric fracture
  10. Debridement of skin/muscle/bone/ fracture
  11. Knee arthroscopy repair of both menisci
  12. Hip replacement
  13. Shoulder arthroscopy/distal clavicle excision
  14. Repair of rotator cuff tendon
  15. Repair fracture of radius/ulna
  16. Laminectomy
  17. Repair of ankle fracture (bimalleolar type)
  18. Shoulder arthroscopy and debridement
  19. Lumbar spinal fusion
  20. Repair fracture of the distal part of radius
  21. Low back intervertebral disc surgery
  22. Incise finger tendon sheath
  23. Repair of ankle fracture (fibula)
  24. Repair of femoral shaft fracture
  25. 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.[21][22] 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.[23][21]

Arthroscopy

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Main article: Arthroscopy

The use of arthroscopic techniques has been particularly important for injured patients. Arthroscopy was pioneered in the early 1950s by 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.[24]

Arthroplasty

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Main article: 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.[25] 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.[25] 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,[25] but it bears a significant risk of revision surgery.[26] Joint replacements are used for other joints, most commonly the hip[27] or shoulder.[28]

A post-surgical concern with joint replacements is wear of the bearing surfaces of components.[29] This can lead to damage to the surrounding bone and contribute to eventual failure of the implant.[29] The plastic chosen is usually ultra-high-molecular-weight polyethylene, which can also be altered in ways that may improve wear characteristics.[29] The risk of revision surgery has also been shown to be associated with surgeon volume.[28][30]

Epidemiology

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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.[31]

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.[32]

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Orthopedic surgery

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from Grokipedia
Orthopedic surgery is a surgical specialty dedicated to the prevention, , and treatment of injuries and diseases affecting the musculoskeletal , encompassing bones, joints, ligaments, tendons, muscles, and associated . This field addresses a wide range of conditions, from acute traumas like fractures and dislocations to chronic disorders such as , , and congenital deformities, often employing both nonsurgical and surgical interventions to restore function and alleviate pain. The term "orthopedics" originated from the Greek words orthos (straight) and pais (child), coined in 1741 by French physician Nicolas Andry in his book Orthopaedia, which emphasized correcting musculoskeletal deformities in children through mechanical devices and exercises. Orthopedic surgeons often specialize in subspecialties addressing specific anatomical regions or patient populations, such as adult reconstruction, pediatric orthopedics, , trauma, spine surgery, and hand or foot/ankle procedures. Common procedures include for joint visualization and repair, with approximately 2.15 million hip and procedures performed annually as of 2023 to manage degenerative diseases. These interventions are typically preceded by conservative treatments like or bracing, emphasizing multidisciplinary care involving nurses, therapists, and rehabilitation specialists. Training for orthopedic surgeons is rigorous and leads to , equipping them to lead healthcare teams in preventing complications such as infections (typically 1-2% in procedures) and failures (2-5%), while advancing research in and personalized treatments. As the population ages and activity levels rise, orthopedic surgery continues to play a pivotal role in improving mobility and worldwide.

Etymology and Terminology

Origin of the Term

The term "orthopedic surgery" traces its origins to the French physician Nicolas Andry de Bois-Regard, who coined the word "orthopédie" in 1741 as a neologism derived from the Greek roots "orthos," meaning "straight" or "correct," and "pais" (or "paidos"), meaning "child." This etymology reflected Andry's intent to describe the prevention and correction of deformities in children, emphasizing non-invasive methods such as exercise, manipulation, and splinting rather than surgical interventions. Andry, a professor at the University of Paris, introduced the term in his seminal two-volume book L’orthopédie ou l’art de prévenir et de corriger dans les enfants les difformités du corps, published in Paris, which was later translated into English as Orthopaedia in 1743. The book targeted parents, educators, and physicians, advocating for early intervention to address musculoskeletal issues like spinal curvatures, , and limb asymmetries in , using practical illustrations such as the famous of a crooked being straightened by a stake—a still associated with the field. Andry's work marked the first dedicated treatise on the subject, shifting focus from mere treatment to proactive prevention of deformities through , posture, and mechanical supports tailored to growing bodies. Over the 19th and 20th centuries, the scope of orthopedics expanded beyond its pediatric origins to encompass adult musculoskeletal conditions, driven by advancements like , aseptic techniques, and , which enabled surgical treatments for fractures, , and trauma in broader populations. This evolution was accelerated by wartime demands and industrial injuries, transforming orthopedics into a comprehensive surgical specialty addressing all ages.

Spelling Variations

The spelling of the term for this exhibits regional variations, primarily between and British/ English. In , "orthopedic" is the predominant form, reflecting a simplification of spelling conventions, while "orthopaedic" is standard in British English, , and other variants, preserving the original from its linguistic roots. Both spellings are widely accepted in international medical contexts and denote the identical branch of focused on the musculoskeletal system. These differences trace back to the term's etymological origins in Greek words "" (straight) and "pais" (child), coined by French physician Nicolas Andry in 1741 as "orthopédie" in his on correcting children's deformities. Upon adoption into English in the and further entrenchment in 19th-century medical texts, such as those by Jean-André Venel and later European and American surgeons, the British tradition retained the "ae" to honor the classical Greek and Latin influences, whereas underwent simplifications influenced by broader orthographic reforms, replacing "ae" with "e" for phonetic ease. Professional bodies illustrate these preferences while bridging the divide. Notably, the American Academy of Orthopaedic Surgeons (AAOS), founded in , deliberately uses "orthopaedic" in its name to align with historical and academic traditions, despite the prevalence of "orthopedic" in everyday U.S. usage. Similarly, the British Orthopaedic Association employs "orthopaedic," reinforcing the spelling's role in formal and institutional .

