All about musculoskeletal surgeries

Table of contents

• Introduction

• Who might require musculoskeletal surgery?

• Benefits of musculoskeletal surgeries

• Types of musculoskeletal surgeries

• What to expect before & after a musculoskeletal surgery?

• Risks & complications associated with musculoskeletal surgeries

• Take home points

• FAQs on musculoskeletal surgery

Introduction

What is musculoskeletal surgery?

Musculoskeletal surgery is a branch of medicine that focuses on diagnosing, treating, and preventing diseases and injuries in the musculoskeletal system. This includes bones, joints, muscles, tendons, ligaments, nerves, and other tissues involved in the movement. Musculoskeletal surgeons or orthopedic surgeons treat conditions such as fractures, dislocations, arthritis and other joint disorders, sports-related injuries, spinal deformities, or trauma. They also perform minimally invasive procedures to treat musculoskeletal pain or injury, such as arthroscopy or joint replacement. Musculoskeletal surgeons work closely with physical therapists and other healthcare professionals to ensure that patients receive comprehensive care. 

Who might require musculoskeletal surgery?

People requiring musculoskeletal surgery include those with

1. Pain and inflammation due to overuse injuries.

Overuse injuries occur due to overuse, staying in one position for too long, and repetitive work-related activities, which could expose muscles and tendons to constant wear and tear. The continuous stress and wear and tear cause pain and inflammation. 

Overuse injuries are also called repetitive strain injuries or cumulative trauma disorders (CTDs).

Examples of common CTDs include

• Neck pain,

• Shoulder pain,

• Lower back pain

• Carpal tunnel syndrome.

2. Trauma

Motor accidents and sports-related injuries can cause fractures or dislocations, tendon tears or ruptures, and nerve damage, which may need surgical correction.

3. Congenital deformities.

They are the physical abnormalities present at or before birth. Some of the congenital disorders of the musculoskeletal system that need surgical correction include

• Arthrogryposis

Arthrogryposis refers to the development of multiple joint contractures affecting two or more areas of the body before birth. 

• Genu varum

Genu varum or bow legs is a condition in which the legs curve outward at the knees while the feet and ankles touch.

• Pectus excavatum

Pectus excavatum or funnel chest is a condition in which the person's breastbone is sunken into the chest.

• Developmental dysplasia of the hip.

Developmental dysplasia of the hip is a congenital condition where the "ball and socket" joint of the hip does not correctly form in infants and young children.

4. Degenerative diseases

Constant wear and tear can cause structures such as joints to weaken and degenerate over time.

Common degenerative diseases of the musculoskeletal system include

• Osteoporosis

This bone disease develops when bone mineral density and bone mass decrease or when the structure and strength of bone change. This can decrease bone strength, increasing the risk of fractures. 

• osteoarthritis (OA) 

Osteoarthritis occurs when the cartilage that cushions the ends of bones in the joints slowly deteriorates. 

• Degenerative disk diseases like spondylosis

Degenerative disc disease is an age-related condition that occurs when one or more discs between the vertebrae of the spinal column break down or deteriorate, leading to pain.

5. Cancer

Cancer can develop in the soft tissues or bones.

Surgery is the typical treatment for musculoskeletal cancers, such as bone cancer and sarcoma. The individuals may be required to undergo limb amputation as a part of the treatment. 

Benefits of musculoskeletal surgeries

Musculoskeletal surgery is a medical procedure that helps treat and repair injuries and diseases of the muscles, bones, tendons, and ligaments. This surgery can provide numerous benefits, including 

• improved mobility

• reduced pain

• increased strength

• restore function and range of motion in affected areas. 

• reduce the risk of further injury or disease in the area due to improved stability. 

By having this type of surgery, individuals can enjoy an improved quality of life by moving more freely with less pain or discomfort.

Types of musculoskeletal surgeries

There are many musculoskeletal surgeries available today that can help reduce pain, improve movement, and restore function. These surgeries can range from minimally invasive procedures to complex reconstructive operations. All the procedures are carried out under general or local anesthesia. Each type of surgery has unique benefits and risks that should be discussed with your doctor before making any treatment decisions.

The common musculoskeletal procedures include

1. Open reduction.

The surgeon realigns fractured bones in open reduction procedures using hardware such as pins and plates, which hold the bones together and help them heal properly.

Surgeons may also use external fixators to keep the bones in place in the case of severe injuries.

2. Soft tissue repair.

Surgeons perform this procedure to repair torn tendons and  ligaments. The procedure also involves replacing damaged tissues with tissues collected from other body parts, as done in ACL reconstruction.

To reconstruct ACL (anterior cruciate ligament), surgeons use the kneecap tendon or hamstring tendon to replace the torn ACL. These procedures usually are minimally invasive, and people undergo them as outpatients.

3. Arthroscopy 

Arthroscopy allows surgeons to look inside the joint and check for any damage. The surgeon makes a small incision into the site and inserts the arthroscope. Arthroscope has a tiny camera that provides images from the inside. This allows the surgeon to diagnose the problem and/or treat the problem. 

