Orthopedic surgery ( from Wikipedia, the free encyclopedia) or orthopedics (also spelled orthopaedics, see below) is the branch of surgery concerned with acute, chronic, traumatic, and overuse injuries and other disorders of the musculoskeletal system. Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means.

Training

Orthopedic surgeons are physicians who have completed additional training in orthopedic surgery after the completion of medical school, either M.D. or D.O. According to the latest Occupational Outlook Handbook (2006-2007) published by the U.S. Department of Labor, between 3-4% of all practicing physicians are orthopedic surgeons.

In the United States and Canada orthopedic surgeons (also known as orthopedists) complete a minimum of 11 years of postsecondary secondary education and clinical training. This training includes obtaining an undergraduate degree (some medical schools require as little as 2 years of undergraduate study, and many Canadian schools only require 3 years), a medical degree or osteopathic degree, and then completing a five-year residency in orthopedic surgery. The five-year residency consists of one year of general surgery training followed by four years of training in orthopedic surgery.

Many orthopedic surgeons elect to do further subspecialty training in programs known as 'fellowships' after completing their residency training. Fellowship training in an orthopedic subspeciality is typically one year in duration (sometimes two) and usually has a research component involved with the clinical and operative training. Examples of orthopedic subspecialty training in the US are:

1. Hand surgery
2. Shoulder and elbow surgery
3. Total joint reconstruction (arthroplasty)
4. Pediatric orthopedics
5. Foot and ankle surgery (Not to be confused with podiatry)
6. Spine surgery (Also performed by neurosurgeons)
7. Musculoskeletal oncology
8. Surgical sports medicine
9. Orthopedic trauma

These are also the nine main sub-specialty areas of orthopedic surgery.

Hand surgery, and more recently Sports Medicine are the only truly recognized sub-specialties within orthopedic surgery by the Accredited Council of Graduate Medical Education (ACGME). The other sub-specialities are informal concentrations of practice. To be recognized as a hand surgeon or sports surgeon, a practitioner must have completed an ACGME-accredited fellowship and obtained a Certificate of Added Qualifications (CAQ) which requires an additional standardized examination.

Practice

Orthopedic surgeons address most musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are as follows:

1. Knee arthrosocpy and meniscectomy
2. Shoulder arthroscopy and decompression
3. Carpal tunnel release
4. Knee arthroscopy and chondroplasty
5. Removal of support implant
6. Knee arthroscopy and anterior cruciate ligament reconstruction
7. Knee replacement
8. Repair of femoral neck fracture
9. Repair of trochanteric fracture
10. Débridement of skin/muscle/bone/fracture
11. Knee arthroscopy repair of both menisci
12. Hip replacement
13. Shoulder arthroscopy/distal clavicle excision
14. Repair of rotator cuff tendon
15. Repair fracture of radius (bone)/ulna
16. Laminectomy
17. Repair of ankle fracture (bimalleolar type)
18. Shoulder arthroscopy and débridement
19. Lumbar spinal fustion
20. Repair fracture of the distal part of radius
21. Low back intervertebral disc surgery
22. Incise finger tendon sheath
23. Repair of ankle fracture (fibula)
24. Repair of femoral shaft fracture
25. Repair of trochanteric fracture

Of orthopedic surgeons applying for certification with the American Board of Orthopedic Surgery between 1999 to 2003 these were the percentages of surgeons in each specialty area:

• General orthopedics: 54.8%
• Spine surgery: 11.3%
• Sports medicine: 10.8%
• Hands and upper extremity: 8.7%
• Adult reconstructive: 3.9%
• Pediatric orthopedics: 3.4%
• Foot and ankle: 3.1%
• Trauma: 2.6%
• Musculoskeletal oncology: 1.3%

A typical schedule for a practicing orthopedic surgeon involves 50-55 hours of work per week divided among clinic, surgery, various administrative duties and possibly teaching and/or research if in an academic setting. In 2006, the median salary for an orthopedic surgeon in the United States was $310,218.

History

Jean-Andre Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. He is considered by some to be the father of orthopedics or the first true orthopedist in consideration of the establishment of his hospital and for his published methods.

Antonius Mathysen, a Dutch military surgeon, invented the plaster of Paris cast in 1851.

