Orthopedic surgery
Encyclopedia
British English
British English, or English , is the broad term used to distinguish the forms of the English language used in the United Kingdom from forms used elsewhere...
) is the branch of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
concerned with conditions involving the musculoskeletal system
Musculoskeletal system
A musculoskeletal system is an organ system that gives animals the ability to move using the muscular and skeletal systems...
. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma
Physical trauma
Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
, sports injuries, degenerative disease
Degenerative disease
A degenerative disease, also called neurodegenerative disease, is a disease in which the function or structure of the affected tissues or organs will progressively deteriorate over time, whether due to normal bodily wear or lifestyle choices such as exercise or eating habits...
s, infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
s, tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...
s, and congenital disorder
Congenital disorder
A congenital disorder, or congenital disease, is a condition existing at birth and often before birth, or that develops during the first month of life , regardless of causation...
s.
Nicholas Andry coined the word "orthopaedics", derived from Greek
Greek language
Greek is an independent branch of the Indo-European family of languages. Native to the southern Balkans, it has the longest documented history of any Indo-European language, spanning 34 centuries of written records. Its writing system has been the Greek alphabet for the majority of its history;...
word
Word
In language, a word is the smallest free form that may be uttered in isolation with semantic or pragmatic content . This contrasts with a morpheme, which is the smallest unit of meaning but will not necessarily stand on its own...
s for orthos ("correct", "straight") and paideion ("child"), when he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children in 1741. Correction of spinal and bony deformities became the cornerstone of orthopedic practice. Today, over 6 months of training is dedicated to the treatment of the pediatric population.
In the United States orthopedics is standard, although the majority of college, university and residency programs, and even the American Academy of Orthopaedic Surgeons, still use the spelling with the Latinate digraph ae. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.
Training
In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school. Subsequently, these medical school graduates undergo residencyResidency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
training in orthopedic surgery. The five-year residency consists of one year of general surgery training followed by four years of training in orthopedic surgery.
Selection for residency training in orthopedic surgery is very competitive. Approximately 700 physicians complete orthopedic residency training per year in the United States. About 10 percent of current orthopedic surgery residents are women; about 20 percent are members of minority groups. There are approximately 20,400 actively practicing orthopedic surgeons and residents in the United States. According to the latest Occupational Outlook Handbook (2009–2010) published by the United States Department of Labor
United States Department of Labor
The United States Department of Labor is a Cabinet department of the United States government responsible for occupational safety, wage and hour standards, unemployment insurance benefits, re-employment services, and some economic statistics. Many U.S. states also have such departments. The...
, between 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 subspecialty is typically one year in duration (sometimes two) and sometimes has a research
Research
Research can be defined as the scientific search for knowledge, or as any systematic investigation, to establish novel facts, solve new or existing problems, prove new ideas, or develop new theories, usually using a scientific method...
component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the United States are:
- Hand surgery
- Shoulder and elbow surgery
- Total joint reconstruction (arthroplastyArthroplastyArthroplasty is an operative procedure of orthopedic surgery performed, in which the arthritic or dysfunctional joint surface is replaced with something better or by remodeling or realigning the joint by osteotomy or some other procedure.-Background:Previously, a popular form of arthroplasty was...
) - Pediatric orthopedics
- Foot and ankle surgery
- Spine surgery
- Musculoskeletal oncology
- Surgical sports medicine
- Orthopedic trauma
These specialty 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 practiced by board-certified Doctors of Podiatric Medicine (D.P.M.) in the United States. Some family practice physicians practice sports medicine; however, their scope of practice is non-operative.
After completion of specialty residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
/registrar
Specialist registrar
A Specialist Registrar or SpR is a doctor in the United Kingdom and Republic of Ireland who is receiving advanced training in a specialist field of medicine in order eventually to become a consultant...
training, an orthopedic surgeon is then eligible for board certification
American Board of Medical Specialties
The American Board of Medical Specialties is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States...
