Ortopedics is a surgical specialty that is specifically devoted to the diagnosis and treatment of the injuries of the musculoskeletal system, congenital malformations, and different diseases and the resulting deformations. Below, we introduce you to the most common orthopedic problems – joint diseases, back problems, traumas, overload-related injuries, and leg-related complaints – alongside with treatment options.
A joint disease may lead to inflammation and an increase in the amount of fluid in the joint cavity. This causes joint pain and reduces the extent of movement. If indicated, a joint can be punctured to remove excessive fluid from the joint cavity. This treatment method can be combined with an intraarticular injection to administer medicine into the joint cavity (sometimes even during the same procedure).
Most of the problems with the shoulder joint are caused by injuries to the surrounding tendons, ligaments and bursae. This may lead to inflammation of a tendon (tendonitis) or a rupture. Causal mechanisms leading to an injury include muscle atrophy (wasting away of a muscle), underuse of muscles, overload and trauma.
In elderly people, the most common problem related to the musculoskeletal system is knee pain. Usually it results from osteoarthritis caused by the breakdown of joint cartilage. In case of arthritis, the whole joint is damaged and inflamed. Osteoarthritis of the knee joint is characterized by the breakdown of the cartilage of the knee joint, which induces changes in surrounding tissues as well. In the early phases of the disease, conservative treatment (various medications, including painkillers, combined with physiotherapy) is used. However, in case of serious damage, knee arthroplasty is used. This is a surgical procedure whereby the damaged knee joint is replaced by an artificial joint.
Arthritis can affect the hip joint as well and its treatment tactics is similar to the knee joint. In addition to artrhitis, hip arthroplasty is also indicated in case of a hip fracture caused by a fall.
However, problems with the hip joint affect not only grown ups. Hip joint dysplasia is one of the most frequent congenital defects. In this condition, the hip joint has not fully developed and the socket portion does not fully cover the ball portion. The earlier the disease is discovered, the faster and more effective is the treatment. For that reason, all newborns are screened for this disease.
About four people out of five experience back pain at least once a life. Most of the problems tend to be related to the lower back. The reasons for back pain can be different, such as weak muscle tone, overweight, hard physical labor, lifestyle, muscle diseases, and traumas. Traumas and hard physical work may induce disc herniation (also called slipped disc) in the vertebra and as a result, the discs start to compress on the nerves, causing strong pain. This condition, which is known as radiculopathy, tends to recur even after successfully treating the first episode. In most cases, changes in lifestyle (training, ergonomic working posture etc), painkillers, muscle relaxants and massage are enough to alleviate the condition. In more complicated cases – when the lower body and legs have become paralyzed, for example – back surgery is indicated.
Traumas and overload-related injuries
Other more frequent traumatic injuries include ruptures of the inner structures of the knee, such as the meniscus and anterior or posterior cruciate ligament. To visualize, diagnose and treat intraarticular problems, a procedure named arthroscopy is often used, whereby a camera (to visualize the problem) and sometimes also other instruments (necessary to perform the treatment) are inserted through a small incision made in the knee region.
Ruptured Achilles tendon, also called ruptured heel cord, is a frequent traumatic injury, especially in younger people and athletes. Its characteristic symptom is inability to stand on tiptoes. Achilles tendon rupture must be treated surgically. In case of a recent trauma, the Achilles tendon is sewn together; in case of an older rupture, one possible treatment option is tendoplasty. In certain rare cases, conservative treatment (plaster cast or special orthosis) can be applied.
Ankle joint is another region susceptible to sprains, falls, and other primarily sports-related traumas. Strains and ruptures of the ligaments in this region are very common.
One particular overload- or trauma-related disease is the carpal tunnel syndrome, which is the most frequent in middle-aged women. Carpal tunnel syndrome results when the nerve that runs through the carpal tunnel (wrist canal) becomes constricted. The symptoms include pain in the wrist and hand alongside with numbness and tingling in the thumb side of the palm. Quite often conservative treatment (rest, orthoses, physiotherapy) gives a very good result, however, in more complicated cases, surgery could be indicated.
Another hand-related disease is the Dupuytren contracture, caused by the thickening of the palmar fascia (palmar aponeurosis) as a result of which one or more fingers become bent in a flexed position. Most often, the fourth and fifth fingers are affected. When the disease progresses, the mobility of fingers decreases gradually, until they become permanently bent and immobile. It is thought that the disease has a strong genetic predisposition, but various factors, such as smoking, alcohol consumption, rheumatoid arthritis, traumas and hard physical labor, increase the risk. Unfortunately, the disease is untreatable, but its symptoms can be alleviated.
Hallux valgus is a condition where the big toe tilts over towards the smaller toes. It is one of the most frequent foot-related problems, caused by the weakening of the muscles that keep the big toe straight. As a result of wearing too tight or unsuitable shoes for a long time, the big toe may tilt towards or on the neighboring toe. In an early stage, the problem can often be alleviated by means of massage, orthoses, ultrasound therapy and electrotherapy. In more serious cases, surgical intervention is necessary.
