Orthopaedic Procedure Definitions

Orthopaedic surgeons address musculoskeletal ailments including arthritis, trauma and congenital deformities using both surgical and non-surgical means.

Here you will find general information on the procedures an orthopaedic surgeon may use to treat you.

For information on specific surgeries, visit the My Surgery page.

Bones:

Autograft (bone grafting)
Biologic tissue, such as bone marrow, skin biopsy, cartilage, bone, from the patient’s own body is used to surgically replace damaged tissue.  In some cases an artificial or synthetic substitute may be used or a donor may be sought for a natural substitute.

When is it used?

Bone grafting is used to repair complex bone fractures or fractures that fail to heal properly.  This procedure may also be used to treat bone tumours.

How is it done?

The biologic tissue is typically harvested from intra-oral sources as the chin or extra-oral sources like the iliac crest of the pelvis.  Tissue may also be sourced from a bone bank.

Laminectomy
A surgical procedure in which part of the posterior bony arch, or lamina, of a vertebra is removed; allows access to the disk.

When is it used?

Laminectomy is done to relieve pressure on the spinal cord or on the nerve roots that emerge from the spinal canal. The procedure may be used to treat a slipped or herniated disk or to treat spinal stenosis.

How is it done?

The surgeon will make a straight incision over the intended vertebrae and down to the lamina, the bony arches of your vertebrae. The ligament joining the vertebrae along with all or part of the lamina is removed so that the involved nerve root is exposed. The surgeon pulls the nerve root toward the centre of your spinal column and removes the disk or part of the disk. Your large back muscle now protects your spine or nerve roots.

Osteotomy
 An osteotomy corrects bone deformities through cutting the bone and resetting it in a better position.  Misaligned joints can cause pain and can degenerate faster than normal joints because the bones aren’t in the correct position to function properly.

When is it used?

An osteotomy is usually performed on hips and knees to relieve pain and allow the joint to function properly.  Osteotomy may be used to improve the weight-bearing position of the lower leg in people with osteoarthritis of the knee.  Osteotomies are also commonly used for foot and ankle procedures such as bunion surgery.

How is it done?

An osteotomy on the shinbone (tibia) or thighbone (femur) reshapes the bone to improve the joint’s alignment.  In knee osteotomy, the surgeon repositions the joint to realign the leg so your knee glides freely and carries weight more evenly.  The surgeon will then realign the healthy bone and cartilage to compensate for the damaged tissue in the joint.  One of several techniques will be used to hold the joint in place while it heals, including a cast, staples or internal plate devices.

The surgically treated bone may require several weeks to heal after surgery.  Patients must also exercise and participate in physical therapy to keep the joint functioning during recovery.

Osteotomy may be a good choice for people who are younger than 60, active or overweight.  Other criteria for good candidates include a lack of inflammation in the joint and uneven damage to the joint.  This surgery can sometimes postpone the need for joint replacement surgery.

For foot and ankle surgery, your surgeon may cut and realign the bones in your foot. The corrected position of the bone may be held with screws, plates or wires.

Patellectomy
Surgical removal of the patella or kneecap.

When is it used? Usually after a bad kneecap fracture.

Rarely performed and only when the patella is shattered and not able to be reconstructed.

How is it done?

In this day and age, this procedure is rarely used. For some very badly broken (fractures) of the patella that can not be put together, your surgeon may remove your patella. For arthritis of the knee involving only the patella, an option may be removal of the patella, but other options are available.

Reduction
A procedure that involves manipulation of a fractured bone or dislocated joint to the correct alignment. These procedures may involve local anesthetic infiltration, procedural sedation or general anesthetic.

When is it used?

When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal without any deformity the bony fragments must be re-aligned to their normal anatomical position. Orthopedic surgeons attempt to recreate the normal anatomy of the fractured bone by reduction.

How is it done?

Reduction could be by Closed or Open methods. Open reduction refers to the method wherein the fracture fragments are exposed surgically by dissecting the tissues. Closed reduction refers to manipulation of the bone fragments without surgical exposure of the fragments. Once the fragments are reduced, the reduction is maintained by application of casts, traction or held by implants which may in turn be external or internal.

Other terms: open reduction, closed reduction, open reduction and internal fixation, external fixation

Resection
Resection is a surgical procedure in which the surgeon removes part or all of a bone.

When is it used?