. Certification by the American Board of Orthopaedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the Board. The process requires successful completion of a standardized written exam followed by an oral exam 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
Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada ' , French: Collège royal des médecins et chirurgiens du Canada, is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada...
; in Australia and New Zealand it is the Royal Australasian College of Surgeons
Royal Australasian College of Surgeons
The Royal Australasian College of Surgeons is the body responsible for training and examining surgeons in Australia and New Zealand. The head office of the College is in Melbourne, Australia....
.
In the United States, specialists in hand surgery and sports medicine may obtain a Certificate of Added Qualifications (CAQ) in addition to their board certification by successfully completing a separate standardized examination. There is no additional certification process for the other subspecialties.
Practice
According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are as follows:- Knee arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
and meniscectomy - Shoulder arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
and decompression - Carpal tunnelCarpal tunnelIn the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the middle compartment of the deep plane of the palm. The tunnel consists of bones and connective tissue...
release - Knee arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
and chondroplastyChondroplastyChondroplasty refers to surgery of the cartilage, the most common being corrective surgery of the cartilage of the knee.Surgery known as thyroid chondroplasty is used to reduce the visibility of the Adam's Apple in transsexual women.... - Removal of support implant
- Knee arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
and anterior cruciate ligament reconstructionAnterior cruciate ligament reconstructionAnterior cruciate ligament reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created... - Knee replacementKnee replacementKnee replacement, or knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis...
- Repair of femoral neck fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
- Repair of trochanteric fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
- Debridement of skinSkin-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...
/muscleMuscleMuscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
/boneBoneBones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...
/fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone... - Knee arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
repair of both menisci - Hip replacementHip replacementHip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe...
- Shoulder arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
/distal clavicleClavicleIn human anatomy, the clavicle or collar bone is a long bone of short length that serves as a strut between the scapula and the sternum. It is the only long bone in body that lies horizontally...
excision - Repair of rotator cuff tendon
- Repair fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
of radius (bone)Radius (bone)The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally...
/ulnaUlnaThe ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form and runs parallel to the radius, which is shorter and smaller. In anatomical position The ulna is one of the two long bones in the forearm, the other being the radius. It is prismatic in form... - LaminectomyLaminectomyLaminectomy is a spine operation to remove the portion of the vertebral bone called the lamina. There are many variations of laminectomy. In the most minimal form small skin incisions are made, back muscles are pushed aside rather than cut, and the parts of the vertebra adjacent to the lamina are...
- Repair of ankle fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
(bimalleolar type) - Shoulder arthroscopyArthroscopyArthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
and debridementDebridementDebridement is the medical removal of a patient's dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue... - Lumbar spinal fusionSpinal fusionSpinal fusion, also known as spondylodesis or spondylosyndesis, is a surgical technique used to join two or more vertebrae. Supplementary bone tissue, either from the patient or a donor , is used in conjunction with the body's natural bone growth processes to fuse the vertebrae.Fusing of the...
- Repair fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
of the distal part of radiusRadius (bone)The radius is one of the two large bones of the forearm, the other being the ulna. It extends from the lateral side of the elbow to the thumb side of the wrist and runs parallel to the ulna, which exceeds it in length and size. It is a long bone, prism-shaped and slightly curved longitudinally... - Low back intervertebral discIntervertebral discIntervertebral discs lie between adjacent vertebrae in the spine. Each disc forms a cartilaginous joint to allow slight movement of the vertebrae, and acts as a ligament to hold the vertebrae together.-Structure:...
surgery - Incise finger tendon sheath
- Repair of ankle fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
(fibula) - Repair of femoral shaft fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
- Repair of trochanteric fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
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. In 2009, the median salary for an orthopedic surgeon in the United States was $406,847.
History
Antonius Mathysen, a Dutch
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
military
Military
A military is an organization authorized by its greater society to use lethal force, usually including use of weapons, in defending its country by combating actual or perceived threats. The military may have additional functions of use to its greater society, such as advancing a political agenda e.g...
surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, invented the plaster of Paris cast in 1851.
Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages
Middle Ages
The Middle Ages is a periodization of European history from the 5th century to the 15th century. The Middle Ages follows the fall of the Western Roman Empire in 476 and precedes the Early Modern Era. It is the middle period of a three-period division of Western history: Classic, Medieval and Modern...
the injured were treated with bandages soaked in horses' blood
Blood
Blood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
which dried to form a stiff, but unsanitary, splint. Traction
Traction (orthopedics)
In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
and splinting
Splint (medicine)
A splint is a device used for support or immobilization of limbs or of the spine.It can be used:* By the emergency medical services or by volunteer first responders, to immobilize a fractured limb before the transportation; it is then a temporary immobilization;* By allied health professionals such...
developed during World War I
World War I
World War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
. The use of intramedullary rod
Intramedullary rod
An intramedullary rod, also known as an intramedullary nail or inter-locking nail or Küntscher nail, is a metal rod forced into the medullary cavity of a bone. IM nails have long been used to treat fractures of long bones of the body. Gerhard Küntscher is credited with the first use of this device...
s to treat fractures of the femur
Femur
The femur , or thigh bone, is the most proximal bone of the leg in tetrapod vertebrates capable of walking or jumping, such as most land mammals, birds, many reptiles such as lizards, and amphibians such as frogs. In vertebrates with four legs such as dogs and horses, the femur is found only in...
and tibia
Tibia
The tibia , shinbone, or shankbone is the larger and stronger of the two bones in the leg below the knee in vertebrates , and connects the knee with the ankle bones....
was pioneered by Gerhard Küntscher
Gerhard Küntscher
Gerhard Küntscher was a German surgeon who inaugurated the intramedullary nailing of long bone fractures, a process that was first performed in November 1939 at the University Department of Surgery in Kiel...
of Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II
World War II
World War II, or the Second World War , was a global conflict lasting from 1939 to 1945, involving most of the world's nations—including all of the great powers—eventually forming two opposing military alliances: the Allies and the Axis...
and led to more widespread adoption of intramedullary fixation of fracture
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
s in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Harborview Medical Center
Harborview Medical Center
Harborview Medical Center, located on Seattle's First Hill, is a public hospital in King County, Washington and is managed by UW Medicine.-Overview:...
in Seattle group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War
Vietnam War
The Vietnam War was a Cold War-era military conflict that occurred in Vietnam, Laos, and Cambodia from 1 November 1955 to the fall of Saigon on 30 April 1975. This war followed the First Indochina War and was fought between North Vietnam, supported by its communist allies, and the government of...
but a major contribution was made by Gavril Abramovich Ilizarov
Gavril Abramovich Ilizarov
Gavriil Abramovich Ilizarov was a Soviet physician, known for inventing the Ilizarov apparatus for lengthening limb bones and for his eponymous surgery...
in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia
Siberia
Siberia is an extensive region constituting almost all of Northern Asia. Comprising the central and eastern portion of the Russian Federation, it was part of the Soviet Union from its beginning, as its predecessor states, the Tsardom of Russia and the Russian Empire, conquered it during the 16th...
in the 1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, and malaligned fractures. With the help of the local bicycle
Bicycle
A bicycle, also known as a bike, pushbike or cycle, is a human-powered, pedal-driven, single-track vehicle, having two wheels attached to a frame, one behind the other. A person who rides a bicycle is called a cyclist, or bicyclist....
shop he devised ring external fixators tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment and lengthening
Distraction osteogenesis
Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction is a surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body...
to a degree unheard of elsewhere. His Ilizarov apparatus
Ilizarov apparatus
The Ilizarov apparatus is named after the orthopedic surgeon Gavriil Abramovich Ilizarov from the Soviet Union, who pioneered the technique. It is used in surgical procedures to lengthen or reshape limb bones; to treat complex and/or open bone fractures; and in cases of infected non-unions of bones...
is still used today as one of the distraction osteogenesis
Distraction osteogenesis
Distraction osteogenesis, also called callus distraction, callotasis and osteodistraction is a surgical process used to reconstruct skeletal deformities and lengthen the long bones of the body...
methods.