History

Early Developments

Orthopedic practices trace their origins to ancient civilizations, where basic techniques for managing fractures and deformities were developed. In ancient Egypt, around 2500 BCE, physicians employed wooden splints crafted from bark, wrapped in linen and grass, to immobilize broken limbs, as evidenced by archaeological findings of mummified remains with healed fractures and descriptions in the Edwin Smith Surgical Papyrus from circa 1600 BCE. The Greeks advanced these methods significantly; Hippocrates (c. 460–370 BCE) detailed systematic approaches to fracture reduction, including the use of traction devices with ropes and wooden splints to restore limb alignment, particularly for femoral and humeral injuries, often incorporating grease and lint for comfort. Romans built upon this knowledge by the 1st century CE, stiffening bandages with starch or gum for enhanced support in treating dislocations and fractures, while also documenting early prosthetic devices. The 18th and 19th centuries marked pivotal milestones in orthopedic understanding and treatment, shifting toward more precise diagnoses and conservative interventions. In 1779, British surgeon provided the first detailed clinical description of spinal , termed , which causes vertebral collapse leading to kyphotic deformity and potential due to cord compression; his observations emphasized the infectious nature and progressive neurological impacts. By the 1870s, Welsh surgeon , often regarded as the father of modern British orthopedics, revolutionized fracture management through his advocacy for prolonged immobilization and rest; he introduced the Thomas splint for applying continuous traction to lower limb injuries and routinely encased limbs in plaster of Paris for rigid support, enabling better healing outcomes in cases of and trauma. The formalization of orthopedics as a specialty was supported by the establishment of dedicated institutions in the late 18th and early 19th centuries. In 1780, Jean-André Venel founded the first orthopedic institute in Orbe, , focused on treating children's skeletal deformities through mechanical corrections and exercises. In , the Royal Orthopaedic Hospital opened in 1838 at 315 , initially as an infirmary for curing and spinal curvatures, providing specialized care for deformities previously managed in general hospitals; it represented a key step in institutionalizing orthopedic treatment in Britain.

Modern Advancements

The 20th century marked a transformative era for orthopedic surgery, profoundly influenced by the exigencies of and , which accelerated innovations in fracture management to address the high volume of battlefield injuries. During , surgeons faced unprecedented numbers of compound s, prompting advancements in internal fixation techniques to stabilize bones more effectively than traditional casting or external splints. Belgian surgeon Albin Lambotte pioneered modern osteosynthesis—the internal fixation of s using plates, screws, and wires—in the early 1900s, with his seminal 1909 publication introducing the term and detailing practical applications that emphasized anatomical reduction and rigid stabilization. Lambotte's methods, refined through wartime experience, laid the groundwork for systematic internal fixation, reducing infection rates and improving recovery times for soldiers. further catalyzed progress, as German forces encountered massive femoral s from high-velocity weapons; in response, Gerhard Küntscher developed the intramedullary nail in 1940, a hollow stainless-steel rod inserted into the cavity to provide axial stability without extensive soft-tissue disruption. This technique, first applied to prisoners of war and later disseminated to Allied surgeons via repatriated patients, revolutionized long-bone treatment by enabling early mobilization and minimizing complications like . In 1958, the AO Foundation was established in by Maurice E. Müller and colleagues, promoting standardized principles of internal fixation that further advanced surgical techniques and global training in orthopedics. Post-1950s milestones built on these wartime foundations, introducing procedures that expanded orthopedic surgery's scope from trauma to elective reconstruction. In 1962, British surgeon performed the first successful total hip arthroplasty at Wrightington Hospital, utilizing a low-friction design with a metal articulating against a high-density polyethylene acetabular cup, coupled with acrylic for fixation. This innovation dramatically alleviated pain and restored mobility for patients with severe , achieving over 90% survivorship at 10 years in early cohorts. Concurrently, in the 1960s, Japanese surgeon Masaki Watanabe advanced by developing fiberoptic instruments that allowed visualization and minimally invasive interventions within joints, such as the knee, without large incisions. Watanabe's refinements, including cold light illumination and precision tools, enabled procedures like meniscectomy with reduced recovery times and lower infection risks, transforming diagnostic and therapeutic approaches to intra-articular pathologies. By the late , orthopedic surgery had diversified into specialized subspecialties, reflecting the field's maturation and the growing complexity of musculoskeletal disorders. emerged as a distinct domain in the , driven by the need to address athletic injuries; the American Orthopaedic Society for Sports Medicine (AOSSM), founded in 1972, formalized training and research in ligament reconstruction, cartilage repair, and shoulder instability management, integrating and rehabilitation. Similarly, orthopedic oncology gained recognition in the late , focusing on limb-salvage techniques for and soft-tissue tumors; the Musculoskeletal Tumor Society (MSTS), established in 1977, promoted multidisciplinary collaboration with , advancing resection-reconstruction strategies that preserved function in over 80% of extremity cases by the 1990s. These subspecialties not only refined surgical precision but also emphasized evidence-based outcomes, solidifying orthopedics as a dynamic, patient-centered .