Many developments in orthopedic surgery resulted from experiences during wartime. On the battlefields of the Middle Ages the injured were treated with bandages soaked in horses' blood which dried to form a stiff, but unsanitary, splint. Traction and splinting developed during World War I. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Dr. Kunchner of Germany. This made a noticeable difference to the speed of recovery of injured German soldiers during World War II and led to more widespread adoption of intramedullary fixation of fractures in the rest of the world. However, traction was the standard method of treating thigh bone fractures until the late 1970s when the Seattle Haborview group popularized intramedullary fixation without opening up the fracture. External fixation of fractures was refined by American surgeons during the Vietnam War but a major contribution was made by Gavril Abrmovich Ilizarov in the USSR. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the1950s. With no equipment he was confronted with crippling conditions of unhealed, infected, and mal aligned fractures. With the help of the local bicycle shop he devised ring external  fixators tensioned like the spokes of a bicycle. With this equipment he achieved healing, realignment and lengthening to a degree unheard of elsewhere. His Ilizarov apparatus is still used today as one of the distraction osteogenesis methods.

David L. MacIntosh pioneered the first successful surgery for the management of the torn anterior cruciate ligament of the knee. This common and serious injury in skiers, field athletes, and dancers invariably brought an end to their athletics due to permanent joint instability. Working with injured football players, Dr. MacIntosh devised a way to re-route viable ligament from adjacent structures to preserve the strong and complex mechanics of the knee joint and restore stability. The subsequent development of ACL reconstruction surgery has allowed numerous athletes to return to the demands of sports at all levels.

Modern orthopedic surgery and musculoskeletal research has sought to make surgery less invasive and to make implanted components better and more durable.

Arthroscopy

The use of arthroscopics tools has been particularly important for injured patients. Arthroscopy was pioneered by Dr. Watanabe of Japan to perform minimally invasive cartilage surgery and re-constructions of torn ligaments. Arthroscopy helped patients recover from the surgery in a matter of days, rather than the weeks to months required by conventional, 'open' surgery. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today and is often combined with meniscectomy or chondroplasty--both of which are removal of a torn cartilage.

Joint replacement

The modern total hip replacement was pioneered by Sir John Charnley in England in the 1960s^.  He found that joint surfaces could be replaced by metal or high density polyethylene implants cemented to the bone with methyl methacrylate cement. Since Charnley, there have been continuous improvements in the design and technique of joint replacement (arthroplasty) with many contributors, including W. H. Harris, the son of R. I. Harris, whose team at Harvard pioneered uncemented arthroplasty techniques with the bone bonding directly to the implant.

Knee replacements using similar technology were started by McIntosh in rheumatoid arthritis patients and later by Gunston and Marmor for osteoarthritis in the 1970's. The modern knee replacement was developed by Dr. John Insall and Dr. Chitranjan Ranawat in New York. Uni-compartment knee replacement, in which only one side of an arthritic knee is replaced, is a smaller operation and has become popular recently.

Joint replacements are available for other joints on a limited basis, most notably shoulder, elbow, wrist and ankle.

In recent years, surface replacement of joints, in particular the hip joint, have become more popular amongst younger and more active patients. This type of operation delays the need for the more traditional and less bone-conserving total hip replacement, but carries significant risks of early failure from fracture and bone death.

One of the main problems with joint replacements is wear of the bearing surfaces of components. This can lead to damage to surrounding bone and contribute to eventual failure of the implant. Use of alternative bearing surfaces has increased in recent years, particularly in younger patients, in an attempt to improve the wear characteristics of joint replacement components. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). The plastic (actually ultra high molecular weight polyethylene) can also been altered in ways that may improve wear characteristics.

Pediatric Orthopedics

The treatment of children with muscoloskeletal problems remains an integral part of modern orthopedic surgery. Many fractures and injuries occur in children due to their high activity level and unique immature skeleton. Treatment of fractures in children is different than adults due to active growth plates in their bones. Damage to the growth plate can lead to significant problems with later bone growth, and at-risk fractures have to be monitored with care.

The treatment of scoliosis is a mainstay of pediatric orthopedics. For poorly understood reasons, curvature develops in the spine of some children, which if left untreated leads to undesirable deformity and may progress to cause chronic pain and breathing problems. The treatment of scoliosis is quite complicated and often involves a combination of bracing and surgery.

Children have other unique musculoskeletal conditions that have been a focus of orthopedics since Hippocrates, including conditions such as club foot and congenital dislocation of hip (also known as developmental dysplasia of the hip). In addition, infections in bones and joints (osteomyelitis) in children are common. In the US, specialized hospitals such as the Shriners hospitals have provided a substantial portion of treatment for children with musculoskeletal deformities and diseases.