Ruth Jackson
Ruth Jackson
Ruth Jackson was the first female board-certified orthopedic surgeon in the U.S. She earned her bachelor's degree in economics and sociology from the University of Texas at Austin, and her medical degree from Baylor College of Medicine in 1928, where she was one of four women in a class of 112...
became the first female Board-certified Orthopaedic Surgeon in the U.S in 1937. Orthopedics continues to be a male-dominated field. In 2006, 12.4% of orthopedics residents were women.
David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament
Anterior cruciate ligament
The anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...
(ACL) of the knee
Knee
The knee joint joins the thigh with the leg and consists of two articulations: one between the fibula and tibia, and one between the femur and patella. It is the largest joint in the human body and is very complicated. The knee is a mobile trocho-ginglymus , which permits flexion and extension as...
. This common and serious injury in skiers
Skiing
Skiing is a recreational activity using skis as equipment for traveling over snow. Skis are used in conjunction with boots that connect to the ski with use of a binding....
, field athletes, and dance
Dance
Dance is an art form that generally refers to movement of the body, usually rhythmic and to music, used as a form of expression, social interaction or presented in a spiritual or performance setting....
rs invariably brought an end to their athletics due to permanent joint instability. Working with injured football
American football
American football is a sport played between two teams of eleven with the objective of scoring points by advancing the ball into the opposing team's end zone. Known in the United States simply as football, it may also be referred to informally as gridiron football. The ball can be advanced by...
players, Dr MacIntosh devised a way to re-route viable ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.
Modern orthopedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.
Arthroscopy
The use of arthroscopic techniques has been particularly important for injured patients. ArthroscopyArthroscopy
Arthroscopy is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision...
was pioneered in the early 1950s by Dr. Masaki Watanabe of Japan to perform minimally invasive cartilage surgery and reconstructions of torn ligaments. Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. 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 orthopedic procedures are now performed arthroscopically.
Arthroplasty
The modern total hip replacementHip replacement
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant. Hip replacement surgery can be performed as a total replacement or a hemi replacement. Such joint replacement orthopaedic surgery generally is conducted to relieve arthritis pain or fix severe...
was pioneered by Sir John Charnley
John Charnley
Sir John Charnley was a British orthopaedic surgeon. He pioneered the hip replacement operation, which is now one of the most common operations both in the UK and elsewhere in the world...
in England in the 1960s. He found that joint surfaces could be replaced by metal or high density polyethylene
Polyethylene
Polyethylene or polythene is the most widely used plastic, with an annual production of approximately 80 million metric tons...
implants cemented to the bone with methyl methacrylate
Methyl methacrylate
Methyl methacrylate is an organic compound with the formula CH2=CCOOCH3. This colourless liquid, the methyl ester of methacrylic acid is a monomer produced on a large scale for the production of poly .-Production:...
bone cement
Bone cement
Bone cements have been used very successfully to anchor artificial joints for more than half a century. Artificial joints are anchored with bone cement. The bone cement fills the free space between the prosthesis and the bone and plays the important role of an elastic zone...
. Since Charnley, there have been continuous improvements in the design and technique of joint replacement
Joint replacement
Replacement arthroplasty [from Greek arthron, joint, limb, articulate, + -plassein, to form, mould, forge, feign, make an image of], or joint replacement surgery, is a procedure of orthopedic surgery in which the arthritic or dysfunctional joint surface is replaced with an orthopaedic prosthesis...
(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
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
patients and later by Gunston and Marmor for osteoarthritis
Osteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
in the 1970s developed by Dr John Insall
John Insall
John Nevil Insall was a pioneering English orthopaedic surgeon who contributed extensively to the advancement of total knee replacement surgery. He designed four models of widely used systems....
in New York utilizing a fixed bearing system, and by Dr Frederick Buechel and Dr Michael Pappas utilizing a mobile bearing system.
