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Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient.

There are ten surgical specialties and this briefing covers orthopaedic surgery.

What does orthopaedic surgery cover?

Orthopaedic surgery is a specialty dealing with acute injuries, congenital and acquired disorders and chronic arthritic or overuse conditions of the bones, joints and their associated soft tissues, including ligaments, nerves and muscles.

Most consultants work alongside general surgeons in emergency trauma dealing with bony and soft tissue injuries admitted through their local A & E Departments. The vast majority also have a specialist interest in a particular orthopaedic condition including the following:

• Joint reconstruction
• Particular anatomical region (eg arm)
• Spine (alongside neurosurgeons)
• Bone tumour surgery
• Rheumatoid surgery
• Sport surgery
• Complex trauma surgery

Paediatric orthopaedics require different fracture treatment due to growing bones and corrective treatment for childhood deformities.

Main operations

Among the main procedures undertaken by orthopaedic surgeons are:

• Joint arthoscopy – a minimally invasive technique which involves inserting probes into the joint to diagnose and repair damaged joint tissue (eg to torn ligaments or floating cartilage).
• Fracture repair – a whole series of techniques are used depending on type, severity and location of fracture to ensure that bones are stable, heal correctly and patient retains function. This can include permanent pins and plates, immobilization, use of external pinning and frames.
• Arthroplasty – the replacement of whole joints, usually due to osteo- and rheumatoid arthritis. Hip and knee replacements are the most common operations.
• General repair procedures on damaged muscle or tendon.
• Corrective surgery – procedures aimed at correcting problems of anatomical alignment which either limit function or would cause long-term problems if left.

Developments

Work into new joint replacement techniques include resurfacing of the hip and shoulder, which leaves patients with much more of their original bone than a total replacement. There is also work into different materials for replacements (including metals, plastics and ceramics).

Biological repair is an area of much research, such as cartilage transplantation or using material grown from stem cells to replace damaged joint tissue (eg tendons and ligament).

Computer-aided navigation enables 3D mapping of a joint and enables greater accuracy for incisions – more research is needed to see if this results in significant improvements for patients.