Orthopedic Surgery

What is ​Orthopedic Surgery?

​Orthopedic surgery is the medical specialty concerned with the surgical and non-surgical treatment of the musculoskeletal system — the bones, joints, muscles, tendons, and ligaments that give the body its structure and allow it to move. It also addresses certain related problems of the nervous system, particularly those arising from injury or degeneration of the spine.

Orthopedic surgeons are trained to manage conditions spanning the full spectrum from acute injuries, such as fractures and torn ligaments, to chronic degenerative diseases, such as osteoarthritis and osteoporosis. Because mobility is so central to daily independence and quality of life, orthopedic surgery plays a significant role in helping patients regain or preserve their ability to move, work, and remain active, whether through surgery, rehabilitation, or a carefully managed combination of both.

Understanding the Musculoskeletal System

The musculoskeletal system is built around the skeleton, a framework of bones that provides structural support and protects the body's internal organs. Where two bones meet, a joint is formed, allowing movement that is guided and stabilised by ligaments, which connect bone to bone, and supported by muscles and tendons, which connect muscle to bone and generate the force needed for movement.

Cartilage, a smooth, flexible tissue found at the ends of bones within joints, allows bones to glide against one another with minimal friction. When any part of this system — bone, joint, muscle, tendon, ligament, or cartilage — becomes damaged, worn, or diseased, it can affect not only that specific area but the broader mechanics of movement, which is why orthopedic assessment often looks beyond the immediate area of pain.

Areas of Focus Within Orthopedic Surgery

Orthopedic surgery covers several specialised areas, often corresponding to a particular part of the body or type of condition:

• Joint Reconstruction: Focuses on the surgical treatment of severely damaged or arthritic joints, most commonly the hip and knee, including partial or total joint replacement.
• Spine Surgery: Addresses conditions affecting the vertebrae, spinal discs, and associated nerves, ranging from degenerative disease to spinal fractures and deformity.
• Sports Medicine: Concerned with injuries related to physical activity and sport, including ligament and tendon injuries, with an emphasis on returning patients to their desired level of activity.
• Hand and Upper Limb Surgery: Covers conditions affecting the hand, wrist, elbow, and shoulder, from nerve compression syndromes to rotator cuff injuries.
• Foot and Ankle Surgery: Addresses structural and soft tissue conditions of the foot and ankle, including deformities, tendon injuries, and fractures.
• Trauma Surgery: Focuses on the urgent surgical management of fractures and musculoskeletal injuries resulting from accidents or significant trauma.
• Musculoskeletal Oncology: Concerned with the diagnosis and treatment of tumours arising in bone or soft tissue, including both primary bone cancers and cancers that have spread to bone.

Common Orthopedic Conditions

Orthopedic surgeons diagnose and treat a wide range of conditions, generally grouped by the area of the body affected:

Hip and Knee Conditions

• Osteoarthritis: The most common form of arthritis, in which the cartilage cushioning a joint gradually wears down over time, causing pain, stiffness, and reduced flexibility, most often affecting the knees, hips, and spine.
• Damaged hip joints: Wear, injury, or inflammatory conditions affecting the hip, a ball-and-socket joint essential for stability and mobility, can significantly affect the ability to walk, stand, and maintain balance.
• Damaged knee cartilage: Injury or gradual wear of the cartilage cushioning the knee joint can cause pain, swelling, and disability, and is commonly associated with osteoarthritis or a specific injury.
• Meniscus tear: A tear in the C-shaped cartilage that cushions the knee joint, often causing pain, swelling, stiffness, and difficulty fully extending the knee.
• Anterior cruciate ligament (ACL) tear: A partial or complete tear of the ligament that stabilises the knee joint, commonly occurring during sports involving sudden stops, twists, or changes in direction.
• Knee fracture: A break in the kneecap (patella), often resulting from a direct impact such as a fall or vehicle accident, or from a sudden, forceful contraction of the thigh muscles.