Terminology

Nicholas Andry joined the word "orthopaedics", derived from Greek words for "correct" or "straight" ("orthos") and "child" ("paidion"), in 1741, when at the age of 81 he published Orthopaedia: or the Art of Correcting and Preventing Deformities in Children.

In the U.S. the spelling orthopedics is standard, although the majority of university and residency programs, and even the AAOS, still use Andry's spelling. Elsewhere, usage is not uniform; in Canada, both spellings are common; orthopaedics usually prevails in the rest of the Commonwealth, especially in Britain.

References

Garrett, WE, et al. American Board of Orthopedic Surgery Practice of the Orthopedic Surgeon: Part-II, Certification Examination. The Journal of Bone and Joint Surgery (American). 2006;88:660-667.

What Is a Hip Replacement?

Hip replacement, or arthroplasty, is a surgical procedure in which the diseased parts of the hip joint are removed and replaced with new, artificial parts. These artificial parts are called the prosthesis. The goals of hip replacement surgery include increasing mobility, improving the function of the hip joint, and relieving pain.

Who Should Have Hip Replacement Surgery?

People with hip joint damage that causes pain and interferes with daily activities despite treatment may be candidates for hip replacement surgery. Osteoarthritis is the most common cause of this type of damage. However, other conditions, such as rheumatoid arthritis (a chronic inflammatory disease that causes joint pain, stiffness, and swelling), osteonecrosis (or avascular necrosis, which is the death of bone caused by insufficient blood supply), injury, and bone tumors also may lead to breakdown of the hip joint and the need for hip replacement surgery.

In the past, doctors reserved hip replacement surgery primarily for people over 60 years of age. The thinking was that older people typically are less active and put less stress on the artificial hip than do younger people. In more recent years, however, doctors have found that hip replacement surgery can be very successful in younger people as well. New technology has improved the artificial parts, allowing them to withstand more stress and strain and last longer.

Today, a person’s overall health and activity level are more important than age in predicting a hip replacement’s success. Hip replacement may be problematic for people with some health problems, regardless of their age. For example, people who have chronic disorders such as Parkinson’s disease, or conditions that result in severe muscle weakness, are more likely than people without chronic diseases to damage or dislocate an artificial hip. People who are at high risk for infections or in poor health are less likely to recover successfully. Therefore they may not be good candidates for this surgery. Recent studies also suggest that people who elect to have surgery before advanced joint deterioration occurs tend to recover more easily and have better outcomes.

What Are Alternatives to Hip Replacement?

Before considering a total hip replacement, the doctor may try other methods of treatment, such as exercise, walking aids, and medication. An exercise program can strengthen the muscles around the hip joint. Walking aids such as canes and walkers may alleviate some of the stress from painful, damaged hips and help you to avoid or delay surgery.

For hip pain without inflammation, doctors usually recommend the analgesic medication acetminophen (Tylenol * ).

For hip pain with inflammation, treatment usually consists of nonsteroidal anti-inflammatory drugs, or NSAIDs. Some common NSAIDs are aspirin and ibuprofen (Motrin, Advil). If you need to take NSAIDs on a long-term basis or at doses that are higher than those obtainable over the counter, you should do so only under a doctor’s supervision. When neither NSAIDs nor analgesics are sufficient to relieve pain, doctors sometimes recommend combining the two. Again, this should be done only under a doctor’s supervision.

In some cases, a stronger analgesic medication such as tramadol or a product containing both acetaminophen and a narcotic analgesic such as codeine may be necessary to control pain.

* Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Topical analgesic products such as capsaicin and methylsalicylate may provide additional relief. Some people find that the nutritional supplement combination of glucosamine and chondroitin helps ease pain. People taking nutritional supplements, herbs, and other complementary and alternative medicines should inform their doctors to avoid harmful drug interactions.

In a small number of cases, doctors may prescribe corticosteroid medications, such as prednisone or cortisone, if NSAIDs do not relieve pain. Corticosteroids reduce joint inflammation and are frequently used to treat rheumatic diseases such as rheumatoid arthritis. The downside of corticosteroids is that they can cause further damage to the bones in the joint. Also, they carry the risk of side effects such as increased appetite, weight gain, and lower resistance to infections. A doctor must prescribe and monitor corticosteroid treatment. Because corticosteroids alter the body’s natural hormone production, which is essential for the body to function, you should not stop taking them suddenly, and you should follow the doctor’s instructions for discontinuing treatment.

