An Overview of Orthopedic Surgery

Orthopedic surgery is the medical specialty dedicated to the surgical treatment of issues related to the musculoskeletal system (i.e., the bones and connective tissues, such as ligaments and tendons). This involves a wide variety of procedures, from ACL and meniscus repair to hip replacement to spinal fusion and more. Orthopedic surgery may be done to treat condition-, age-, or accident-related concerns, and therefore may be carefully planned or entirely unexpected.

Surgeries of this type can also vary greatly in terms of how invasive they are, the risks they carry, and what it takes to recover from them.

Over the years, the field of orthopedic surgery has expanded to encompass many subspecialties and the treatment of many musculoskeletal disorders in patients of all ages.

Some of the common orthopedic surgery subspecialties include:

• Foot and ankle surgery
• Hand surgery
• Hip and knee reconstruction
• Pediatric orthopedics
• Spine disorders
• Sports medicine
• Trauma surgery

These and others often overlap with other medical specialties, including neurosurgery, plastic surgery, rheumatology, and podiatry. Orthopedic surgeons often have to work closely with other physicians in order to manage complex problems.

In addition, orthopedic surgeons work directly with primary care doctors, pediatricians, anesthesiologists, emergency room physicians, as well as non-physician clinicians such as physician assistants, athletic trainers, orthopedic technologists, nurse practitioners, and others.

Most orthopedic surgical procedures involve bones or joints. Some surgeries can be performed arthroscopically (by looking inside a joint with a camera), others through minimal incisions, and still others require larger, more invasive incisions.

Some of the more commonly performed orthopedic surgical procedures include:

• ACL reconstruction
• Meniscus repair
• Knee or hip replacement
• Shoulder arthroscopy and debridement
• Repair of fractures
• Rotator cuff repair
• Carpel tunnel release
• Intervertebral disk surgery
• Spinal fusion
• Removal of support implant

It's important to reinforce the fact that the vast majority of people who consult with an orthopedic surgeon never actually go to an operating room for treatment. Orthopedic surgeons ensure that non-surgical options, if potentially useful, are explored before recommending surgery.

There are risks associated with any surgery. While most often these can be controlled, and most procedures are very safe, there are possible complications that should be understood by patients before undergoing orthopedic surgery.

There is a broad spectrum of options for anesthesia for orthopedic procedures. General anesthesia—where you are unconscious for the procedure—carries the greatest risk of complications, compared to regional and local anesthesia. These can range from mild and temporary (e.g., nausea, chills) to serious (e.g., breathing problems, cognitive dysfunction). It is also possible to be allergic to/have an adverse reaction to anesthesia.

Not every type of anesthesia will work for every surgery. And for some people (e.g., those with high blood pressure or obesity), a specific type of anesthesia may be considered safer.

Infection is probably the most common concern people have about their upcoming orthopedic surgery. Infections after surgery can sometimes be simple to manage; other times, they may require additional surgical procedures and prolonged treatment.

There are steps that can be taken to help reduce the chance of having an infection.

A blood clot can form in the veins after orthopedic surgery, a problem called a deep vein thrombosis (DVT). Sometimes DVTs can migrate from the veins and travel to the lungs where they can cause a pulmonary embolism (PE).

Often, a surgeon will recommend treatment such as compression, mobilization, or blood thinners to prevent blood clots from forming.

Recovery after orthopedic surgery depends on the specific procedure a surgeon has performed, as well as factors such as your age and adherence to your doctor's recommendations.

Most procedures involve some type of post-surgical therapy to regain joint mobility and restore strength to the extremity. In addition, many orthopedic conditions are preceded by poor mechanics or functioning of an extremity.

For example, many people with a rotator cuff tear in their shoulder have been compensating for months or longer. In order to restore normal shoulder mechanics, not only does the tear need to be surgically addressed, but the other muscles and joints around the shoulder may require treatment.

Pain is common after an orthopedic surgical procedure, but there are more and better options for managing post-surgical pain today than there have ever been in the past. More orthopedic surgeons are using long-acting local anesthetics, regional nerve blocks, and other techniques to control pain and limit the need for narcotic medications.

Make sure you know what your orthopedic surgery procedure entails and that you are prepared for it by asking good questions of your doctor. Ensuring you have the equipment, medications, and any other necessities you'll need after surgery taken care of ahead of time will help get your recovery started right, so be sure to ask what's recommended. Most of all, take instructions related to re-starting activities seriously.