Spinal Conditions

• Spondylosis: A general term for degenerative changes in the spine resulting from the gradual wear and tear of spinal discs and joints over time.
• Slipped (herniated) disc: Occurs when the outer ring of a spinal disc tears, allowing its soft inner core to protrude and potentially press on nearby nerves, causing pain that may radiate beyond the back.
• Degenerative disc disease: Age-related changes to the structure of the spinal discs, sometimes accelerated by injury, which can lead to reduced disc height and flexibility over time.
• Spinal stenosis: A narrowing of the spinal canal that places pressure on the spinal cord or nerves, often causing pain, numbness, or weakness, particularly in the legs.
• Spinal fractures: Breaks in one or more bones of the spinal column, which can result from significant trauma or from weakened, osteoporotic bone.
• Scoliosis: An abnormal sideways curvature of the spine, which can vary considerably in severity and may require monitoring or treatment depending on the degree of curvature.
• Lower back pain: A very common condition affecting the lumbar region of the spine, which can stem from a wide range of underlying causes, from muscular strain to disc or joint-related problems.

Shoulder and Elbow Conditions

• Rotator cuff tear: An injury to the group of muscles and tendons stabilising the shoulder joint, which can result from gradual degeneration or a specific incident such as a fall.
• Frozen shoulder: A condition, also known as adhesive capsulitis, causing pain and progressive stiffness in the shoulder joint, most common in adults between the ages of 40 and 60 and more frequent among those with diabetes.
• Dislocated shoulder: Occurs when the head of the upper arm bone is forced out of its socket, often during sports or traffic accidents, and requires prompt repositioning and assessment.
• Tennis elbow: An overuse injury causing pain at the bony point on the outside of the elbow, resulting from repeated gripping and wrist movements, whether from sport, work, or everyday activity.
• Elbow dislocation: Occurs when the bones of the elbow joint are forced out of alignment, typically from a fall onto an outstretched arm, and can occur alongside a fracture.

Hand and Wrist Conditions

• Trigger finger or thumb: A condition in which a finger or thumb becomes stuck in a bent position before suddenly straightening, caused by inflammation and narrowing of the tendon sheath.
• Carpal tunnel syndrome: Compression of the median nerve as it passes through the wrist, causing numbness, tingling, and weakness in the thumb and first few fingers, often worsened by repetitive hand and wrist use.

Foot and Ankle Conditions

• Flat feet: A condition in which the arches of the feet flatten under pressure, which can contribute to pain or altered gait in some individuals.
• Ankle sprains and fractures: Injuries resulting from an awkward twist or forceful impact to the ankle, ranging from ligament sprains to bone fractures.
• Bunions: A bony deformity at the base of the big toe, usually developing gradually due to sustained pressure that pushes the big toe out of its normal alignment.
• Plantar fasciitis: Inflammation of the thick band of tissue running along the bottom of the foot, and the most common cause of heel pain.
• Achilles tendonitis: Inflammation of the Achilles tendon connecting the calf muscles to the heel bone, commonly resulting from overuse during sports or repetitive activity.

Bone and Systemic Conditions

• Fractures: A broad term for any cracked or broken bone, ranging from simple breaks that heal with immobilisation to complex fractures requiring surgical stabilisation.
• Osteoporosis: A condition in which bones lose density and strength as mineral loss outpaces the body's ability to rebuild bone tissue, significantly increasing the risk of fracture, particularly in the hip, spine, and wrist.
• Gout: A form of arthritis caused by a build-up of uric acid crystals within a joint, causing sudden, severe pain and swelling that can last for days to weeks.
• Rheumatoid arthritis: An autoimmune condition in which the body's immune system mistakenly attacks the lining of the joints, causing inflammation, pain, and progressive joint damage.
• Tendonitis: Inflammation of a tendon, the connective tissue linking muscle to bone, generally resulting from overuse or repetitive strain.
• Bone cancer: An uncommon cancer that can develop directly within a bone (primary bone cancer) or spread to bone from elsewhere in the body (secondary or metastatic bone cancer), affecting people of all ages.

