Arthritis, a broad term for joint inflammation and damage, is a common source of chronic pain and disability. While multiple specialists play a role in arthritis management, the orthopedic surgeon holds a distinct position. This article clarifies the orthopedic surgeon’s specific role, which extends beyond just surgical intervention in the treatment of joint disease.
Understanding the Difference Between Specialists
The care for arthritis is typically divided between rheumatology and orthopedic surgery. The distinction lies in their focus: the rheumatologist manages the disease, and the orthopedic surgeon manages the resulting structural damage.
The rheumatologist specializes in the medical management of systemic, inflammatory, and autoimmune diseases, such as Rheumatoid Arthritis or Psoriatic Arthritis. They diagnose the underlying cause of inflammation and manage disease progression using pharmacological treatments. Medications like DMARDs and biologics control the immune response throughout the body.
The orthopedic surgeon specializes in the mechanical and structural integrity of the musculoskeletal system. Their expertise centers on the damage caused by arthritis, most commonly Osteoarthritis, a “wear-and-tear” condition. They focus on restoring function, managing localized pain, and correcting physical deformities. When inflammatory arthritis progresses to severe joint destruction, the surgeon manages the end-stage mechanical problems.
Non-Surgical Care Managed by Orthopedics
An orthopedic specialist’s involvement often begins with conservative, non-invasive treatments aimed at preserving the joint and delaying the need for operative procedures. Physical therapy is a cornerstone of non-surgical management, focusing on strengthening surrounding muscles to improve stability and absorb shock. Therapists also work to maintain or improve the joint’s range of motion, reducing stiffness and improving mobility. Mechanical support, such as bracing or assistive devices, helps offload pressure from damaged joint surfaces, particularly in the knee or ankle.
Localized pharmacological interventions are administered to manage acute symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) are a common initial recommendation, helping to decrease swelling and pain. For more direct relief, orthopedic surgeons utilize joint injections.
Corticosteroid injections deliver a potent anti-inflammatory agent directly into the joint space to quickly reduce swelling and pain, offering temporary relief. Another option is viscosupplementation, which involves injecting hyaluronic acid, a gel-like substance, into the joint (most commonly the knee). Since hyaluronic acid acts as a lubricant and shock absorber, the injection supplements depleted joint fluid to improve movement.
Surgical Options for Severe Arthritis
When conservative treatments fail to provide adequate pain relief or functional improvement, the orthopedic surgeon evaluates the patient for surgery. The goal of these procedures is to alleviate pain and improve mechanical function through repair or replacement.
Total joint arthroplasty, or joint replacement, is the most common surgical procedure for severe, end-stage arthritis, especially in the hip and knee. This involves removing damaged cartilage and bone surfaces and replacing them with prosthetic components made of metal, plastic, or ceramic. The artificial joint replicates the smooth, pain-free motion of a healthy joint, offering a durable solution for advanced joint destruction.
For younger patients with localized arthritis damage, an osteotomy may be performed to realign the joint and redistribute weight-bearing forces. This technique involves cutting and reshaping the bone near the joint to shift the load from the damaged area to a healthier surface. Reducing stress on the affected area can effectively delay the need for total joint replacement for many years.
Arthrodesis, or joint fusion, is another surgical option where two or more bones are permanently joined together using plates, screws, or rods. While this eliminates all motion in the joint, it also eliminates bone-on-bone pain and provides maximum stability. This procedure is typically reserved for smaller joints, such as those in the ankle, wrist, or spine, where stability is prioritized over maintaining a full range of motion. Arthroscopy, a minimally invasive technique using a small camera, is sometimes used to remove loose fragments of cartilage or bone.