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Orthopaedics is a branch of medicine that deals with correction of bone and muscle deformity, often with the use of surgery. It is estimated to cost £8,785,890 a year, accounting for 16% of the total cost of surgery in the UK. Whilst hip and knee replacements are the most common major procedures in orthopaedic surgery, this diverse department performs a range of other techniques from arthroscopy to muscle and tendon repair to corrective surgery for anatomical malalignment.
‘Arthroscopy’ is essentially key-hole surgery in joints. It involves making a few small incisions around the joint and the introduction of instruments like a scope (a small camera so you can see the inside of the joint) and specially adapted tools to manipulate the tissues inside. This procedure is often used to visualise different parts of the joint to assess the level of joint damage or injury and to diagnose conditions like arthritis. It can also be used to deliver treatments such as cartilage repair, removal of loose fragments or excess fluid drainage.
As the incisions are very small, there is often less post-operative pain in comparison to an ‘open’ surgery, and a quicker recovery. In fact, patients undergoing arthroscopy are often day cases, meaning that they don’t need to stay in the hospital overnight. Arthroscopy can be used in several joints, such as knees, hips, ankles, shoulders, elbows and wrists, to both assess joint damage and deliver therapeutic treatments.
Generally, fractures are managed using ‘internal’ or ‘external’ fixation. External fixation, using metal frames and braces or casting, stabilises the bones and soft tissues from outside allowing the bones to heal. Internal fixation involves the surgical implantation of plates, screws and wires to physically align the bones and hold them together whilst they heal.
After an injury, a specialist will be able to examine the affected bones and look at X-rays and other necessary imaging to determine if there is a fracture or break in the bone. Following this, they will be able to decide on the best option to treat that fracture and allow the bone to heal correctly and restore function.
Arthroplasty is the medical term for joint replacement, and is most commonly used to replace the hip and knee joints, increasingly so in the ageing population. This can be used as curative treatment for many joint problems, such as fractures or arthritis, where pain and reduced mobility have a significant impact on day-to-day activities.
Joint replacement can confer significant benefits including reduced pain and improved range of motion in the affected joints. This can have a massive knock-on effect on general well-being, health and independence.
Orthopaedic specialists are also able to treat injuries in muscles and soft tissues. Conditions such a tendonitis or tendon or muscle tears can be managed surgically to physically repair tears or remove damaged tissue. For the majority of problems involving soft tissue damage, conservative treatment such as physiotherapy and pain relief is effective. In cases where this is not sufficient, invasive surgery is often beneficial in managing these conditions and restoring function.
Some conditions affecting the anatomical alignment of bones (e.g. scoliosis causing lateral curvature in the spine) can severely limit function and cause long-term pain and problems if left untreated. Orthopaedic specialists can use a number of surgical and fixation techniques to re-align, treat and monitor these conditions to prevent the development of more serious problems.
Aside from traumatic injuries, orthopaedic surgery is commonly used to treat long-term, chronic joint conditions. However, there are a wide array of treatment options available before surgery is necessarily required. For weight-bearing joints (knees, hips and ankles), weight loss and exercise are often enough to alleviate pain and restore function. Physiotherapy is also a fantastic way to treat joint and soft tissue problems. Injections (usually steroid-based) are another alternative to manage these kinds of conditions. Failing these, surgery is usually the next course of action in treatment, and, aside from the risks associated with surgery, are generally successful in returning people back to their original function and daily living. The specialty of orthopaedic medicine encompasses all of this within a multidisciplinary team of surgeons, physiotherapists, specialist nurses and occupational therapists.