Recognising When to See an Orthopedic Surgeon

• Persistent joint pain: Pain in a joint that continues for several weeks, worsens over time, or does not respond to rest and over-the-counter pain relief, generally warrants further evaluation.
• Reduced range of motion: Noticeable difficulty moving a joint through its normal range, or stiffness that limits everyday activities, can indicate an underlying structural problem.
• A recent injury with swelling or instability: Significant swelling, bruising, or a feeling that a joint is "giving way" following an injury should be assessed promptly to rule out a fracture or ligament tear.
• Numbness, tingling, or weakness: These symptoms, particularly in the hands, arms, or legs, can indicate nerve compression, whether from a spinal condition or a localised issue such as carpal tunnel syndrome.
• A visible deformity or inability to bear weight: An obviously misshapen limb or an inability to put weight on an injured leg or ankle generally indicates a fracture or dislocation requiring urgent assessment.
• Chronic back or neck pain: Pain that persists, radiates into the arms or legs, or is accompanied by numbness or weakness, may indicate an underlying spinal condition worth investigating.

Risk Factors for Musculoskeletal Conditions

• Age: The risk of degenerative conditions such as osteoarthritis, osteoporosis, and spinal disc disease increases progressively with age, as cartilage, bone density, and disc structure naturally decline over time.
• Repetitive strain and overuse: Activities involving repeated movements, whether from sport, occupation, or hobbies, increase the risk of tendon and joint injuries such as tennis elbow and tendonitis.
• Sports participation: Certain sports carry a higher risk of acute injuries such as ligament tears, fractures, and dislocations, particularly those involving contact, jumping, or rapid changes in direction.
• Obesity: Excess body weight places additional mechanical strain on weight-bearing joints, particularly the knees and hips, accelerating cartilage wear over time.
• Low bone density: Reduced bone density, whether due to age, menopause, or other factors, significantly increases the risk of fractures, even from relatively minor falls.
• Autoimmune and metabolic conditions: Conditions such as rheumatoid arthritis and gout have their own distinct risk factors, including genetic predisposition and, in the case of gout, diet and metabolic factors affecting uric acid levels.
• Smoking: Smoking impairs bone healing and has been associated with reduced bone density, increasing the risk of both fractures and complications following orthopedic surgery.

How Orthopedic Surgeons Diagnose Conditions

• Clinical examination: A thorough physical assessment of movement, strength, stability, and areas of tenderness forms the foundation of every orthopedic evaluation.
• X-rays: Typically the first imaging test used, X-rays provide a clear view of bone structure, making them effective for detecting fractures, joint space narrowing, and alignment issues.
• CT scans: Provide a more detailed, cross-sectional view of bone and surrounding structures than a standard X-ray, often used when a more precise assessment of a complex fracture or spinal condition is needed.
• MRI scans: Particularly useful for evaluating soft tissue structures such as ligaments, tendons, and cartilage, which do not show up clearly on X-ray.
• Bone mineral densitometry (DEXA scan): Measures bone density, most commonly used to diagnose osteoporosis and assess fracture risk, particularly in postmenopausal women and older adults.
• Nerve conduction studies: Used to assess nerve function in conditions such as carpal tunnel syndrome, helping confirm the diagnosis and gauge its severity.
• Joint fluid analysis: In certain cases, such as suspected gout, fluid may be drawn from an affected joint and examined to confirm the presence of uric acid crystals or rule out infection.

Treatment Approaches in Orthopedic Surgery

Orthopedic treatment generally begins with the least invasive appropriate option, progressing to surgery only when more conservative measures do not adequately relieve symptoms or restore function.