Education and Training

Residency Requirements

Orthopedic surgery is a medical specialty trained through residency programs after earning an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) degree from an accredited medical school; there is no distinct "orthopedic MD school." In the United States and , orthopedic surgery residency follows a standardized five-year postgraduate program following completion of , designed to develop comprehensive surgical expertise in musculoskeletal disorders. In the U.S., the Accreditation Council for Graduate Medical Education (ACGME) mandates a 60-month , with the first year (PGY-1) requiring six months of orthopedic rotations and six months of non-orthopedic experiences, such as or critical care, to build foundational skills. Subsequent years (PGY-2 through PGY-5) emphasize at least 36 months on orthopedic services, including mandatory rotations in trauma, spine , pediatric orthopedics, joint reconstruction, hand and foot , , orthopedic , and rehabilitation, with progressive resident responsibility culminating in independent management during the final 24 months at a single institution. Similarly, in , the Royal College of Physicians and Surgeons of Canada (RCPSC) oversees a five-year residency, incorporating 26 blocks of foundational junior followed by advanced orthopedic rotations in areas like trauma, spine, and pediatrics to ensure broad competency. Residency programs prioritize key ACGME core competencies, including patient care through hands-on surgical skills such as fixation and arthroscopic procedures, medical knowledge encompassing detailed , , and of musculoskeletal conditions, and systems-based practice for effective patient management in multidisciplinary settings. Residents advance through milestones that track progression from supervised basic interventions—like wound closure and simple care in early levels—to independent performance of complex surgeries, such as spinal fusions or pediatric reconstructions, by graduation, with an emphasis on evidence-based decision-making, professionalism, and quality improvement. All U.S. programs must be ACGME-accredited, ensuring compliance with duty-hour limits (e.g., 80 hours per week averaged over four weeks) and incorporation of didactic sessions—at least four hours weekly—covering , , and , with residents logging 1,000 to 3,000 procedures by program end. Admission to orthopedic surgery residency is highly competitive, particularly in the U.S., where the 2024 National Resident Matching Program (NRMP) Main Residency Match offered 916 positions but attracted 1,492 applicants, resulting in a 99.9% fill rate and match success rates of 79.3% for U.S. MD seniors but only 45.7% for U.S. DO seniors. In the 2025 match, positions increased to 929 with a 100% fill rate. Successful applicants typically demonstrate strong academic performance, including passing performance on the (pass/fail since 2022) and high Step 2 CK scores averaging above the national mean, alongside research experience and letters of recommendation highlighting surgical aptitude. In Canada, the Canadian Resident Matching Service (CaRMS) similarly reflects intense competition, with applicants selected based on medical school performance, interviews, and extracurricular involvement in orthopedics.

Subspecialty Fellowships

After completing an orthopedic surgery residency, which provides foundational rotations across various subspecialties, many surgeons pursue fellowship training to gain expertise in a specific area. These programs typically last one year and are accredited by the Accreditation Council for Graduate Medical Education (ACGME) in the United States. Common fellowships include orthopedic sports medicine, which focuses on treating athletic injuries through arthroscopic and rehabilitative techniques; hand surgery, emphasizing upper extremity disorders; spine surgery, addressing deformities and degenerative conditions; pediatric orthopedics, managing musculoskeletal issues in children; adult joint reconstruction, involving hip and knee replacements for degenerative diseases; and hip preservation and hip arthroscopy, which focus on diagnosing and treating conditions such as femoroacetabular impingement, labral tears, and hip flexor strains, often using keyhole (arthroscopic) surgery. Over 90% of graduating orthopedic residents now pursue such fellowships, reflecting a trend toward increased specialization amid rising demand for focused expertise. This high participation rate has grown steadily, with match rates exceeding 90% annually across subspecialties. Fellowships often integrate clinical practice with , requiring fellows to contribute to scholarly projects, which enhances career opportunities in academic or high-volume settings. Certification in certain subspecialties is available through the American Board of Orthopaedic Surgery (ABOS), which offers subspecialty certificates in orthopaedic and of the hand following completion of an ACGME-accredited fellowship, submission of case logs, and passage of an additional examination. For other areas like pediatric orthopedics and joint reconstruction, while ABOS primary certification is required, subspecialty recognition often comes via society-specific credentials, such as those from the Pediatric Orthopaedic Society of North America or the American Association of Hip and Knee Surgeons, typically after fellowship training. Globally, fellowship structures vary; in , programs are often shorter, ranging from 6 to 12 months, and may emphasize clinical immersion over dedicated research components, contrasting with the U.S. model's standard one-year duration and research integration. For instance, fellowships in the , such as those at Orthopaedics, commonly offer six-month or one-year options for senior trainees to refine skills in trauma or .

