While the special interests of all orthopaedic specialists are the diagnosis and treatment of disorders of the musculoskeletal system, the role of these healthcare professionals may be fulfilled in a variety of ways. Often referred to by colleagues in other disciplines as orthopods, some choose to adopt the role of a physician, applying non-surgical techniques like braces, traction, and medication to treat patients with postural problems, malformations of the spine such as scoliosis, and simple fractures. Of these, some may choose to focus on sports medicine, treating sports-related injuries and favouring a preventative approach where possible.
Others will have completed a course of surgery enabling them to perform the more invasive procedures often required when treating severe trauma cases, as well as those with degenerative conditions of the bones and joints, such as osteoarthritis. Likewise, even among the specialists in orthopaedic surgery, many decide to limit their focus even further. For example, there are those who choose to concentrate on applying the unique skills associated with the treatment of musculoskeletal disorders in paediatric patients. Others will devote their time to the surgical repair of complex fractures to restore mobility and, in extreme cases, even to avoid the need for an amputation.
Among the most recent of these sub-specialisms are arthroscopy and arthroplasty, both of which have been experiencing a marked increase in demand, in recent years. The invention of the arthroscope marked a significant turning point for the capabilities of the orthopaedic specialist, particularly in the area of diagnostics. Inserted into a joint, this invaluable instrument provides the user with a magnified, full-colour video image of the bones of the joint and the surrounding soft tissue that is far more informative than a conventional X-ray. No longer restricted to a diagnostic role, arthroscopy has since been adapted as a means to perform a number of minimally invasive procedures that would, previously, have required the surgeon to expose the entire joint.
Smart tools apart, undoubtedly the most significant advances in this discipline have been the development of prosthetic joints and the surgical techniques of arthroplasty required to implant them. The average orthopaedic specialist of today tends to regard this as the single most successful intervention in the history of the discipline to date.
Most often performed on patients with advanced osteoarthritis, arthroplasty involves the removal of any diseased sections of bone and their subsequent replacement with synthetic substitutes designed to assume their functions. The parts used may be metallic, ceramic, or plastic, and used in various combinations of metal-on-plastic, metal-on-metal, and ceramic-on-ceramic.
While it tends to be the total or partial replacement of a damaged knee or hip joint that an orthopaedic specialist is most often called upon to perform, replacements of shoulder, hip, and ankle joints are also routinely undertaken by many surgeons today. Furthermore, where once these were highly invasive procedures, there has been huge progress in the development of minimally invasive techniques that combine the use of an arthroscope with a coupe of keyhole incisions.
These procedures, however, are exacting and require exceptional skills and experience on the part of an orthopaedic specialist who is willing to undertake them. For patients in South Africa, those skills are to be found at the Life Wilgers Hospital in Pretoria.