Osteoarthritis (OA) is one of most common diseases

Osteoarthritis, sometimes abbreviated to “OA”, is the most common form of arthritis, a very common disease. It is a chronic, slowly progressing disease that involves the breakdown of articular cartilage, the normally smooth, slippery covering that allows the bones of your joints to slide over each other.
The wear and tear on joints accumulated over the years is the only identifiable factor for many people. Trauma (for injury) is another contributing factor. Overuse or occupational injuries, as well as sport injuries, are commonly associated with OA.  Obesity plays a part, too, as extra weight puts added stress on weight bearing joints, like the hip and knee; but even light weight ballerinas are at greater risk of developing OA of the big toe and hip, due to great stresses put on these joints.  OA tends to affect weight bearing, hard working joints. As you’d expect, the hardest working and weight-bearing joints are the ones usually affected by OA. These include the hips, knees, feet, spine, and hands. Except, as a result of injury or un-usual stress, ankles, wrists, and elbows are not common sites for OA, although other types of arthritis can affect these areas. People with OA in one joint often have OA in other joints. This so-called generalized arthritis is more common in women than in men and may be inherited. With OA, articular cartilage breaks down and wears away. The rest of our discussion will focus on the knee joint, a common site of OA. The knee is a complex joint, composed of bone, cartilage, membranes, and joint fluid all working together for easy, comfortable motion.  In OA, the joint breaks down in stages, over a time; smooth cartilage becomes pitted and frayed. Damaged cartilage is less elastic, and more readily affected by overuse or injury. Synovial fluid may also lose its cushioning and lubricating properties. The ends of the bone can thicken and form spurs where the ligaments and synovial lining attach. Finally, bits of bone or cartilage (sometimes called ‘joint mice’) float in the joint space, causing further damage and pain. Eventually, large areas of cartilage may wear away completely, so bones scrape over each other painfully. The joint may lose its proper alignment, and much of its function.

Improved fracture management: open reduction and internal fixation During the past few decades, there have been significant advances in the way orthopaedists treat fractures. Consequently, fractures are now healing more dependably and with less residual deformity than ever before. Patients treated for orthopaedic trauma are more likely to subsequently lead normal lives without significant disability.

One of the initial accomplishments of the AO was the conception of 4 treatment principles that are still valid today. The first principle stresses the importance of obtaining an anatomical reduction of the fracture fragments, especially when the fracture extends into the joint. If closed methods of reduction prove inadequate, open reduction of the fragments by surgical means is carried out. Anatomic reduction is desired to prevent the development of posttraumatic arthrosis and to improve the chances of having a long-lasting and fully functional joint.

The second principle is an extension of the first. After obtaining a good reduction of the fracture fragments, it is necessary to achieve stable fixation of the fragments to maintain the proper anatomic shape. This can be accomplished by a variety of methods ranging from external splints, such as plaster fixation, to internal fixation by plates, screws, wires, and intramedullary nails. Also included are transcutaneous splints—the so-called external fixators. Success of the modern fixation techniques over the past several decades has spawned substantial interest by equipment and instrument manufacturers to develop fracture stabilization equipment.

The third principle is an important concept that has been increasingly recognized as a critical element for proper fracture healing. The preservation of the blood supply to the bone fragments and the soft tissue by means of atraumatic surgical techniques is vital in maintaining adequate nutrition to the fragments and preventing bone necrosis. Understanding of this simple concept is due in large part to the greater efforts of basic science researchers directed at the study of osteosynthesis.

The fourth principle, early and pain-free mobilization, emphasizes the desire for early postoperative motion of the muscles and joints adjacent to the fracture. This concept was contrary to the opinion of the time—that prolonged immobilization was necessary for proper fracture healing to occur. The primary reason for advocating early, protected mobilization is that early motion prevents many of the undesirable sequelae that had, at that time, been accepted as unavoidable with the treatment of fractures. Problems, such as stiff joints, marked muscle atrophy, and osteoporosis, were common following immobilization, and more troublesome complications, such as pneumonia, decubitus ulceration, and deep vein thrombosis, were due in large part to prolonged recumbency. The move from an era in which prolonged immobilization was the mainstay of treatment to today’s emphasis on early motion and rehabilitation has improved, without compromise, fracture healing and posttraumatic musculoskeletal function.

Before the advent of total joint arthroplasty, patients with significant arthritis of the hip or knee were often forced to endure their pain, with only minimal relief obtained by analgesic medications and other conservative treatments.

Total joint arthroplasty (replacement) of the hip and the knee have been received with much enthusiasm by the orthopaedic community because of their ability to relieve pain and restore function. The ideas and techniques initiated by the pioneers of joint replacement have given orthopaedic surgeons the power to improve patients’ lives irrevocably and have forever changed the surgical treatment of arthritic joints.

Today, total joint replacement of the hip and the knee are among the most successful surgical procedures performed by any specialty, with marked relief of pain and improved joint function in the majority of patients treated. Total joint replacement is a cost-effective procedure that significantly improves a patient’s quality of life and mobility.

The subspecialty of hand surgery has acquired a valuable tool with the development of microsurgical techniques to perform technically challenging procedures such as nerve and small-vessel repair. Truly remarkable is the ability of surgeons, with the aid of an operating microscope, to re-implant a patient’s severed hand or arm with good recovery of limb function.

Spinal surgery has also seen great improvements recently. Minimally invasive disc surgery and enhanced spinal fusions for degenerative disorders are significant advances. Spinal instrumentation, i.e., implantable devices used in the surgical treatment of spinal disorders, has been developed and can significantly correct spinal deformities that were previously untreatable. Likewise, rigid spinal fixation by the pedicle screw and other devices and advances in the techniques of vertebrectomy have improved the treatment of cancer patients with spinal metastases or patients with infection. Often, these treatments can result in significant pain relief and neurological recovery.

In paediatric orthopaedics, one of the major areas of progress has been the greatly improved treatments now available for patients diagnosed with malignant bone tumours. These treatments have resulted in the increased survival of many patients whose diagnoses previously carried grave prognoses. Defects created by tumour resection are treated more effectively as well. Techniques such as distraction osteogenesis and bone transport now are used in the reconstruction of these bone defects and in cases in which significant trauma or infection has resulted in deformity. These relatively new technologies, originally used to correct limb length discrepancies in children, can dramatically correct limb deformity and restore function .

Today, orthopaedic researchers strive to improve orthopaedic treatment modalities through better understanding of the composition, structure, and function of musculoskeletal tissues. Much knowledge has been gained in the past few decades regarding disease processes, such as rheumatoid and degenerative arthritis, and the body’s response to injury.

Additionally, the areas of biomechanics and biomaterials have helped create the implants and prostheses that are now an integral part of orthopaedic surgery. Research will continue at a never-before-seen pace and will certainly improve the understanding and treatment of musculoskeletal problems.
Finally, it would be wrong for medical specialists today, especially orthopaedists, not to mention the contribution of diagnostic radiology in regard to diagnostic decision making. Computed tomography and magnetic resonance imaging have found a niche in orthopaedics and are likely to remain as useful diagnostic tools.