Scope of Practice

Conditions Treated

Orthopedic surgery addresses a wide range of musculoskeletal disorders, primarily categorized into degenerative, traumatic, congenital, and neoplastic conditions. These disorders affect bones, joints, ligaments, tendons, muscles, and associated structures, often requiring surgical intervention when conservative measures fail. Degenerative conditions involve the progressive deterioration of musculoskeletal tissues, most commonly osteoarthritis, which causes cartilage breakdown in joints leading to pain, stiffness, and reduced mobility. Rheumatoid arthritis, an autoimmune disorder, also falls under this category, resulting in chronic joint inflammation, synovial proliferation, and potential joint destruction, particularly affecting the hands, wrists, and feet. Traumatic conditions arise from injuries such as fractures, which are breaks in bones often caused by high-impact events like falls or accidents, and dislocations, where bones are forced out of their normal positions, commonly in the or . These injuries can lead to immediate , swelling, and functional impairment, with fractures classified by type (e.g., open or closed) based on involvement. Hip flexor strains, which involve overstretching or tearing of the muscles that flex the hip, represent another common traumatic condition, often resulting from sudden movements in sports or activities. Additionally, conditions like femoroacetabular impingement (FAI), a developmental abnormality causing abnormal contact between the femoral head and acetabulum, and associated labral tears in the hip joint, frequently arise from or lead to traumatic episodes and are treated by orthopaedic surgeons specializing in hip preservation, hip arthroscopy, or sports-related hip conditions; these specialists diagnose and treat such issues, often using keyhole surgery (arthroscopy). Congenital conditions are present at birth due to developmental anomalies, including (talipes equinovarus), a deformity where the foot is twisted inward and downward, affecting approximately 1 in 1,000 newborns and potentially limiting mobility if untreated. Spinal deformities like , characterized by an abnormal lateral curvature of the spine greater than 10 degrees, represent another key example, often idiopathic in adolescents and leading to uneven posture and . Neoplastic conditions encompass tumors, which can be benign (e.g., osteochondromas) or malignant (e.g., osteosarcomas), originating from or cells and potentially causing , swelling, or pathological fractures depending on their growth rate and location. These tumors require careful to determine surgical resectability. Diagnosis of these conditions typically begins with a thorough , including assessment of , stability, tenderness, and , tailored to orthopedic evaluation. Imaging modalities such as X-rays for initial alignment and detection, MRI for and visualization, and CT scans for detailed three-dimensional structure analysis are essential for confirming diagnoses and planning interventions.

Nonsurgical Interventions

Nonsurgical interventions form the cornerstone of orthopedic management for many musculoskeletal conditions, aiming to alleviate pain, restore function, and prevent progression without operative procedures. These approaches are typically recommended as first-line treatments, particularly when symptoms are mild to moderate, and can be highly effective in promoting healing and improving . is a primary nonsurgical method, involving tailored exercises to enhance strength, flexibility, and stability. It addresses imbalances in muscle support around affected areas, reducing pain and improving mobility through techniques such as , , and neuromuscular training. Evidence from clinical reviews indicates that significantly benefits patients with by increasing and functional endurance, with low risk of adverse effects. For conditions like tendonitis, can effectively reduce inflammation and support recovery when initiated early. Bracing provides external support to immobilize or stabilize injured structures, facilitating natural in cases such as minor fractures or sprains. Functional braces, which allow controlled movement, are preferred over rigid casts for many upper and lower extremity injuries due to better patient comfort, reduced complications, and comparable outcomes to more invasive options. Studies on ankle fractures demonstrate that functional bracing achieves similar functional recovery to at one year, with fewer complications. For vertebral compression fractures, rigid bracing can decrease pain for up to six months post-injury, supported by moderate-quality evidence. Medications play a key role in symptom control, with nonsteroidal anti-inflammatory drugs (NSAIDs) commonly used to reduce pain and in acute and chronic orthopedic issues. NSAIDs like ibuprofen or naproxen effectively manage postoperative and injury-related pain, decreasing opioid requirements after fractures by targeting inflammatory pathways. Biologic injections, such as (PRP), harness the patient's own blood components to promote tissue repair and reduce in conditions like or early joint degeneration. Clinical data affirm PRP's safety profile, with minimal systemic risks beyond temporary local swelling, and its ability to improve joint function. Lifestyle modifications complement other interventions by addressing modifiable risk factors, such as and activity adjustments, to lessen joint stress. For , maintaining a healthy weight through diet and low-impact exercise can lower levels and slow disease progression, with studies showing that even modest reduces knee loading by up to 30%. Regular aerobic activities like or walking, combined with , enhance overall joint health without exacerbating symptoms. These interventions are indicated primarily for early-stage osteoarthritis, where they can manage symptoms effectively, or minor fractures, where conservative care promotes union without surgery. Evidence from systematic reviews supports their use in knee and hip osteoarthritis, demonstrating pain reduction and functional improvement that delays or avoids surgical needs in a significant proportion of patients, with success rates around 70-80% in select cohorts. For minor nondisplaced fractures, nonsurgical approaches yield healing rates comparable to operative methods, often exceeding 80% union without complications. Orthopedic nonsurgical care often employs a multidisciplinary approach, integrating input from physiatrists—who specialize in —and pain specialists to optimize outcomes. Physiatrists coordinate comprehensive plans focusing on function restoration through non-invasive means, while collaborating with pain experts for targeted therapies like injections or cognitive strategies. This teamwork, as practiced in specialized clinics, enhances , adherence, and long-term pain control.