Sometimes, corticosteroids are injected into the hip joint. A joint lubricant such as Hyaluronan may also be injected into the hip joint to relieve pain.

If exercise and medication do not relieve pain and improve joint function, the doctor may suggest a less complex corrective surgery before proceeding to hip replacement. One common alternative to hip replacement is an osteotomy. This procedure involves cutting and realigning bone, to shift the weight from a damaged and painful bone surface to a healthier one. Recovery from an osteotomy takes 6 to 12 months. Afterward, the function of the hip joint may continue to worsen and additional treatment may be needed. The length of time before another surgery is needed varies greatly and depends on the condition of the joint before the procedure.

What Does Hip Replacement Surgery Involve?

The hip joint is located where the upper end of the femur, or thigh bone, meets the pelvis, or hip bone. A ball at the end of the femur, called the femoral head, fits in a socket (the acetabulum) in the pelvis to allow a wide range of motion.

During a traditional hip replacement, which lasts from 1 to 2 hours, the surgeon makes a 6- to 8-inch incision over the side of the hip through the muscles and removes the diseased bone tissue and cartilage from the hip joint, while leaving the healthy parts of the joint intact. Then the surgeon replaces the head of the femur and acetabulum with new, artificial parts. The new hip is made of materials that allow a natural gliding motion of the joint.

In recent years, some surgeons have begun performing what is called a minimally invasive, or mini-incision, hip replacement, which requires smaller incisions and a shorter recovery time than traditional hip replacement. Candidates for this type of surgery are usually age 50 or younger, of normal weight based on body mass index, and healthier than candidates for traditional surgery. Joint resurfacing is also being used.

Regardless of whether you have traditional or minimally invasive surgery, the parts used to replace the joint are the same and come in two general varieties: cemented and uncemented.

Cemented parts are fastened to existing, healthy bone with a special glue or cement. Hip replacement using these parts is referred to as a “cemented” procedure. Uncemented parts rely on a process called biologic fixation, which holds them in place. This means that the parts are made with a porous surface that allows your own bone to grow into the pores and hold the new parts in place. Sometimes a doctor will use a cemented femur part and uncemented acetabular part. This combination is referred to as a hybrid replacement.

Is a Cemented or Uncemented Prosthesis Better?

The answer to this question is different for different people. Because each person’s condition is unique, the doctor and you must weigh the advantages and disadvantages.

Cemented replacements are more frequently used for older, less active people and people with weak bones, such as those who have osteoporosis, while uncemented replacements are more frequently used for younger, more active people.

Studies show that cemented and uncemented prostheses have comparable rates of success. Studies also indicate that if you need an additional hip replacement, or revision, the rates of success for cemented and uncemented prostheses are comparable. However, more long-term data are available in the United States for hip replacements with cemented prostheses, because doctors have been using them here since the late 1960s, whereas uncemented prostheses were not introduced until the late 1970s.

The primary disadvantage of an uncemented prosthesis is the extended recovery period. Because it takes a long time for the natural bone to grow and attach to the prosthesis, a person with uncemented replacements must limit activities for up to 3 months to protect the hip joint. Also, it is more common for someone with an uncemented prosthesis to experience thigh pain in the months following the surgery, while the bone is growing into the prosthesis.

What Can Be Expected Immediately After Surgery?

You will be allowed only limited movement immediately after hip replacement surgery. When you are in bed, pillows or a special device are usually used to brace the hip in the correct position. You may receive fluids through an intravenous tube to replace fluids lost during surgery. There also may be a tube located near the incision to drain fluid, and a type of tube called a catheter may be used to drain urine until you are able to use the bathroom. The doctor will prescribe medicine for pain or discomfort.

On the day after surgery or sometimes on the day of surgery, therapists will teach you exercises to improve recovery. A respiratory therapist may ask you to breathe deeply, cough, or blow into a simple device that measures lung capacity. These exercises reduce the collection of fluid in the lungs after surgery.

As early as 1 to 2 days after surgery, you may be able to sit on the edge of the bed, stand, and even walk with assistance.

While you are still in the hospital, a physical therapist may teach you exercises such as contracting and relaxing certain muscles, which can strengthen the hip. Because the new, artificial hip has a more limited range of movement than a natural, healthy hip, the physical therapist also will teach you the proper techniques for simple activities of daily living, such as bending and sitting, to prevent injury to your new hip.

