From the Guidelines
The foundations of orthopaedic surgery are built on a thorough understanding of musculoskeletal anatomy, biomechanics, and pathophysiology, as well as mastery of surgical techniques and evidence-based practice. The core knowledge areas include bone, joint, muscle, tendon, ligament, and nerve structures and their interrelationships, with biomechanical principles explaining how forces affect the musculoskeletal system during movement and weight-bearing 1. Pathophysiology knowledge is essential for understanding disease processes like osteoarthritis, osteoporosis, and trauma responses.
Key areas of focus in orthopaedic surgery include:
- Surgical techniques, such as open procedures, arthroscopy, and minimally invasive approaches
- Fixation methods using plates, screws, nails, and prosthetic implants
- Perioperative management, involving patient selection, risk assessment, anesthesia coordination, and postoperative care
- Evidence-based practice, guiding treatment decisions based on the best available evidence, such as the findings that carpal tunnel decompression and total knee replacement show superiority over non-operative care 1
- Technological advances like computer navigation, robotics, and 3D printing, which continue to evolve the field
Orthopaedic surgeons must also develop strong clinical reasoning skills to diagnose conditions accurately through history-taking, physical examination, and appropriate imaging interpretation. According to a recent umbrella review of level 1 evidence, there is an urgent need to prioritize research into common elective orthopaedic interventions compared with no treatment, placebo, and non-operative treatment 1.
In terms of specific procedures, the evidence suggests that carpal tunnel decompression and total knee replacement are effective interventions, with a study published in the BMJ in 2021 finding that these procedures showed superiority over non-operative care 1. However, it is essential to note that most common elective orthopaedic interventions lack readily available high-quality evidence, highlighting the need for further research in this area.
From the Research
Foundations of Orthopaedic Surgery
- Orthopaedic surgery is a specialty of surgery dedicated to the prevention, diagnosis, and treatment of diseases and injuries of the musculoskeletal system in all age groups 2
- Careers in orthopedic surgery span the spectrum from general orthopedics to those of subspecialty expertise in orthopedic trauma, hand, pediatrics, total joint, foot and ankle, sports medicine, and oncology to name a few 2
Preoperative Planning
- Preoperative planning is an essential prerequisite for the success of orthopaedic procedures 3
- Traditionally, preoperative planning involved the written down, step by step "blueprint" of the surgical procedure, but advances in technology have led to the use of software that enables surgeons to perform preoperative planning on digital radiographs and to construct 3D digital models or prototypes of various orthopaedic pathologies from a patient's CT scans 3
- Evidence-to-date suggests that preoperative planning and briefings are effective means of favorably influencing the outcomes of orthopaedic procedures 3
Sedation Practices
- There is limited direct evidence on sedation practices in orthopaedic surgery, but a study on MRI sedation practices found that many outpatients may be scanned before the peak effect of anxiolytics prescribed, and that a standard sedation protocol is associated with a more appropriate drug choice, as well as optimized monitoring and postprocedure care 4