Surgical Procedures

Arthroscopy Techniques

Arthroscopy is a minimally invasive surgical technique in orthopedic surgery that allows visualization, diagnosis, and treatment of disorders through small incisions, typically 4 to 6 millimeters in size, using an arthroscope—a fiber-optic instrument equipped with a camera and light source—to transmit images to a video monitor. Additional specialized instruments are inserted through separate portals to perform repairs, such as trimming damaged tissue or reconstructing ligaments, while distending the with sterile saline solution to improve and reduce . This approach contrasts with traditional open surgery by minimizing tissue disruption, which facilitates precise interventions on structures like , ligaments, and synovium. The technique originated in the early , with Japanese surgeon Kenji Takagi developing the first practical arthroscope in after initial experiments on cadavers in , though roots trace back to 19th-century innovations like the cystoscope. Advancements accelerated in the and 1960s through Masaki Watanabe's refinements, including the introduction of fiber-optic technology and the Watanabe #21 arthroscope in 1957, which enabled clinical use. By the 1970s, the adoption of video cameras and high-definition imaging transformed arthroscopy from a primarily diagnostic tool into a therapeutic modality, now performed routinely in modern operating rooms with advanced portals and instrumentation. Common applications include knee arthroscopy for meniscus repair, where torn cartilage is sutured or partially resected to restore joint stability, and shoulder arthroscopy for rotator cuff debridement, involving the removal of inflamed or degenerated tendon tissue to alleviate pain and improve mobility. Hip arthroscopy, performed by orthopaedic surgeons specializing in hip preservation or sports medicine, is used to treat conditions such as femoroacetabular impingement (FAI) and labral tears, involving trimming of bone spurs and repair or reconstruction of the labrum to address abnormal contact and stabilize the joint. These procedures are frequently applied to address acute injuries, chronic degenerative conditions, and inflammatory disorders in weight-bearing or high-mobility joints like the knee, shoulder, elbow, ankle, hip, and wrist. Key advantages of arthroscopic techniques include reduced postoperative pain, minimal scarring, and accelerated recovery, with most procedures conducted on an outpatient basis—nearly 100% in some institutional series—allowing patients to resume daily activities within days and return to sports in weeks. Compared to open surgery, lowers risk and enables earlier rehabilitation, contributing to its status as the most common orthopedic procedure today.

Arthroplasty Methods

Arthroplasty, commonly known as joint replacement surgery, is primarily indicated for patients with end-stage arthritis, such as or , where conservative treatments like medications, , and lifestyle modifications have failed to alleviate severe and functional limitations. This procedure is reserved for cases involving significant joint degeneration that impairs daily activities, with preoperative assessments often including and, occasionally, arthroscopic diagnostics to confirm the extent of damage. The most common types of arthroplasty focus on the hip and knee joints. Total hip arthroplasty (THA) replaces the entire hip joint with prosthetic components, including a femoral stem, acetabular cup, and bearing surfaces, while total knee arthroplasty (TKA) resurfaces the distal femur, proximal tibia, and patella using similar modular implants. For knees affected by unicompartmental disease—where arthritis is isolated to one compartment (medial, lateral, or patellofemoral)—partial replacements, such as unicompartmental knee arthroplasty (UKA), target only the damaged area, preserving more native bone and ligaments compared to total replacements. Materials in these prostheses typically include metals like cobalt-chromium or for structural components due to their strength and ; ceramics such as alumina or zirconia for bearing surfaces to minimize wear; and , often ultra-high molecular weight or highly cross-linked variants, for liners that provide low-friction articulation. Common pairings include metal-on- for its durability and cost-effectiveness, ceramic-on-ceramic for reduced wear in younger patients, and metal-on-metal (though less favored due to potential ion release). In UKA, metal femoral and tibial components are paired with a spacer to restore spacing. Surgical steps generally begin with an incision over the joint—posterior or anterior for the , medial parapatellar for the —to expose the area, followed by bone preparation through osteotomies to resect damaged surfaces and ream the to accommodate implants. Implants are then positioned and fixed, either cemented (using polymethylmethacrylate for immediate stability, ideal in older patients or poor quality) or uncemented (relying on press-fit or biological ingrowth for long-term , suited to younger, active individuals). Closure and postoperative care follow, with UKA procedures often shorter (1-2 hours) and less invasive than total replacements. Success rates for primary THA and exceed 95% at 10 years, with implant survivorship reflecting pain relief and functional restoration in the majority of patients; cemented fixation often shows slightly higher short-term reliability, while uncemented options provide comparable long-term outcomes in suitable candidates. UKA achieves excellent medium- to long-term survivorship when indications are strictly met, though revision rates may be higher if disease progresses to other compartments.