Flat feet are caused by a congenital or acquired deformation of the feet, characterized by the flattening of the longitudinal and transverse arches of the foot. The reasons for this roblem include nerve and muscle diseases, but also wearing unsuitable shoes. Sometimes the person with flat feet is free of complaints, but sometimes he or she may experience pain caused by foot overload. However, it should be noted that in infants the arches of the sole do not develop until a certain age and it is perfectly normal. Walking barefoot and special exercises promote the development of proper arches.
Similarly to flat feet, knock knees (X-legs) and bow legs (O-legs) are normal at certain ages. All children are born with bow legs. In the second and third year of life, slight knock knees are the norm. Only by school age, the legs become comparatively straight. In case of a prominent deformation that causes symptoms, it is advisable to consult an orthopedic surgeon.
Orthopaedic surgeon’s consultation€25–€132
An orthopaedic surgeon specializes on diagnosing, monitoring and treating chronic and acute diseases of the human skeletal system and associated structures (bones, joints, ligaments, tendons and muscles). During the first appointment, the orthopaedic surgeon usually examines the patient and prescribes necessary tests and analyses. This doctor can also give advice about the prevention of bone and joint disorders and plan subsequent treatment.
Achilles tendon surgery€460–€3800
Achilles tendon surgery is a surgical procedure to repair a ruptured Achilles tendon (“heel cord”). The ends of the tendon are sewn together during the operation. There are many different sewing techniques and an open surgery is not always necessary. After the operation it is necessary to wear a cast or a special orthosis for 6–8 weeks and use crutches for walking, because immobilization promotes the healing of the tendon.
Ankle arthroscopy is a minimally invasive operation of the ankle joint, performed via small (ca 5 mm long) incisions in the joint region. The camera-assisted arthroscope is equipped with special instruments for diagnosing cartilage damage and performing intra-articular treatment procedures, such as removal of osteophytes (bony lumps or bone spurs), resection of soft tissues and removal of a loose body (incl. pieces of bone and cartilage). The operation can be performed under general anesthesia, but also under regional anesthesia in a day surgery unit. Indications for the procedure include chronic ankle pain, synovitis (inflammation of the joint capsule), impingement syndrome and loose bodies in the joint cavity.
Arthroscopic meniscal resection€451–€2330
Arthroscopic meniscal resection is a minimally invasive knee joint operation whereby the torn part of the meniscus is removed. For the arthroscopic surgery, small (ca 5 mm long) incisions are made in the anterior part of the knee joint. A camera-assisted arthroscope is used to visualize the inside of the joint. The damaged part of the meniscus is then removed with special instruments. In younger patients it is possible to restore the integrity of the meniscus by suturing it with a special thread. General anesthesia is used for the operation, but it can also be performed under spinal anesthesia in a day surgery unit.
Diagnostic knee arthroscopy (excl. meniscus, resection, loose body)€544–€2932
Diagnostic arthroscopy is a minimally invasive intra-articular procedure performed via small (ca 5 mm long) incisions to specify the diagnosis of the joint disease. A camera-assisted arthroscope is used to visualize the inside of the joint and evaluate the condition and damage of the knee. If necessary, the diagnostic arthroscopy can immediately be followed by a surgical treatment procedure.
Shoulder arthroscopy is a minimally invasive intra-articular shoulder operation performed via small (ca 5 mm long) incisions in the joint region. The camera-assisted arthroscope is equipped with special instruments for performing intra-articular treatment procedures and restoring the integrity of the injured structures. General anesthesia is used for the operation, but it can also be performed under spinal anesthesia in a day surgery unit. Indications for the procedure include shoulder joint dislocation, synovitis, tendon injuries, rotator cuff injury, adhesive capsulitis (“frozen shoulder” characterized by thickening and contraction of the joint capsule), joint surface damage, subacromial bursitis, post-traumatic arthrosis, and chondromatosis.
Hip arthroscopy is a surgical minimally invasive intra-articular procedure, performed via small (ca 5 mm long) incisions in the hip joint region. The camera-assisted arthroscope is equipped with special instruments for diagnosing joint structure damage and performing immediate treatment procedures like removing a loose body from the joint cavity or repairing cartilage injuries. For the operation, either general or regional anesthesia is used. After the arthroscopic surgery the patient must keep lying down for 24 hours. Indications for the procedure include tears in the hip joint structures, cartilage loose bodies in the joint, hip joint luxation, early-stage arthritis and various cartilage injuries.
Anterior cruciate ligament (ACL) reconstruction€1800–€5400
Anterior cruciate ligament (ACL) reconstruction is a surgical procedure and the only treatment option for a torn anterior cruciate ligament. The operation, which is usually arthroscopic, is performed by means of a camera-assisted arthroscope equipped with special instruments. Small (ca 5 mm long) incisions are made in the knee joint region. During the procedure, the torn ligament is replaced with the patient’s own or a donor’s tendon, because the torn ligament cannot be sutured back together. Another name for this procedure is tendoplasty.