Arthroscopy is commonly used for conditions affecting knees, elbows, shoulders, ankles, hips, and wrists. However, arthroscopy is not recommended to treat osteoarthritis of the knee. Evidence shows that it’s not effective in improving osteoarthritis knee pain.

4. Osteotomy

Osteotomy is a procedure where the surgeon cuts and reshapes bones to correct deformities or realign joints.

For example, surgeons perform knee osteotomy to relieve pressure on the knee joint and transfer the person’s body weight to the healthier side of the knee. Another example is the spinal osteotomy, performed by surgeons to correct spine curvature and relieve pain.

5. Joint fusion surgery

Arthrodesis or joint fusion surgery is a procedure performed to fuse two or more bones to

• limit deformity,

• reduce pain,

• increase strength,

• improve joint stability.

The surgeon may remove damaged joint areas and fuse the bones using plates and pins.

6. Joint replacement

In joint replacement surgery, the surgeon removes damaged joints and replaces them with a plastic, ceramic, or metal prosthesis.

They also remove the damaged parts of the joints and replace them with implants. They will also add a spacer between the implants to ensure the joint moves smoothly. Some examples of joint replacement surgeries are knee and hip replacement surgeries.

A study found that total joint replacement can improve a person’s quality of life and pain. This makes joint replacement surgeries valuable for people with hip and knee OA whose bodies do not respond to conventional treatments.

What to expect before & after a musculoskeletal surgery?

Musculoskeletal surgery is a major medical procedure that can significantly impact your life. It is important to understand what to expect before and after the surgery to prepare yourself for the process. Before the surgery, you will go through pre-operative tests and consultations with your doctor, while after the surgery, you will need to follow specific instructions for recovery.

Getting ready for surgery

Once you’ve decided to have surgery, you must get ready. You’ll get the best surgery results if you’re at your healthiest and fittest. Depending on your circumstances, you may need to

• Quit habits like smoking and drinking.

• Loose weight.

• Exercise to strengthen your body.

• Prepare your home to welcome you after the surgery and have a comfortable recovery by removing trip hazards, installing handrails in the shower, etc.

Things to note after the surgery

• Watch your wound as advised by your surgeon.

• Depending on your surgery, you may require some aids such as walking aids, shower stools, etc. Talk to an occupational therapist about aids and equipment. 

• Stay active – Perform the exercises as instructed by your physiotherapist, ensuring you get the most benefit from your surgery.

• Take medication as prescribed.

• Look after yourself – eat healthily, drink plenty of water, sleep well, quit smoking, and deal with your emotions.

Recovering from a musculoskeletal surgery can be a long and difficult process. It is important to understand the different stages of recovery and the timeline associated with them to plan for a successful recovery. The time it takes to recover from a musculoskeletal surgery depends on several factors, such as the type of procedure, the patient's overall health, and how well they follow post-operative instructions. With proper care and attention, most patients can expect to return to their normal activities within a few weeks or months after their surgery.

Risks & complications associated with musculoskeletal surgeries

Musculoskeletal surgeries are complex procedures that involve the manipulation of muscles, bones, and joints. Before undergoing, it is important to know the risks and complications associated with these surgeries. There may be long-term effects on the patient's ability to move or function normally after surgery. Patients must understand these risks before deciding whether to proceed with musculoskeletal surgery. 

The common complications of musculoskeletal surgeries include

• Infection.

As with all surgical procedures, there is a risk for musculoskeletal surgeries. The risk of infection increases in diabetic patients, those who do not keep the wound clean, immunosuppressed patients, patients with rheumatoid arthritis, etc.

• Blood clots

Surgery of the lower limb and a period of immobilization could increase the risk of blood clots in the lower limb. Other factors that could lead to blood clots following surgery are 

• Previous blood clots

• Pregnancy

• Smoking

• Obesity

• HRT

• Increased age

• Thrombophilia

• Dehydration.

Wriggling the toes, massaging calves, and moving lower limbs as much as possible will help maintain healthy circulation during the reduced mobility period. 

• Bleeding

It is common to have bleeding post-surgery. Contact your doctor immediately if you observe uncontrolled bleeding.

• Nerve damage, 

Numbness, tingling, muscle weakness, or burning are the most common signs and symptoms of nerve damage after surgery.

• Delayed healing and scarring

Some wounds may heal more slowly than usual and heals with scars.

• Swelling

Swelling is normal after surgery. As the body begins healing, thousands of cells reach the affected body part. This is part of the first stage of healing, called the inflammatory phase. The influx of all of these cells into the area causes more swelling.

Take home points

• Musculoskeletal surgery is a medical procedure used to treat musculoskeletal disorders. These disorders range from simple sprains and strains to more complex conditions such as fractures, dislocations, and joint replacements. 

• A musculoskeletal surgeon is a specialist with the expertise to diagnose and treat these conditions.

• Various musculoskeletal surgeries are available depending on the condition being treated. These include arthroscopic surgery, open reduction, joint replacement, tendon repair, etc.

•  Each type of surgery carries its risks and benefits, which should be discussed with your doctor before proceeding with any treatment plan.