Fracture and Trauma Management

Fracture and trauma management in orthopedic surgery focuses on the acute treatment of injuries resulting from high-energy impacts, falls, or other traumatic events, aiming to restore anatomical and promote while minimizing complications. Surgical intervention is often required for displaced or unstable to achieve optimal outcomes, guided by established principles that balance mechanical stability with biological preservation. These techniques are particularly critical in settings where rapid stabilization can prevent further damage and support systemic recovery. The foundational principles of fracture management, as outlined by the AO Foundation, emphasize four key elements: reduction to restore length, alignment, rotation, and articular congruity; stable fixation to maintain reduction and allow early mobilization; preservation of blood supply to support biological ; and early, active functional rehabilitation to optimize recovery. These principles apply across techniques, ensuring that alignment prevents , stability promotes formation, and biological respect avoids devascularization of fragments. Open reduction and internal fixation (ORIF) is a primary method for treating displaced fractures, involving surgical exposure to realign fragments and secure them using plates and screws. Plates are contoured to the surface and fixed with cortical or locking screws to provide absolute stability, facilitating primary through direct fragment contact; this approach is ideal for intra-articular or metaphyseal fractures where precise reduction is essential. serves as an alternative or provisional method for complex cases, such as open fractures with , contamination, or hemodynamic instability, where pins or wires are inserted into segments and connected externally via frames to maintain , alignment, and rotation without extensive disruption. This technique offers adjustable stability and allows for gradual correction, though it requires meticulous pin care to prevent infection. For fractures, such as those in the or , intramedullary nailing provides robust internal stabilization by inserting a metal rod into the medullary after reduction, often with reaming to enhance fit and locking screws proximally and distally to control rotation and length. This load-sharing method aligns with AO principles by restoring axial alignment and promoting secondary healing through formation, with benefits including minimal stripping and early . In emergency contexts, protocols prioritize life-threatening injuries using the (ATLS) framework, with orthopedic interventions focusing on damage control orthopedics to stabilize fractures rapidly—such as applying external fixators for pelvic or injuries to control hemorrhage and prevent fat embolism—before definitive fixation once the patient is stabilized. Complications in fracture management include non-union, defined as failure of healing after nine months, occurring in 5-10% of cases overall and higher in tibial shaft fractures (up to 12%) due to factors like poor , , or inadequate stability; early recognition and revision surgery are essential to address these risks.

Epidemiology

Prevalence of Disorders

Musculoskeletal disorders represent a significant burden, with being the most prevalent condition addressed in orthopedic care. According to the , approximately 528 million people worldwide were living with in 2019, reflecting a 113% increase since 1990 due to population growth and aging. This condition disproportionately affects weight-bearing joints like the knees and hips, contributing to and reduced across diverse populations. In the United States, osteoporosis-related fractures alone account for approximately 2 million cases annually as of 2024, underscoring the scale of bone-related issues that often necessitate orthopedic intervention. Several key risk factors drive the incidence of these disorders. Aging is a primary contributor, as the global population aged 65 and older is projected to double by 2050, leading to a substantial increase in demand for procedures like total joint arthroplasty, projected to rise by 70% by 2050. exacerbates risk, with studies indicating that individuals with obesity face up to a fourfold increase in compared to those with normal weight, largely due to mechanical stress on joints. Among younger demographics, are prevalent, with over 3.5 million children and adolescents under age 14 treated annually in the United States for such injuries, often involving fractures or damage that may require long-term orthopedic management. Demographic trends further highlight disparities in . Women experience notably higher rates of -related fractures, with one in three women over age 50 worldwide likely to suffer an fracture in their lifetime, compared to one in five men, attributable to factors like postmenopausal decline and lower peak bone mass. Post-2020, global orthopedic procedure volumes rebounded from disruptions, with a 5% growth in 2024 to 30.5 million procedures worldwide, influenced by aging populations and delayed elective care. Updated estimates from the indicate exceeded 550 million by 2020 and continues to rise. These patterns emphasize the need for targeted prevention strategies in vulnerable groups to mitigate the overall burden of orthopedic conditions. In the United States, the utilization of orthopedic surgeries has shown substantial growth over the past two decades, particularly for arthroplasties addressing degenerative joint conditions. Between 2000 and 2019, the annual volume of primary total hip arthroplasties (THA) increased by 177%, while primary total knee arthroplasties (TKA) rose by 156%, reflecting broader demographic shifts toward an aging population and rising prevalence of osteoarthritis. These trends align with data from the Healthcare Cost and Utilization Project (HCUP), which indicate a 136% increase in total joint arthroplasty procedures from 494,005 in 2000 to 1,166,121 in 2014, driven by expanded access to elective surgeries and advancements in implant technology. By 2024, the U.S. orthopedic market, encompassing surgical procedures and related devices, reached approximately $59.2 billion annually, underscoring the economic scale of these interventions. Globally, orthopedic surgery utilization is experiencing accelerated growth in , fueled by rapid population aging and increasing rates of musculoskeletal disorders. Countries such as , , and are projected to see heightened demand for procedures like joint replacements due to their expanding elderly populations, with prevalence expected to rise in tandem with the proportion of individuals aged 65 and older. This regional shift contributes to a broader worldwide increase, with an estimated 30.5 million orthopedic surgical procedures performed globally in 2024, marking a 4.5% rise from the previous year. In the U.S., the annual cost burden of musculoskeletal conditions, including surgeries, exceeds $420 billion as of 2022 when accounting for direct medical spending, with broader estimates including lost wages reaching up to $980 billion based on 2014 data (likely higher today). Looking ahead, projections indicate continued escalation in orthopedic surgery volumes, primarily driven by demographic factors such as the aging baby boomer generation and rising rates. Based on 2018 projections using data up to 2014, primary THA and procedures are forecasted to reach approximately 635,000 and 1.28 million annually by 2030, respectively, representing a combined total of over 1.9 million hip and knee replacements, with revisions adding several hundred thousand procedures annually; more recent analyses suggest adjustments may be needed due to evolving trends. These estimates emphasize the need for expanded surgical capacity, with total joint arthroplasty caseloads potentially requiring a doubling by 2050 to meet demand without overburdening providers.