How Long Are Recovery and Rehabilitation?

Usually, people do not spend more than 3 to 5 days in the hospital after hip replacement surgery. Full recovery from the surgery takes about 3 to 6 months, depending on the type of surgery, your overall health, and the success of your rehabilitation.

What Are Possible Complications of Hip Replacement Surgery?

According to the American Academy of Orthopedic Surgeons, more than 193,000 total hip replacements are performed each year in the United States and more than 90 percent of these do not require revision.

New technology and advances in surgical techniques have greatly reduced the risks involved with hip replacements.

The most common problem that may arise soon after hip replacement surgery is hip dislocation. Because the artificial ball and socket are smaller than the normal ones, the ball can become dislodged from the socket if the hip is placed in certain positions. The most dangerous position usually is pulling the knees up to the chest.

The most common later complication of hip replacement surgery is an inflammatory reaction to tiny particles that gradually wear off of the artificial joint surfaces and are absorbed by the surrounding tissues. The inflammation may trigger the action of special cells that eat away some of the bone, causing the implant to loosen. To treat this complication, the doctor may use anti-inflammatory medications or recommend revision surgery (replacement of an artificial joint). Medical scientists are experimenting with new materials that last longer and cause less inflammation. Less common complications of hip replacement surgery include infection, blood clots, and heterotopic bone formation (bone growth beyond the normal edges of bone). Studies are also looking at the use of bisphosphonates, ciprofloxacin, pentoxifylline, and other medications to prevent this bone resorption around the implants.

When Is Revision Surgery Necessary?

Hip replacement is one of the most successful orthopaedic surgeries performed. Studies have shown that more than 90 percent of people who have hip replacement surgery will never need to replace an artificial joint. However, because more people are having hip replacements at a younger age, and wearing away of the joint surface becomes a problem after 15 to 20 years, replacement of an artificial joint, which is also known as revision surgery, is becoming more common. It is more difficult than first-time hip replacement surgery, and the outcome is generally not as good, so it is important to explore all available options before having additional surgery.

Doctors consider revision surgery for two reasons: if medication and lifestyle changes do not relieve pain and disability, or if x rays of the hip show damage to the bone around the artificial hip that must be corrected before it is too late for a successful revision. This surgery is usually considered only when bone loss, wearing of the joint surfaces, or joint loosening shows up on an x ray. Other possible reasons for revision surgery include fracture, dislocation of the artificial parts, and infection.

What Types of Exercise Are Most Suitable for Someone With a Total Hip Replacement?

Proper exercise can reduce stiffness and increase flexibility and muscle strength. People who have an artificial hip should talk to their doctor or physical therapist about developing an appropriate exercise program. Most of these programs begin with safe range-of-motion activities and muscle-strengthening exercises. The doctor or therapist will decide when you can move on to more demanding activities. Many doctors recommend avoiding high-impact activities, such as basketball, jogging, and tennis. These activities can damage the new hip or cause loosening of its parts. Some recommended exercises are walking, stationary bicycling, swimming, and cross-country skiing. These exercises can increase muscle strength and cardiovascular fitness without injuring the new hip.

What Hip Replacement Research Is Being Done?

To increase the chance of surgical success and decrease the risk of complications and prosthesis failure, researchers are working to develop new surgical techniques, more stress-resistant materials, and improved prosthesis designs. They are also studying ways to reduce the body’s inflammatory response to the artificial joint components.

Researchers are also studying gender and ethnic discrepancies in those who have the procedure, and characteristics that make some people more likely to have successful surgery.

Other areas of research address issues of recovery and rehabilitation, such as appropriate postsurgical analgesia for older people, and home-health and outpatient programs.

Where Can People Find More Information About Hip Replacement Surgery?

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Phone: 301-495-4484 or 877-22-NIAMS (226-4267) (free of charge)
TTY: 301-565-2966
Fax: 301-718-6366
E-mail: NIAMSInfo@mail.nih.gov
http://www.niams.nih.gov/

NIAMS provides information about various forms of arthritis and rheumatic disease and other bone, muscle, joint, and skin diseases. It distributes patient and professional education materials and refers people to other sources of information. Additional information and updates can also be found on the NIAMS Web site.