Resection is used to ease pain and improve movement when diseased joints in the feet make walking extremely difficult. Resection is used to remove bunions from toes, and also used on the wrists, thumbs and elbows.

How is it done?

In resection, the surgeon removes a portion of the bone from a stiff or immobile joint and creates a space between the bone and the joint. The bone does not grow back. Instead, scar tissue grows in and fills the space where the bone was, offering more flexibility. The joint is less stable than it was when it was healthy.

Joints:

Arthroscopy

Arthroscopy or arthroscopic surgery is a procedure in which a surgeon explores the inside of your joint by using an instrument called an arthroscope.  The arthroscope functions like a tiny TV camera, letting your surgeon see the inside of your joint, magnified many times on a screen.

When is it used?

Surgeons use arthroscopy to make a diagnosis, to assess joint damage, to remove or repair damaged cartilage, and to smooth rough joint surfaces.  Arthroscopy is often used on knees and shoulders, but is beginning to be used more for joints such as hips, wrists, elbows and ankles.  Arthroscopy is also used to repair ligaments and tendons in the shoulder or to reconstruct ligaments in the knee.

How is it done?

The doctor inserts an arthroscope and other tools through one or two small incisions in your skin.  The arthroscope is a thin tube with a light at the end, and is connected to a closed-circuit television in the operating room.  The surgeon views the inside of the joint on the TV screen, identifying problems, such as loose pieces of cartilage or worn cartilage.  Using other tools, the surgeon can then smooth out portions of rough cartilage or even remove floating pieces that are causing pain.

An arthroscopy is usually performed on an outpatient basis.

Arthrodesis (Fusion)
Arthrodesis or bone fusion is when two bones that form a joint are fused together to restrict movement.

When is it used?

This kind of surgery can help relieve pain and provide stability to the joint, making the joint bear weight more effectively.  Typically arthrodesis is used for ankles, wrists, spine, neck, fingers or thumbs.

How is it done?

The damaged joint cartilage is removed and in some cases some of the nearby bone is removed too.  Then screws, plates or rods are inserted into the bones to hold them together.  This enables the joined bones to grow together.  The procedure helps relieve pain and ensure stability for the damaged joint.

Arthroplasty (Replacement)
Arthroplasty or total joint replacement (TJR) surgery is when a damaged joint is replaced with a prosthesis or artificial joint.

Other acronyms or references include:  THR, total hip replacement; TKR, total knee replacement; THA, total hip arthroplasty; TKA, total knee arthroplasty; and TJA, total joint arthroplasty.

When is it used?

Arthroplasty is typically performed when all conservative treatments, such as medications and exercise, have failed to provide pain relief and improve function.  Replacing the joint allows it to function more smoothly and with less pain. Many joints in the body can be replaced through arthroplasty, including hips, knees, ankles, toes, shoulders, elbows, wrists and fingers.

How is it done?

After making an incision in the affected joint, the surgeon then cuts away the damaged or diseased bone or cartilage, resurfacing and reshaping the ends of the bones so the joint can be rebuilt.  The surgeon inserts a prosthesis or artificial joint part, which is held in place either by a special cement adhesive or by the bone growing around it.

Lavage
The irrigation or thorough washing of an affected joint with high-volume saline solution and antibiotic content. It may also be used to clean tissues damaged in trauma situations.

What joints is it used for?

Lavage may be done on knees, shoulders, feet, and hands.

How is it done?

Degenerative tissue or fronds of joint material are washed or rinsed by injecting a fluid into the joint through a tiny incision – similar to the arthroscope. (It is sometimes done open in the trauma scenario).

Revision
A revision or redo is the removal of the original implant or prosthesis, and replacing these with a new implant when referring to joint replacement surgery. Other types of surgery involve revising the previous surgery in hopes to help the patient recover if the initial surgery has not attained a satisfactory result.

When is it used?

Occasionally implants fail for a variety of reasons such as polyethylene (plastic) wear, loosening, dislocation or deep infection.

How is it done?

After making an incision in the affected joint, the surgeon then cuts away at the damaged or failed prosthesis.  The surgeon may need to resurface and reshape the ends of the bones for the new prosthesis.  The surgeon inserts the new prosthesis or artificial joint part, which is held in place either by a special cement adhesive or by the bone growing around it.

Synovectomy
Synovectomy is the removal of the diseased synovium, the joint lining that can become inflamed in rheumatoid arthritis (RA), causing pain, swelling and disability.