Innovations and Future Directions

Robotic and Minimally Invasive Surgery

Robotic systems have transformed orthopedic surgery by enabling greater precision in procedures such as total hip and knee arthroplasty, minimizing human error and optimizing implant positioning. The MAKO robotic-arm system, developed by Stryker, utilizes preoperative CT-based planning and intraoperative haptic guidance to achieve sub-millimeter accuracy in bone preparation and implant placement, with mean alignment errors of 0.92° and resection deviations of 0.39-0.65 mm (91.7% within ≤1 mm) in clinical studies. These systems reduce intraoperative blood loss by up to 30-35% compared to conventional techniques, primarily due to precise tissue handling and decreased need for extensive exposure, as evidenced in meta-analyses of randomized controlled trials (RCTs). Recent integrations of AI enhance preoperative planning and real-time adaptation in robotic systems. Minimally invasive techniques in orthopedic surgery emphasize smaller incisions—typically 6-10 cm for and 2-5 cm for spine procedures—compared to traditional open approaches of 13-15 cm or more, thereby preserving muscle integrity and reducing postoperative . In arthroplasty, these methods facilitate direct anterior or posterior mini-incisions, while in spine surgery, they enable endoscopic or tubular retractors for decompression and fusion with minimal disruption to surrounding tissues. Adoption of robotic and minimally invasive approaches has surged, with projections reaching up to 70% by 2030 in the U.S., driven by economic benefits such as amortized costs through higher procedure volumes and improved reimbursements for advanced technologies. RCTs underscore the clinical advantages, demonstrating shorter hospital stays, often reduced by about 2 days with robotic-assisted methods versus conventional , alongside lower complication rates and faster return to function. For instance, in total hip , robotic-assisted cohorts showed reduced length of stay by 1-2 days without compromising long-term outcomes. These innovations collectively enhance patient recovery while maintaining surgical efficacy, positioning them as standard in precision-driven orthopedic care.

Regenerative and Biologic Therapies

Regenerative and biologic therapies in orthopedic surgery leverage autologous biological agents and cellular mechanisms to promote the repair and regeneration of musculoskeletal tissues, offering alternatives or adjuncts to traditional surgical methods. These approaches focus on stimulating natural healing processes through growth factors, stem cells, and engineered scaffolds, with applications spanning defects, repairs, and bone nonunions. Clinical evidence supports their safety and efficacy in select indications, though standardization and long-term outcomes remain areas of ongoing research. Platelet-rich plasma (PRP) involves concentrating platelets from a patient's blood to release growth factors that enhance , , and cellular proliferation at injury sites. In orthopedic surgery, PRP accelerates fracture healing and improves outcomes in procedures like joint arthroplasty and , as demonstrated in clinical trials showing reduced healing times and enhanced bone formation. For soft tissue applications, such as tears and lateral , PRP injections provide short- to mid-term pain relief and functional improvements, with meta-analyses indicating superior efficacy in higher-dose formulations. Stem cell injections, primarily using mesenchymal stem cells (MSCs) derived from or , exploit their multipotent differentiation to regenerate , , and . Systematic reviews of clinical studies confirm MSCs' safety and success in treating , chondral defects, osteonecrosis, and nonunions, with sources like marrow used in over half of reported cases leading to radiographic and patient-reported improvements. A prominent technique for cartilage regeneration is matrix-induced autologous chondrocyte implantation (MACI), a two-stage procedure where harvested are expanded and seeded onto a scaffold for implantation into defects. Long-term follow-up of 15 knees revealed durable benefits, including Lysholm scores rising from 59.6 preoperatively to 82.7 at 15 years, IKDC scores from 50.6 to 69.7, and 86% of patients rating function as "much better" or "better." In (ACL) repair augmentation, biologics like PRP and aspirate concentrate (BMAC) enhance graft integration and reduce complications. Randomized trials show PRP decreasing early postoperative by approximately 1.1 points on the VAS scale and improving IKDC scores short-term, while BMAC accelerates MRI-assessed graft maturation and synovial coverage without long-term biomechanical superiority. For rotator cuff healing, biologic therapies significantly bolster repair integrity. Adipose-derived MSCs reduce re-tear rates to 14.3% compared to 28.5% in controls, and concentrate injections maintain 87% integrity at 10 years, with overall improvements in , function, and Constant scores across leukocyte-poor PRP and MSC applications. Future advancements include 3D-printed scaffolds, which utilize hybrid biomaterials such as (PCL) combined with or to create customizable, porous structures mimicking architecture. These scaffolds support osteoinduction through controlled release of growth factors like , achieving compressive strengths of 3-80 MPa and degradation over 1-24 months to facilitate vascularized regeneration in defects. Gene therapy emerges as a transformative prospect for regeneration, integrating viral vectors (e.g., adenovirus, AAV) or non-viral nanoparticles to deliver osteogenic genes like and VEGF within tissue-engineered scaffolds. Preclinical models demonstrate enhanced healing and in large segmental defects, positioning this approach for clinical adoption by 2030 to address nonunions affecting 10-15% of fractures.

