An Overview of Orthopedic Surgery

Orthopedic surgery is the medical specialty that performs treatment of the musculoskeletal system. This includes the bones, joints, muscles, tendons, ligaments, and nerves in your body. Orthopedic surgeons perform a variety of surgical and nonsurgical treatments to address problems of the musculoskeletal system, so the reason you may be referred to one is likely to be quite different than a friend.

Over the years, the field of orthopedics has expanded to encompass many sub-specialties and the treatment of a wide variety of musculoskeletal disorders in patients of all ages. Some of the common sub-specialties that orthopedists manage include:

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

There are other conditions and sub-specialties also treated by orthopedists. In addition, there is often overlap with other medical specialists including neurosurgeons, plastic surgeons, rheumatologists, and podiatrists. 

Orthopedic surgeons often have to work closely with other physicians in order to manage complex problems. Every day, I work directly with primary care doctors, pediatricians, anesthesiologists, and emergency room physicians, for example. In additions, orthopedists often work with other non-physician clinicians including 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 have larger, more invasive incisions.

Some of the more commonly performed orthopedic surgical procedures include ACL reconstruction, meniscus repair, and knee replacement. You can learn more about these and other procedures by exploring these helpful articles:

• 10 Common Knee Surgeries
• Common Shoulder Surgeries
• 6 Types of Spine Surgery

It's important to reinforce the fact that the vast majority of people treated by an orthopedic surgeon never need to go to an operating room for treatment. While many have the perception that for treatment to be successful the problem needs surgical repair, that is not always the case. In fact, most orthopedic problems can be treated non-surgically. However, there are some situations where the best option may be a surgical procedure.

There are risks associated with a surgical treatment the treatment any time one is performed. While most often these risks can be controlled, and most procedures are very safe, there are possible complications that you should understand if you're planning on orthopedic surgery.

Any time a surgery is performed, most patients will have some type of anesthetic. There is a broad spectrum of options for anesthesia for orthopedic procedures that range from local anesthesia to a general anesthesia, with many options in between. Not every type of anesthesia will work for every surgery, but most often there are options that you may consider. For some people, a specific type of anesthesia may be considered safer. Risks of anesthesia depend on a number of factors including the type of anesthesia, other conditions you may have (your medical comorbidities), and the surgery being performed.

Another common risk of any orthopedic surgery is infection. This is probably the most common concern I hear from patients about an upcoming surgery. Infections after surgery can sometimes be simple to manage; other times they may require additional surgical procedures and prolonged treatment. There are steps you can take when having an orthopedic surgical procedure that will help reduce the chance of having an infection.

One other risk that is common to many orthopedic surgical procedures is a blood clot. A blood clot can form in your veins, a problem called a deep venous thrombosis (DVT). Sometimes these DVTs can migrate from the veins and travel to the lungs where they can cause a serious breathing problem called a pulmonary embolism (PE). Often your 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 your surgeon has performed. 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 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 surgeons are using long-acting local anesthetics, regional nerve blocks, and other techniques to control pain and limit the need for narcotic medications. In general, surgeons try to limit the use of narcotic medications after surgery. These medications have potentially serious side effects and can become addictive, so they only used sparingly after orthopedic surgery.

What to Expect: Make sure you know what your procedure entails and that you are prepared for it by asking good questions of your doctor. Ensuring you have equipment, medications, and any other necessities you'll need after surgery taken care of ahead of time will help you out immensely. Write down any other questions you have for your doctor and take this list to your appointment. When your doctor gives you the answers, make sure you write down the answer so you don't forget.

Types of Anesthesia: There are a number of options for anesthesia for most surgical procedures. Not every option is equally effective for every surgical procedure, and some options may be safer for particular patients. Discuss what may be best for your individual surgical procedure with your doctor and anesthesiologist.

Ways to Prevent Infection: You can help prevent infection. Know how to take care of your skin both before and after surgery. Follow your surgeon's instructions when caring for your bandage and keeping the incision area clean. Make sure any health care providers or friends and family who visit you wash their hands before coming into contact with you.