• Medication: Pain relief and anti-inflammatory medications help manage symptoms for many orthopedic conditions, while specific medications are used to address conditions such as gout and osteoporosis.
• Physiotherapy: Structured exercise and movement therapy helps strengthen supporting muscles, improve flexibility, and restore function, often forming the first line of treatment for many musculoskeletal conditions.
• Bracing and splinting: External supports help stabilise an injured joint or limb, protecting it during the healing process or while awaiting further treatment.
• Injections: Corticosteroid or other targeted injections can help reduce inflammation and pain directly at the site of a joint or tendon problem.
• Arthroscopy: A minimally invasive surgical technique using a small camera and instruments inserted through tiny incisions, commonly used to diagnose and treat joint problems such as meniscus tears.
• Joint replacement surgery: For severely damaged or arthritic joints, most commonly the hip or knee, the damaged joint surfaces are removed and replaced with an artificial prosthesis, typically considered once other treatments have failed to adequately relieve pain or restore function.
• Fracture fixation: Surgical stabilisation of a broken bone using plates, screws, rods, or pins, used for fractures that are unlikely to heal properly without surgical support.
• Spinal surgery: A range of procedures addressing conditions such as herniated discs and spinal stenosis, aimed at relieving pressure on the spinal cord or nerves and stabilising the spine where needed.
• Tendon and ligament repair: Surgical repair or reconstruction of torn tendons or ligaments, such as the rotator cuff or ACL, aimed at restoring joint stability and function.

The Role of Rehabilitation in Orthopedic Recovery

Recovery from an orthopedic condition or procedure rarely ends once surgery is complete, or once an injury has been treated. Rehabilitation, the structured process of restoring strength, movement, and function, plays a central role in determining how fully and how quickly a patient returns to their normal activities.

A tailored rehabilitation programme, often combining physiotherapy with a gradual, staged return to activity, helps rebuild the strength and confidence needed to use a joint or limb safely again, while also reducing the risk of re-injury. For conditions involving significant muscle or joint deconditioning, whether due to prolonged immobility, ageing, or a chronic health condition, rehabilitation addresses not just the original injury but the broader physical capability needed for daily life.

Orthopedics and Ageing: Protecting Bone and Joint Health

Joint pain and reduced bone strength are common concerns as people age, though they are not always an inevitable part of ageing itself. Cartilage naturally thins over time, bone density gradually declines, particularly after menopause, and the combined effect of years of use can contribute to conditions such as osteoarthritis and osteoporosis.

• Maintaining physical activity: Regular, joint-friendly exercise helps preserve muscle strength and joint flexibility, both of which support mobility and reduce the risk of falls.
• Monitoring bone density: Regular bone density screening, particularly for postmenopausal women and older adults, allows osteoporosis to be identified and treated before a fracture occurs.
• Fall prevention: Since fractures in older adults often result from falls, addressing home safety, balance, and strength plays an important role in protecting bone health.
• Adequate nutrition: Sufficient calcium and vitamin D intake supports bone strength, while adequate protein intake helps maintain muscle mass as part of overall musculoskeletal health.

Advances in Orthopedic Surgery

Orthopedic surgery continues to evolve with new technology aimed at improving precision and outcomes for patients.

• Robotic-assisted surgery: Robotic systems are increasingly used in joint replacement surgery to help surgeons achieve more precise implant positioning, which may contribute to improved joint function and implant longevity.
• Artificial intelligence in surgical planning: AI-based tools are increasingly used to assist with pre-operative planning, helping tailor the surgical approach more precisely to an individual patient's anatomy.
• Minimally invasive techniques: Ongoing refinement of arthroscopic and other minimally invasive techniques continues to reduce surgical trauma, generally supporting shorter hospital stays and faster recovery.

Many musculoskeletal conditions, particularly chronic ones such as osteoarthritis, osteoporosis, and rheumatoid arthritis, are managed on an ongoing basis rather than cured outright. With an appropriate combination of treatment, rehabilitation, and lifestyle adjustment, the great majority of patients are able to maintain meaningful mobility and continue participating in the activities that matter most to them.

Our dedicated teams of experienced multidisciplinary specialists and healthcare professionals work together to provide treatment plans tailored to the needs of our patients on their recovery journey.

Speak to our Specialists today.