Complications and Outcomes

Perioperative Risks

Orthopedic surgery, like other invasive procedures, carries inherent perioperative risks that can affect patient outcomes in the immediate postoperative period. Surgical site infections (SSIs) represent one of the most common complications, occurring in approximately 1-2% of cases across various orthopedic procedures, with higher rates observed in joint replacements and trauma surgeries. thrombosis (DVT) is another prevalent risk, particularly following lower extremity surgeries, where immobility and hypercoagulability elevate incidence to 40-60% without prophylaxis; however, this is substantially mitigated through therapies such as (LMWH) or direct oral anticoagulants (DOACs). Implant failure, including loosening or breakage, affects up to 5-10% of cases in the early postoperative phase, often linked to mechanical stress or inadequate fixation in fracture management. Patient-specific factors significantly influence these risks, with comorbidities such as diabetes mellitus exacerbating perioperative complications through impaired and heightened susceptibility. Diabetic patients undergoing orthopedic surgery experience up to a twofold increase in postoperative rates and overall morbidity compared to non-diabetics, underscoring the need for preoperative optimization of glycemic control. Enhanced Recovery After Surgery (ERAS) protocols have emerged as a standardized approach to mitigate these risks, incorporating multimodal interventions like preoperative , minimized , and early mobilization to reduce complication rates by 30-50% and shorten hospital stays in orthopedic settings. Anesthetic strategies play a crucial role in managing perioperative hazards, particularly in reducing reliance on that can contribute to respiratory depression and . Regional techniques, such as peripheral nerve blocks, have been endorsed in post-2020 guidelines for orthopedic procedures, demonstrating a 50-70% reduction in consumption during the first 24-48 hours postoperatively while improving control and facilitating faster ambulation. These blocks, often combined with multimodal analgesia in ERAS frameworks, lower the incidence of and sedation-related complications without increasing risks.

Rehabilitation and Recovery

Rehabilitation following orthopedic surgery typically begins immediately after the procedure to promote mobility, reduce pain, and prevent complications such as joint stiffness or . Physical therapy often starts on the first postoperative day, with inpatient sessions focusing on gentle range-of-motion exercises, bed mobility, and basic transfers. For total hip arthroplasty, patients are commonly allowed as tolerated from day one, progressing to weaning off assistive devices within 2-3 weeks if pain and balance permit. In total knee arthroplasty, similar early mobilization occurs, aiming for near-full knee extension and over 70 degrees of flexion within the first week. These protocols are tailored by the surgical team but emphasize progressive loading to achieve independent ambulation by 4-6 weeks post-op. Hospital stays for knee replacement surgery typically last 1-2 days, depending on recovery progress. Long-term recovery milestones vary by procedure but generally include achieving full by 10-12 weeks for hip replacements and over 120 degrees of knee flexion by 8-12 weeks, alongside strength comparable to 80% of the unaffected limb. Outpatient continues for 6-12 weeks, incorporating strengthening, balance training, and functional activities to support return to daily living. Multidisciplinary care is integral, involving physical and occupational therapists, rehabilitation physicians, and surgeons who collaborate to monitor progress and adjust plans. Therapists educate patients on home exercises, while physicians oversee for and prophylaxis against acute risks like thrombosis. This team approach ensures early detection of issues such as persistent , which can be addressed through targeted interventions like . Mild to moderate swelling may persist for 3-6 months after knee replacement, managed through ice application and elevation. Most patients resume normal activities within 3-6 weeks, though full recovery takes several months. Post-recovery, emphasis is placed on low-impact exercises such as walking or swimming to maintain joint health. Patient outcomes in orthopedic surgery rehabilitation are generally positive, with approximately 85-90% of individuals reporting high satisfaction at post-procedure for common surgeries like and replacements. Functional improvements are commonly measured using the Western Ontario and McMaster Universities Index (WOMAC), where scores typically decrease from preoperative levels above 50 to below 20 at , indicating substantial gains in pain relief, stiffness reduction, and physical function. These metrics highlight the effectiveness of structured rehabilitation in restoring , though individual variability exists based on factors like age and comorbidities. Long-term monitoring through follow-up visits sustains these gains, with multidisciplinary input helping to mitigate any residual limitations.

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