The musculoskeletal system is a framework of bones, joints, muscles, ligaments, and tendons that provides the body’s structure, stability, and movement. When disease, trauma, or chronic wear compromises this system, specialized procedures are necessary to restore function and manage discomfort. These interventions are performed by orthopedic surgeons with the goal of repairing injuries, correcting structural deformities, and alleviating persistent pain that has not responded to non-surgical treatments. The procedures range from minimally invasive techniques used for diagnosis to extensive surgeries that replace damaged components.
Procedures Focused on Joints: Replacement and Visualization
Procedures targeting the body’s articulation points, or joints, are frequent given the high incidence of wear-and-tear conditions like osteoarthritis. The most definitive treatment for a severely damaged joint surface is arthroplasty, commonly known as joint replacement. This surgical process involves removing the diseased or damaged parts of a joint and replacing them with a prosthetic implant made of metal, plastic, or ceramic components. A total joint replacement, such as a total hip or total knee arthroplasty, involves resurfacing both sides of the joint to eliminate the source of bone-on-bone friction and restore smooth motion.
Partial joint replacement, or unicompartmental arthroplasty, may be an option when damage is confined to only one section of the joint. The goal of any arthroplasty is to relieve the chronic pain associated with advanced arthritis or severe injury and significantly improve the patient’s quality of life and mobility. These implants are designed to mimic the motion of the natural joint.
A less invasive approach to treating joint issues is arthroscopy, a procedure that allows surgeons to visualize the inside of a joint without making a large incision. The surgeon inserts an arthroscope, a thin instrument containing a camera, through small incisions. This technique is used for both diagnosis and treatment of internal joint problems, typically those affecting the soft tissues and cartilage.
Arthroscopy is commonly used for procedures like repairing a torn meniscus in the knee, addressing labral tears in the hip or shoulder, or removing loose fragments of bone or cartilage. Because the incisions are small, this method generally leads to less soft tissue damage, quicker recovery times, and reduced post-operative pain compared to traditional open surgery. Visualization provides detailed images, enabling precise repair and manipulation within the joint space.
Interventions for Bone Trauma and Stabilization
When a bone sustains a complex fracture, stabilization is required to ensure proper healing and alignment. Open Reduction Internal Fixation (ORIF) is a procedure used to treat fractures that are displaced, unstable, or involve the joint surface. The “open reduction” means the surgeon makes an incision to visually realign the broken bone fragments into their anatomical position.
The “internal fixation” component involves securing the realigned bones using specialized hardware, which may include metal plates, screws, rods, or pins. For long bones, an intramedullary rod may be inserted down the central canal to provide stability from the inside. This hardware holds the bones firmly in place, allowing the natural healing process to occur while maintaining the correct alignment of the bone.
In cases of severe trauma, such as open fractures or extensive soft tissue damage, external fixation may be chosen. This technique involves placing metal pins or wires into the bone fragments through small incisions, connecting them to a rigid frame located outside the body, forming a scaffold-like structure that stabilizes the fracture. External fixation provides immediate stability, often necessary when severe swelling or contamination prevents immediate internal fixation. It can be used as a temporary measure until the soft tissues have healed enough for ORIF, or it may serve as the definitive treatment. While ORIF is the primary surgical method, non-operative methods like casting and splinting are still routinely used for simple, non-displaced fractures.
Surgical Treatment of Soft Tissues and Nerve Compression
Musculoskeletal procedures frequently focus on the surrounding non-bony structures, including tendons, ligaments, and peripheral nerves. Tendon and ligament repair procedures are common, particularly following sports injuries or traumatic events that result in a tear. For example, an anterior cruciate ligament (ACL) reconstruction often involves replacing the torn ligament with a graft taken from another tendon, such as the hamstring or patellar tendon, to restore knee stability.
Similarly, a rotator cuff repair addresses tears in the tendons surrounding the shoulder joint by reattaching the torn tendon back to the bone. These repairs aim to restore the structural integrity of the joint and enable the patient to regain full strength and range of motion. Many soft tissue repairs are now performed using minimally invasive arthroscopic techniques, reducing the size of the surgical incision and the resulting recovery time.
Another category targets nerve compression, where surrounding tissues press on a nerve, causing pain, numbness, or weakness. Nerve decompression surgery involves locating the point of pressure and surgically removing or releasing the structure that is causing the entrapment. Carpal Tunnel Release is a common example, where the transverse carpal ligament in the wrist is cut to relieve pressure on the median nerve.
A similar procedure is performed for cubital tunnel syndrome, involving compression of the ulnar nerve at the elbow. In some cases, the nerve may also be repositioned, or transposed, to prevent it from being compressed again by surrounding anatomical structures. By relieving the pressure on the nerve, these procedures aim to restore normal nerve signaling and alleviate the symptoms of nerve entrapment.
Specialized Spinal Column Procedures
Procedures involving the vertebral column are specialized due to the complex nature of the spine and its proximity to the nervous system. Spinal fusion, or arthrodesis, is a definitive stabilization procedure, involving the permanent joining of two or more vertebrae into a single, solid bone. This is typically achieved by placing bone graft material between the vertebrae and using metal hardware, such as plates, screws, and rods, to hold them immobile while the bone heals.
Fusion is performed to stabilize the spine following trauma, to correct deformities like scoliosis, or to treat chronic pain caused by degenerative conditions that make the spine unstable. While it eliminates motion at the fused segment, the goal is to resolve instability and alleviate associated nerve pain.
Another common group of spinal interventions are decompression procedures, which aim to relieve pressure on the spinal cord or nerve roots. A laminectomy involves removing the lamina, the bony arch on the back of the vertebra, to enlarge the spinal canal and create more space for the nerves. This is often used to treat spinal stenosis, a narrowing of the canal.
A discectomy is a procedure frequently performed alongside a laminectomy, where a surgeon removes a damaged or herniated portion of an intervertebral disc that is pressing on a nerve. Many of these spinal procedures are increasingly performed using minimally invasive techniques, utilizing small incisions and specialized retractors to minimize damage to the surrounding muscles. These less-invasive methods can lead to faster recovery times compared to traditional open spine surgery.