Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθόςorthos ("correct", "straight") and παιδίονpaidion ("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 ligatureæ 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
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
Early orthopedics
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 Pariscast 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]
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 an osteoclast 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.
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
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:
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
Radiography to identify eventual bone fractures after a knee injuryOrthopedic 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]
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]
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 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
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]
Hip replacement is a surgical procedure in which the hip joint is replaced by a prosthetic implant, that is, a hip prosthesis. Hip replacement surgery can be performed as a total replacement or a hemi/semi(half) replacement. Such joint replacement orthopaedic surgery is generally conducted to relieve arthritis pain or in some hip fractures. A total hip replacement consists of replacing both the acetabulum and the femoral head while hemiarthroplasty generally only replaces the femoral head. Hip replacement is one of the most common orthopaedic operations, though patient satisfaction varies widely between different techniques and implants. Approximately 58% of total hip replacements are estimated to last 25 years. The average cost of a total hip replacement in 2012 was $40,364 in the United States, and about $7,700 to $12,000 in most European countries.
Arthroplasty is an orthopedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodeled, or realigned by osteotomy or some other procedure. It is an elective procedure that is done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.
Knee replacement, also known as knee arthroplasty, is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability, most commonly offered when joint pain is not diminished by conservative sources. It may also be performed for other knee diseases, such as rheumatoid arthritis. In patients with severe deformity from advanced rheumatoid arthritis, trauma, or long-standing osteoarthritis, the surgery may be more complicated and carry higher risk. Osteoporosis does not typically cause knee pain, deformity, or inflammation, and is not a reason to perform knee replacement.
Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. Although records show that it has been implemented since the 1990s, CAOS is still an active research discipline which brings together orthopedic practitioners with traditionally technical disciplines, such as engineering, computer science and robotics.
Joint replacement is a procedure of orthopedic surgery known also as arthroplasty, in which an arthritic or dysfunctional joint surface is replaced with an orthopedic prosthesis. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by less-invasive therapies. Joint replacement surgery is often indicated from various joint diseases, including osteoarthritis and rheumatoid arthritis.
Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school or osteopathic medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.
Unicompartmental knee arthroplasty (UKA) is a surgical procedure used to relieve arthritis in one of the knee compartments in which the damaged parts of the knee are replaced. UKA surgery may reduce post-operative pain and have a shorter recovery period than a total knee replacement procedure, particularly in people over 75 years of age. Moreover, UKAs may require a smaller incision, less tissue damage, and faster recovery times.
Evan Flatow is an American orthopaedic surgeon-scientist. As of 2023, he is President of Mount Sinai West, part of the Mount Sinai Health System. He published more than 400 book chapters and peer-reviewed articles. Flatow is indicated as principal or co-principal investigator for nine research grants and listed on six patents for influential shoulder implant systems.
"Professor" Derek McMinn is a British orthopaedic surgeon and inventor who practised in Birmingham, United Kingdom at the BMI Edgbaston Hospital until his suspension in 2020. McMinn is currently under police investigation for allegedly keeping the body parts of thousands of patients over a 25-year period.
Michael J. Bronson is an American orthopaedic surgeon who is Chairman of the Department of Orthopedic Surgery, Mount Sinai West and Mount Sinai Morningside, and Chief of Joint Replacement Surgery at the Icahn School of Medicine at Mount Sinai in New York, and the author of advances in the development of minimally invasive surgical instruments to advance unicondylar partial knee replacement, including the Vision Total Hip System, a widely used hip replacement system that avoids the use of cement.
Khaled J. Saleh is a board-certified orthopaedic surgeon specializing in the diagnosis and treatment of orthopaedic conditions, and is known for surgery relating to adult reconstruction and joint replacement. Saleh's work has been supported by nearly $7 million in grant funding, resulting in over 200 scientific publications.
David Giorgio Mendes Nassi is an Israeli orthopedic surgeon who has developed advanced methodologies and systems in the area of Hip and Knee artificial joint replacement. .
The following outline is provided as an overview of and topical guide to trauma and orthopaedics:
Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.
Ashok Rajgopal is an Indian orthopaedic surgeon, credited with close to 20,000 Arthroscopic and over 35,000 Total Knee Arthroplasty surgeries and reported to be one of the most experienced in his field in India. He was honoured by the Government of India in 2014, by bestowing on him the Padmashri, the fourth highest civilian award, for his services to the fields of orthopaedic surgery. He has also been awarded the Dr. BC Roy award by the Medical Council of India to "Recognize the Best Talents in Encouraging the Development of Specialties in Different Branches in Medicine" for 2014.
Raymond Rocco Monto is a Board Certified orthopaedic surgeon with a practice on Nantucket, Massachusetts. Monto's work includes developments in sports medicine, Tennis elbow surgery, hip arthroscopy, platelet-rich plasma, and innovative orthobiologic treatments for chronic disorders including Achilles tendonitis and plantar fasciitis. Monto lectures frequently in the United States and around the world.
Reverse shoulder replacement is a type of shoulder replacement in which the normal ball and socket relationship of glenohumeral joint is reversed, creating a more stable joint with a fixed fulcrum. This form of shoulder replacement is utilized in situations in which conventional shoulder replacement surgery would lead to poor outcomes and high failure rates.
Raju Vaishya is an Indian researcher with contributions in the field of orthopaedics. He is former President and founder member of Indian Cartilage Society (2018–19) and Founder President of Arthritis Care Foundation. He has established a center for Autologous Chondrocyte Implantation (ACI) at Indraprastha Apollo Hospitals, New Delhi, India. Instrumental (PSI) in starting the first cartilage club in Delhi, to enhance the awareness about the cartilage science and regenerative treatments used in Orthopaedics. He has the credit of doing the first preplan patient specific instruments (PSI) total knee arthroplasty, in Northern India in May 2013.
Dr. Javad Parvizi is an American Board Certified orthopaedic surgeon and the director of clinical research at the Rothman Orthopaedic Institute, Philadelphia. He holds the James Edwards Professor Chair of Orthopaedics at Thomas Jefferson University. He is the co-founder of the International Consensus Meeting and President of the Musculoskeletal Infection Society (MSIS).
Justin Peter Cobb is a British professor of orthopaedic surgery at Imperial College London, known for introducing medical robotics into orthopaedic surgery. He is a member of the Royal Medical Household and was royal orthopaedic surgeon to the Queen. He is on the staff at King Edward VII's Hospital (KEVII) and is civilian advisor in orthopaedics to the Royal Air Force (RAF). His research has also included themes relating to designing new devices such as for ceramic hip resurfacing, 3D printing in orthopaedics, and training in surgical skills. He is a director of the MSk laboratory based in the Sir Michael Uren Hub.
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