Orthopedic surgeons are physicians who specialise in the musculoskeletal system: bones, joints, muscles, ligaments, tendons, and the nerves that run through all of it. In Canada that means medical school, a five-year residency, and usually a further year or two of fellowship training in a subspecialty such as knee, shoulder, hand, spine, foot and ankle, trauma, or pediatrics.
The word "surgeon" in the title is misleading in one important way. A large share of the work is deciding who does not need an operation, and saying so.
What the job actually involves
- Diagnosis. History, physical examination, and imaging such as X-ray, ultrasound, CT or MRI. Imaging is used to answer a question raised by the examination, not as a starting point. Scans of pain-free people routinely show tears, disc bulges and arthritis, so a finding on a scan only means something when it matches the clinical picture.
- Treatment planning. Weighing surgical against non-surgical options for this particular person, their goals and their tolerance for risk.
- Surgery, where it is indicated. Repairing, reconstructing, stabilising or replacing damaged structures.
- Follow-up and rehabilitation. Monitoring healing and working with physiotherapy, because the operation is generally the smaller half of the outcome.
Conditions they see
Trauma. Fractures, dislocations, and tendon or ligament ruptures such as Achilles and ACL injuries.
Osteoarthritis. Still widely described as wear and tear, which is an outdated and unhelpful model. Osteoarthritis is a disease of the whole joint involving cartilage, bone, synovium and the surrounding muscle, with genetic, metabolic and inflammatory contributors. It is not caused by using your joints too much. That distinction matters, because the wear-and-tear story convinces people to stop moving, and reduced activity makes osteoarthritis worse rather than better.
Spinal conditions. Including disc herniation and spinal stenosis. Note that disc degeneration on imaging is near-universal by middle age and correlates poorly with whether someone has back pain. "Degenerative disc disease" describes an appearance, not automatically the cause of your symptoms.
Inflammatory arthritis. Rheumatoid and related conditions are primarily managed by rheumatology, with surgery for joint damage that medication cannot address.
Congenital and developmental conditions. Clubfoot, developmental dysplasia of the hip, scoliosis.
Sports injuries. Rotator cuff tears, meniscal tears, stress fractures, recurrent instability.
Common procedures
Joint replacement. Hip and knee replacement for advanced arthritis are among the most reliably effective operations in medicine, with substantial pain relief for most people. Most people. A significant minority remain dissatisfied or continue to have pain afterwards, and implants have a finite lifespan, which is why age and activity level factor into timing.
Arthroscopy. Keyhole surgery using a camera inside the joint. Excellent for some problems, including ligament reconstruction and mechanical locking from a displaced fragment.
Fracture fixation. Plates, screws, rods and external frames to hold bone in position while it heals.
Soft tissue repair. ACL reconstruction, rotator cuff repair, tendon repair.
Spinal surgery. Discectomy for a herniated disc compressing a nerve, decompression for stenosis, fusion for instability or deformity.
Where surgery does less than people expect
This is the part usually left out, and it is the part most worth knowing.
Arthroscopic surgery for degenerative meniscal tears and knee osteoarthritis has been tested repeatedly against exercise therapy and against placebo surgery, and it does not perform better. This is one of the more robust findings in orthopedics, and it applies to a very common presentation: middle-aged knee pain with a meniscal tear on MRI. Structured exercise is the first-line treatment.
Subacromial decompression for shoulder impingement has similarly not outperformed placebo surgery in high-quality trials.
Spinal fusion for non-specific low back pain, as opposed to fusion for instability or deformity, has weak supporting evidence.
Repeated corticosteroid injections give short-term relief, and there is reasonable concern that frequent intra-articular injections may accelerate cartilage loss. They are a way to buy time, not a treatment.
None of this means surgery is unnecessary. It means the honest answer to "can you fix this?" is sometimes no, and a surgeon who tells you that is doing the job properly.
Non-surgical management
For most musculoskeletal complaints this is where treatment starts and often where it ends.
- Exercise-based rehabilitation. The best-supported treatment for osteoarthritis, tendinopathy, most back pain and most shoulder pain. It is also the slowest and least satisfying, which is why people go looking for something else.
- Medication. Anti-inflammatories and analgesics for symptom control, with their own risks over long-term use.
- Bracing and orthotics. Useful for specific problems. Evidence for custom foot orthotics is mixed, and the idea that they correct alignment is on shakier ground than the idea that they change symptoms in some people.
- Activity and load modification. Adjusting what you do and how much, rather than stopping.
New technology, realistically
Robotic-assisted joint replacement improves the accuracy of implant positioning. Whether that translates into better pain relief, function or implant survival for patients has not been demonstrated. It is a promising tool with an unproven outcome benefit so far.
3D printing is genuinely useful for custom implants in complex reconstruction and revision cases.
Platelet-rich plasma and stem cell injections deserve plain speech. PRP has mixed evidence and no consistent benefit across the conditions it is marketed for. Stem cell therapy for orthopedic conditions is largely unproven, is not an approved treatment in Canada for these uses, and is frequently sold privately at high cost on the strength of claims the research does not support. If a clinic offers to regenerate your cartilage, ask what trial evidence supports that and who is paying for it.
When to see one
In Ontario you generally need a referral from a family physician or nurse practitioner, and wait times for non-urgent consultation are often long. That makes it worth knowing when the referral is actually the right step.
Reasonable reasons to be referred: a fracture or suspected fracture, a joint that has dislocated, a deformity after injury, pain that has not improved with a proper course of rehabilitation, progressive weakness or numbness, arthritis limiting your daily life enough to consider joint replacement, or an inability to bear weight.
For most new aches, a family physician or physiotherapist is the better first stop. Starting rehabilitation early tends to produce better results than waiting months for a consultation that may conclude with a referral to rehabilitation anyway.
What no article can do is tell you which category you are in. That takes an examination and someone putting hands on the problem. Human 2.0 is owned and operated by an orthopedic surgeon, and our physiotherapy and rehabilitation team works from the same assessment, so if you are unsure whether what you have needs a surgeon or needs a plan, you can book an assessment and start there.
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