The practice of orthopedics has sub-specialties; for example, a surgeon may specialize in hand and wrist procedures; another may devote her/his expertise to knee and hip joint replacements. Knee ligament repairs are another area that some orthopedic surgeons attain eminence. Since torn knee ligaments are relatively frequent in professional and amateur sports, there are those whose reputation is well known among athletes and their agents. One example is Dr. James P. Bradley, M.D. M.S., one of the principals of Burke & Bradley Orthopedics at the University of Pittsburgh Medical Center. He is also the head surgeon for the Pittsburgh Steelers.
Knees
Numerous injuries and degenerative conditions require knee surgery. One of the standards for sports activities, such as soccer, football, and basketball, is damage to the anterior cruciate ligament or ACL (located in the center of the knee joint). Approximately 50% of ACL tears involve injury to other structures of the knee. The action of pivoting, sidestepping, and awkward landings causes the most injuries to ACLs. Consequently, there are more than 150,000 ACL surgeries annually in the United States. However, not all ACL injuries necessitate surgery, although the individual may still need the services of an orthopedic specialist to make a diagnosis.
Injuries also occur to the posterior cruciate ligament (PCL) (located in the back of the knee) and the Collateral Ligament (located on the sides of the knee). The latter consists of the lateral collateral ligament on the outside of the knee. Its counterpart is the medial collateral, situated on the inside of the knee.
Partial and total knee replacements (TKR) occur on a more frequent basis than ligament injuries. There are more than 250,000 ligament injuries each year. However, there are about 700,000 in 2014, according to the American Academy of Orthopaedic Surgeons (AAOS) report of 2018. The majority of these surgeries are for people 65 years and older. Many candidates for a TKR suffer from osteoarthritis that can lead to a breakdown of the knee joint. The condition causes severe pain and lack of mobility.
Hips
Hip arthroplasty or total hip replacement (THR) is second to knees for major joints needing surgery. The AAOS reported that there are about 400,000 THRs each year. As with knees, the prevalence of hip operations continues to increase as the U.S. population has a higher percentage of seniors who remain active. THRs may increase by 142% by 2030 to reach 1.23 million replacements annually! Because of the quantity of potential surgical candidates, some orthopedic surgeons specialize in total or partial knee and hip procedures.
Shoulder
The number of people seeking medical treatment for shoulder injuries may exceed 8 million annually in the U.S. Approximately half of these involve the rotator cuff. It consists of muscles and tendons that keep the ball of the humerus or upper arm bone attached to the shoulder socket. The four muscles and tendons that play a role are:
- Supraspinatus – lifts your arm
- Infraspinatus – rotates and extends the arm
- Teres Minor – assists in arm rotation
- Subscapularis – rotates, helps you hold the arm straight out and lower it
Damage to the rotator cuff is typical in sports as tennis, swimming, and baseball, as well as physical labor, where there is a lot of repetitive motion. Examples of the latter are painting, carpentry, and construction (hammering). Wear and tear, or trauma to the joint, is another cause. The more severe and frequent damage is a partial or full-thickness or complete tear of the supraspinatus tendon. As with all major joints, degeneration occurs with age. The good news is that 80% of patients do not need surgery.
Spine
This category is a sub-specialty for orthopedic surgeons. The necessity for surgery might be the result of trauma, osteoarthritis, displaced discs, a curvature of the spine, and fracture. The latter procedure, known as kyphoplasty, is the result of a compression fracture to the spine. The minimally invasive operation stabilizes the bone with a liquid cement injection.
An orthopedic surgeon or a neurosurgeon can perform a discectomy. When there is a herniated or ruptured disc in the spine, the surgeon removes the damaged portion of the disc. The procedure may require the complete removal of the disc if the bulging disc is pinching a nerve.
Patients with degenerative bone in the spine may need a spinal fusion. The surgeon places a bone or bone-like material between two vertebrae. Alternatively, metal plates, rods, and screws might be required to hold the vertebrae together to restore the stability of the spine.
Operations of the spine may also result from spondylolisthesis, a condition when one or more of the vertebrae slips out of place. The three principal causes are congenital (birth deformity), isthmic (stress fractures), and degenerative. The latter is common in aging discs that lose their sponginess allowing bone to rub on bone in the spinal column. When chronic pain and decreased mobility occur, the orthopedic surgeon may recommend a spinal fusion or stabilization of the vertebrae.
Finally, one injury requiring an orthopedic specialist affects about 6 million people in the U.S. each year. The damage is a fracture or broken bone that, in most cases, demands immediate medical attention. The most common fracture before age 75 involves the wrist. Tibial fractures (shin bone) have the highest number of breaks among the body’s long bones, with roughly 500,000 fractures yearly. More severe breaks, particularly open fractures (protrusion through the skin), may need the surgeon to repair using screws, plates, or rods as a permanent attachment to the tibia.
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