NIH Osteoporosis and Related Bone Diseases~National Resource Center
2 AMS Circle
Bethesda, MD 20892–3676
Phone: 202–223–0344 or 800–624–BONE (624–2663) (free of charge)
TTY: 202–466–4315
Fax: 202–293–2356
http://www.osteo.org

The NIH Osteoporosis and Related Bone Diseases~ National Resource Center provides patients, health professionals, and the public with an important link to resources and information on metabolic bone diseases. The mission of NIH ORBD~NRC is to expand awareness and enhance knowledge and understanding of the prevention, early detection, and treatment of these diseases as well as strategies for coping with them. The Center provides information on osteoporosis, Paget’s disease of bone, osteogenesis imperfecta, primary hyperparathyroidism, and other metabolic bone diseases and disorders.

American Academy of Orthopaedic Surgeons
P.O. Box 1998
Des Plains, IL 60017
Phone: 800–824–BONE (2663) (free of charge)
www.aaos.org

The academy provides education and practice management services for orthopaedic surgeons and allied health professionals. It also serves as an advocate for improved patient care and informs the public about the science of orthopaedics. The orthopaedist’s scope of practice includes disorders of the body’s bones, joints, ligaments, muscles, and tendons. For a single copy of an AAOS brochure, send a self-addressed stamped envelope to the address above or visit the AAOS Web site.

American Physical Therapy Association
1111 North Fairfax Street
Alexandria, VA 22314–1488
Phone: 703–684–2782 or 800–999–2782, ext. 3395 (free of charge)
Fax: 703–684–7343
www.apta.org

This national professional organization represents and promotes the profession of physical therapy, and furthers the profession’s role in the prevention, diagnosis, and treatment of movement dysfunctions, and the enhancement of the physical health and functional abilities of members of the public.

Arthritis Foundation
P.O. Box 7669
Atlanta, GA 30357–0669
Phone: 404–965–7888 or 800–568–4045 (free of charge)
or call your local chapter (listed in the telephone directory)
www.arthritis.org

This is the major voluntary organization devoted to arthritis. The foundation publishes pamphlets on arthritis that may be obtained by calling the toll-free telephone number. The foundation also can provide physician and clinic referrals. Local chapters also provide information and organize exercise programs for people who have arthritis.

For Your Information

This publication contains information about medications used to treat the health condition discussed here. When this publication was printed, we included the most up-to-date (accurate) information available. Occasionally, new information on medications is released.

For updates and for any questions about any medications you are taking, please contact the U.S. Food and Drug Administration at 1-888-INFO-FDA (1-888-463-6322, a toll-free call) or visit their Web site at www.fda.gov.

Arthroscopic Menisectomy  $1,860
Arthroscopic Shaving of Cartilage  $1,350
Arthrscopic Ligament Reconstruction  $3,600
Arthroscopic Ankle, Knee, Elbow, Shoulder, Hip  $1,500
Anterior Cruciate Ligament  $3,690
Cervical Disectomy  $3,900
Polypectomy  $1,950
Carpal Tunnel Surgery  $1,200
Birmingham Hip Resurfacing  $7,500
Disc Hernia $6,300
Hallux Vagus  $1,200
Hemi Arthroplasty  $2,400
Trigger Finger Correction  $690
Hip Revision Replacement - Unilateral  $6,600
Knee Revision Replacement  - Bilateral  $6,900
Ankle Replacement  $6,300
Arthodesis - Ankle Joint Fusion  $4,500
Finger or Toe Endoprosthesis $3,600
Partial Shoulder Endoprosthesis  $7,200
Total Shoulder Endoprosthesis  $9,000
Dynesys Surgery  $3,000
Leg Orthesis - Plan, Large, Carbon Fiber  $3,000-$5,400
Hip Resurfacing Unilateral  $7,200
Hip Resurfacing Bilateral $13,000

Knee & Hip Replacement Prices...

Knee Replacement Surgery-Single  $6,000 (includes implant)
Knee Replacement Surgery-Double  $10,200 (includes implants)
Hip Replacement Surgery -Single  $5,400 (includes implant)
Hip Replacement Surgery - Double $10,200 (includes implants)
 
Illizarove Technique Prices...

Limb Lengthening $3,600 (includes implant)
Deformity Correction  $3,990 (includes implant)
Problem fractures, Non-union, Infectious, Bone Gap  $4,200 (includes implant)

Fusion Surgery Prices...

Cervical  $5,490
Lumber  $6,990

Sports Injuries Surgery Prices...

Menisectomy  $1,650
Shaving of Cartilage  $1,350

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