Uni-compartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, is an alternative to a total knee replacement in a select patient population.
Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist, ankle, spine, and fingers.
In recent years, surface replacement of joints, in particular the hip joint, have 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.
One of the main problems with joint replacements is wear of the bearing surfaces of components. This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic (actually ultra high-molecular-weight polyethylene) can also be altered in ways that may improve wear characteristics.
See also
- Bone fractureBone fractureA bone fracture is a medical condition in which there is a break in the continuity of the bone...
- Bone graftingBone graftingBone grafting is a surgical procedure that replaces missing bone in order to repair bone fractures that are extremely complex, pose a significant health risk to the patient, or fail to heal properly....
- Broström procedure
- Computer Assisted Orthopedic Surgery
- Arbeitsgemeinschaft für OsteosynthesefragenArbeitsgemeinschaft für OsteosynthesefragenArbeitsgemeinschaft für Osteosynthesefragen , also AO Foundation, commonly called AO is a non profit organization dedicated to improving the care of patients with musculoskeletal injuries and their sequelae through research, development, education and quality assurance in the principles, practice,...
- Gait analysisGait analysisGait analysis is the systematic study of animal locomotion, more specific as a study of human motion, using the eye and the brain of observers, augmented by instrumentation for measuring body movements, body mechanics, and the activity of the muscles. Gait analysis is used to assess, plan, and...
- Halo Brace
- Hand surgeryHand surgeryThe field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take place in the hand or upper extremity including injury and infection. Hand surgery may be practiced by graduates of general surgery, orthopedic surgery and plastic surgery...
- Podiatric surgery
- Orthopedic nursingOrthopaedic nursingOrthopaedic nursing is a nursing specialty focused on the prevention and treatment of musculoskeletal disorders. Orthopaedic issues range from acute problems such as fractures or hospitalization for joint replacement to chronic systemic disorders such as loss of bone density or lupus...
- TractionTraction (orthopedics)In orthopedic medicine, traction refers to the set of mechanisms for straightening broken bones or relieving pressure on the spine and skeletal system.There are two types of traction: skin traction and skeletal traction....
- Partial knee replacement
- EpiphysiodesisEpiphysiodesisEpiphysiodesis is a Pediatric surgical procedure in which the epiphyseal plate of a bone is either removed, or a cube containing part of it rotated 90° and reinserted.This procedure is used to:*Lengthen an abnormally short leg...
- Reconstructive surgeryReconstructive surgeryReconstructive surgery is, in its broadest sense, the use of surgery to restore the form and function of the body, although Maxillo-Facial Surgeons, Plastic Surgeons and Otolaryngologists do reconstructive surgery on faces after trauma and to reconstruct the head and neck after cancer.Other...
- Buddy wrappingBuddy wrappingBuddy wrapping or buddy taping is the act of bandaging a damaged finger or toe together with a healthy one. The bandage is usually stiff, not allowing the digits to move; the healthy digit acts as a splint, keeping the damaged one in a natural position for healing...
- Anterior cruciate ligament reconstructionAnterior cruciate ligament reconstructionAnterior cruciate ligament reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after anterior cruciate ligament injury. The torn ligament is removed from the knee before the graft is inserted through a hole created...
- Tommy John surgeryTommy John surgeryTommy John surgery, known in medical practice as ulnar collateral ligament reconstruction, is a surgical procedure in which a ligament in the medial elbow is replaced with a tendon from elsewhere in the body...
External links
- American Academy of Orthopaedic Surgeons
- American Osteopathic Academy of Orthopedics
- Arthroscopy Association of North America
- European Federation of National Associations of Orthopaedics and Traumatology
- American Orthopaedic Society for Sports Medicine
- Wheeless' Textbook of Orthopaedics
- The International Society of Orthopaedic Surgery and Traumatology
- The Journal of Bone and Joint Surgery, American Volume
- The Journal of Bone and Joint Surgery, British Volume
- Arthroscopy: The Journal of Arthroscopic and Related Surgery