When is it used?

Removing the diseased tissue can help relieve severe pain and swelling and can slow joint damage associated with rheumatoid arthritis.  Synovectomy is used most commonly to treat the knees, shoulders, hands, wrists and ankles.

How is it done?

In synovectomy, the surgeon usually removes the diseased portions of the synovium using an arthroscope [LINK to Arthroscopy info].  For large joints, a large incision may be used in some cases.  In time, the diseased synovium may grow back, leading to another synovectomy or possibly joint replacement surgery in the future.

Muscles, tendon, fascia, bursa:

Fasciotomy
A surgical procedure where the fascia, soft tissue component of the connective tissue system, is cut to relieve tension or pressure.

When is it used?

Fasciotomy is a limb-saving procedure when used to treat increased pressure, usually caused by inflammation, within a confined space (compartment) in the body.  Without prompt treatment the pressure impairs blood supply, leading to nerve damage and muscle death. It is also sometimes used to treat chronic compartment stress syndrome.

How is it done?

The surgeon will cut through the skin into the affected compartment, removing the affected tissue and relieving the limb swelling and pressure.

Open Release
Surgery in which a ligament is cut to release pressure and relieve pain.

When is it used?

Open release surgery may be recommended when nonsurgical treatment has been unsuccessful; if severe symptoms restrict normal daily activities; if there is damage to the median nerve or a risk of nerve damage; or if tumours or other growths need to be removed.  Most commonly used for the carpal ligament in the wrist / hand to relieve the symptoms of carpal tunnel syndrome.

How is it done?

An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

Tenotomy
A tenotomy is a procedure in which the surgeon releases the tendon, allowing the joint to move normally.

When is it used?

A tenotomy is used most commonly to treat clubfoot.  It involves releasing the heel cord, Achilles tendon, thus allowing the ankle joint to move normally.

How is it done?

The surgeon will make a small incision and then put a small cut into the tendon above the heel.  No stitches are required.  The ankle and foot are put in a cast for one to three weeks in the fully corrected position after the tenotomy.  This allows the tendon to regenerate in a longer, more flexible position.

Other:

Aspiration
Bone marrow aspiration removes a small amount of bone marrow fluid and cells through a needle put into a bone.

When is it used?

A bone marrow aspiration is done to help diagnose conditions that affect the bone marrow; to help determine the cause of abnormal blood tests; to measure the amount of iron, or other substances, that blood cells need for growth.

How is it done?

An aspiration needle will be put through your skin and into your bone to reach the bone marrow.  Adults usually have a sample of bone marrow fluid taken from the back of the pelvic bone.  Babies and young children may have the sample taken from the front of the lower leg bone, just below the knee.

The aspiration is usually done by a hematologist, oncologist or pathologist.

A joint may also be aspirated if there is an excessive amount of fluid inside.

Debridement
The removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue.

When is it used?

Debridement may be done on any tissue or joint.

How is it done?

Degenerative tissue or fronds of joint material are removed using a small vacuum that is pushed into the joint through a tiny incision possibly using arthroscopic techniques. It may also be done as an open procedure, using incisions to debride and remove damaged or diseased tissue.

Degenerative tissue or fronds of joint material are removed using a small vacuum that is pushed into the joint through a tiny incision possibly using arthroscopic techniques. Your surgeon may also use “open” techniques using incisions to “debride” and remove dameged or diseased tissue.

Discectomy
A surgical procedure in which an intervertebral disc is removed.

When is it used?

To treat nerve root or spinal cord compression by removing the pressure. This procedure is used when non-surgical treatments have failed.

How is it done?

The orthopaedic or neurosurgeon makes a small incision between two discs.  Only the portion of disc material pressing on the spinal nerve is removed.  The intervertebral foramen, the bone channel through which the spinal nerve runs, is then enlarged giving the nerve more room to exit the spinal canal.  To prevent the vertebrae from collapsing and to increase stability, the open space is often filled with bone graft.  Sometimes a titanium plate is screwed on the vertebrae to increase stability, especially when there is more than one disc involved.

Distraction Osteogenesis
A surgical process used to reconstruct skeletal injuries or deformities and lengthen the long bones of the body. 

When is it used?

Although distraction osteogenesis is most often used in the treatment of post-traumatic injuries, it is increasingly used to correct limb discrepancies caused by congenital conditions and old injuries.