Posterior cruciate ligament (PCL) reconstruction€1800–€2500
Posterior cruciate ligament (PCL) reconstruction is a surgical procedure and the only treatment option for a torn posterior cruciate ligament. The operation,which is usually arthroscopic, is performed by means of a camera-assisted arthroscope equipped with special instruments. Small (ca 5 mm long) incisions are made in the knee joint region. During the procedure, the torn ligament is replaced with the patient’s own or a donor’s tendon – this is sometimes called tendoplasty. Once the posterior cruciate ligament has been torn, suturing it back together is not an effective method for restoring knee joint stability.
Artrhoscopic capsular release for frozen shoulder€1800–€4880
Artrhoscopic capsular release or arthroscopy with resection is a surgical procedure for releasing the shoulder capsule to improve the mobility of the shoulder and alleviate pain. Usually this operation is used for the treatment of frozen shoulder syndrome. Like other arthroscopic procedures, this surgery is also minimally invasive, performed via small (ca 5 mm long) incisions made in the shoulder joint region. By means of a camera-assisted arthroscope, equipped with special instruments, the shoulder capsule is released by cutting through and removing the thickened and inflamed ligaments that inhibit joint mobility.
Hallux valgus correction€420–€2560
Hallux valgus correction is a surgical procedure to remove a bony bump called bunion on the big toe. Nowadays several different methods are used to correct the valgus deformity, depending on the extent of the deformity, the existence of arthritic changes and the experience of the doctor. All surgical methods are based on correcting the bone deformity and releasing the connective tissue of the toe. Special footwear must be worn for 2–4 weeks after the operation to avoid applying pressure to the operated region and to facilitate healing.
Ankle ligament surgery€3750–€5080
Ankle ligament surgery is a surgical procedure to restore the stability of the ankle joint and relieve pain by means of reconstructing the lateral ligament. This is an open operation whereby the ruptured lateral ligament is replaced with the patient’s own or a donor’s tendon. After the operation it is necessary to wear a cast or a special orthosis for 2–6 weeks and use crutches for walking.
Decompressive lumbar laminectomy€2000–€7000
Decompressive lumbar laminectomy is a surgical procedure to treat lumbar radiculopathy, lumbar disc herniation and spinal stenosis. The operation is undertaken to relieve the pressure on the spinal canal, free the compressed (impinged) nerve root and restore the integrity of the vertebral column. This procedure is indicated in cases of chronic (that is, permanent) back pain that is resistant to conservative treatment (drugs and physiotherapy), and makes walking difficult or causes weakness and numbness in legs. In addition, impingement of spinal nerves may cause problems with urinating or defecating – if that is the case, immediate operative treatment is indicated. The patient may stand up from the bed in the evening of the first post-operative day already, however, it is not advisable to return to work before 4–6 weeks, depending on the nature of the work.
Hip replacement or hip arthroplasty is a surgical procedure to replace the hip joint with an artificial joint (also called endoprosthesis). This surgery is indicated when the patient’s worn or injured hip joint inhibits limb mobility or causes abnormal limb postures and all the other treatment options have failed to relieve pain. The aim of the operation is to restore normal posture and mobility of the limb and to alleviate pain. In case of total hip arthroplasty, a metal or ceramic prosthesis with a round head is inserted in the femur and the acetabulum (a socket in the pelvis for the head of the femur) is also replaced with a metal socket. Hemiarthroplasty (only the femoral head is replaced) is used in elderly patients in case of femoral neck fractures or pseudoarthrosis (“false joint”).
Knee replacement or knee arthroplasty is a surgical procedure to replace the knee joint with an artificial joint (also called endoprosthesis). This surgery is indicated when the patient’s worn or injured knee joint inhibits limb mobility or causes abnormal limb postures and all the other treatment options have failed to relieve pain. The aim of the operation is to restore normal posture and mobility of the limb and to alleviate pain. In case of total knee arthtroplasty, the ends of both femur and tibia are replaced with artificial metal components and a tibial polyethylene insert is used. Hemiarthroplasty – a procedure involving the replacement of only half of the knee joint – can be used in cases of moderate arthrosis and one-sided cartilage damage.
Carpal tunnel surgery€400–€2440
Carpal tunnel surgery is a surgical procedure to treat carpal tunnel syndrome (caused by pressure on a nerve in the wrist). The operation involves cutting the transverse carpal ligament, which helps to enlarge the tunnel and relieve pressure on the nerve. Carpal tunnel surgery is indicated when symptoms are recurrent and disturb daily life, and when drugs fail to relieve the pain. The operation is usually performed under local anesthesia.
Surgery for Dupuytren contracture€300–€3247
Dupuytren contracture (a condition in which one or more fingers become permanently bent in a flexed position) is treated with an operation called palmar fasciectomy whereby the surgeon removes the damaged fascia (sheet of connective tissue). After the procedure, the straightened fingers are placed in a cast, which is replaced by a special splint after 4–7 days. This operation is indicated when there is a flexion contracture of over 30° between a metacarpal bone and a phalanx, and also an interphalangeal contracture. The operation is performed under local anesthesia.