How is it done?

A corticotomy, cutting of the bone, is used to fracture the bone into two segments, and the two bone ends of the bone are gradually moved apart during the distraction phase, allowing new bone to form in the gap.  When the desired length is reached, a consolidation phase follows in which the bone is allowed to keep healing. Distraction osteogenesis has the benefit of simultaneously increasing bone length and the volume of surrounding soft tissues.

External Fixation
Stabilization of a fracture or unstable joint by inserting pins into bone proximal and distal to the injury that are then attached to an external frame.

When is it used?

External fixation is used on fractures in which a cast would not allow proper alignment of the fracture.  It is often used to treat open fractures, and sometimes may be used as a temporary solution.

External fixation is also used in limb lengthening.  For example, people with short limbs can have their legs lengthened.

How is it done?

Your surgeon will drill holes into uninjured areas of bones around the fracture and insert or screw special bolts or wires into the holes.  Outside the body, a rod or a curved piece of metal with special ball-and-socket joints is attached to the bolts to make a rigid support.  The fracture can be set in the proper anatomical configuration by adjusting the ball-and-socket joints.

Internal Fixation
Surgical insertion of screws and/or plates to stop motion across a fracture or joint to encourage bony healing or fusion.

When is it used?

This type of surgery is usually used in people who have fractures in which the bones can be properly aligned.  These include fractures of any bones which cannot be treated with casting or immobilization alone.  Hip fractures may require internal fixation to allow for bone healing.  In some cases the treatment for hip fractures may be arthroplasty (replacement) techniques.

An implant is a medical device made to replace and act as a missing biological structure.  In orthopaedic surgery, implants may refer to devices that are placed over or within bones to hold a fracture reduction while prosthesis would be the more appropriate term for devices that replace a part or whole of a defunct joint. In this context implants may be placed within the body (internal) or placed outside the body (external).

Implants include:  screws, nails, plates and prosthesis for joint replacements.

How is it done?

The site is exposed surgically, the bones aligned and then secured with screws, nails, or appropriate implant.

Intramedullary Nailing or Rodding
A procedure for the fixation of fractures in which a nail or rod is inserted into the intramedullary canal of the bone from one of its two ends.

When is it used?

It is used in long bone fractures of the lower extremity, especially the femur and tibia, that are not too close to the joint.

Femur (thighbone), tibia (shinbone) fractures are commonly treated by intramedullary nailing. Your surgeon may choose to use rodding (nailing) of the humerus and forearm, but this is less common. A nail may also be used to hold bones together during fusion procedures such as knee fusions and fusions of the ankle.

How is it done?

A hole is made into the bone away from the fracture and a nail inserted into the marrow portion of the bone to stabilize the fracture.

An incision is made at the end of the bone and instruments are used to make a hole the bone so that the rod can be placed down the bone to hold the two ends of the bone together.

Limb Salvage
Surgical removal of a tumour or infection without amputation of the affected extremity.

When is it used?

In the treatment of bone tumours or bone cancers.  It may also be used for infected tissue or gangrene where the blood supply (circulation) is poor.

How is it done?

Instead of amputation the affected bone is removed and is replaced in one of two ways (a) bone graft, in which a bone from elsewhere from the body is taken or (b) artificial bone is put in.  If infected or ischemic (poor circulation) tissue is removed, it may be replaced by muscle or skin grafts, or it may be left to heal in using dressing changes and wound care techniques.

Percutaneous Pinning
Insertion of pins into bone through small puncture wounds in the skin for stabilization of a fracture or a dislocated joint that was realigned by closed reduction.

When is it used?

Many fractures can be manipulated into satisfactory positions, immobilized in an appropriate cast and allowed to heal.  Some fractures, however, cannot be held in a satisfactory position and require an additional form of fixation.  This is usually the case with displaced fractures of the first metacarpal and of the proximal phalanges of the hand and of about two-thirds of fractures of the distal end of the radius (wrist).  Children with a fracture around the elbow are commonly treated using this technique.

How is it done?

Pinning involves the manipulation, with x-ray guidance, of the fracture into an acceptable position, and the immediate insertion of metal pins, called wires, through the skin, into one bone fragment and across the fracture line into the other bone fragment.  The pins are normally left in position for between four and six weeks, and removed when the fracture has healed.