1. Introduction to Orthopedic Diseases

Orthopedic diseases encompass a broad spectrum of musculoskeletal disorders affecting the bones, joints, muscles, ligaments, tendons, and cartilage. These conditions may arise due to degenerative processes, autoimmune disorders, congenital anomalies, infections, trauma, or metabolic imbalances.

Definition of Orthopedic Diseases

Orthopedic diseases can be classified into three major categories:

• ✅ Degenerative Diseases – Osteoarthritis, osteoporosis, and spinal stenosis.
• ✅ Inflammatory/Autoimmune Disorders – Rheumatoid arthritis, lupus, and ankylosing spondylitis.
• ✅ Trauma and Congenital Deformities – Fractures, scoliosis, and developmental dysplasia of the hip.

These conditions result in pain, stiffness, decreased mobility, disability, and a diminished quality of life if left untreated.

2. Detailed Classification of Orthopedic Diseases

Degenerative Joint Diseases

Degenerative diseases involve the gradual deterioration of joint structures due to chronic wear and tear.

Osteoarthritis (OA)

1. Definition:
   • ✔️ Progressive cartilage degradation leading to bone-on-bone contact and joint dysfunction.
   • ✔️ Most common in the knee, hip, hands, and spine.
2. Pathophysiology:
   • ✔️ Articular cartilage loss → Increased friction → Pain and stiffness.
   • ✔️ Subchondral bone remodeling → Osteophyte formation (bone spurs).
   • ✔️ Synovial inflammation → Joint swelling and restricted motion.
3. Symptoms:
   • ✔️ Morning stiffness lasting < 30 minutes.
   • ✔️ Crepitus (crackling sound) on movement.
   • ✔️ Joint pain worsens with activity and improves with rest.
4. Radiographic Findings:
   • ✔️ Joint space narrowing.
   • ✔️ Osteophyte (bone spur) formation.
   • ✔️ Subchondral sclerosis and cysts.
5. Treatment:
   • ✔️ NSAIDs & Corticosteroid injections for pain relief.
   • ✔️ Hyaluronic acid injections to lubricate the joint.
   • ✔️ Total Knee Replacement (TKR) or Total Hip Replacement (THR) for severe cases.

Inflammatory and Autoimmune Disorders

Inflammatory orthopedic diseases involve immune-mediated destruction of joints and connective tissues.

Rheumatoid Arthritis (RA)

Definition:

• ✔️ Chronic autoimmune disease characterized by synovial inflammation, joint destruction, and systemic involvement.
• ✔️ Affects small joints first (fingers, wrists), then larger joints (knees, hips).

Pathophysiology:

• ✔️ T-cell activation → Synovial hyperplasia (pannus formation).
• ✔️ Cytokine release (TNF-α, IL-6) → Cartilage and bone erosion.
• ✔️ Rheumatoid factor (RF) and anti-CCP antibodies → Immune complex deposition.

Symptoms:

• ✔️ Morning stiffness >60 minutes.
• ✔️ Symmetric joint pain (bilateral hands, feet).
• ✔️ Ulnar deviation, Swan-neck, and Boutonnière deformities.

Diagnostic Markers:

• ✔️ ESR & CRP (inflammation).
• ✔️ Positive Rheumatoid Factor (RF) & Anti-CCP antibodies.
• ✔️ Joint erosions on X-ray.

Treatment:

• ✔️ Methotrexate + Biologics (TNF inhibitors like Etanercept, Infliximab).
• ✔️ NSAIDs & Corticosteroids for symptomatic relief.
• ✔️ Joint replacement in end-stage RA.

Metabolic Bone Disorders

Metabolic bone diseases involve abnormal bone remodeling, leading to fragility and fractures.

Osteoporosis

Definition:

• ✔️ Systemic skeletal disorder causing low bone mass and increased fracture risk.
• ✔️ Common in postmenopausal women and elderly men.

Pathophysiology:

• ✔️ Estrogen/Testosterone → Increased osteoclast activity.
• ✔️ Bone Mineral Density (BMD) → Fragile bones.
• ✔️ Vertebral, hip, and wrist fractures are most common.

Symptoms:

• ✔️ Silent disease until fractures occur.
• ✔️ Loss of height, kyphosis (Dowager’s hump).
• ✔️ Fragility fractures (hip, spine, wrist).

Diagnosis:

• ✔️ DEXA scan (T-score ≤ -2.5 SD).
• ✔️ Serum Calcium, Vitamin D.
• ✔️ Normal PTH and ALP.

Treatment:

• ✔️ Bisphosphonates (Alendronate, Zoledronic acid).
• ✔️ Calcium (1200 mg/day) & Vitamin D (800 IU/day).
• ✔️ Denosumab (RANKL inhibitor) for severe cases.

Orthopedic Surgical Procedures

Joint Replacement Surgery

Indications:

• ✔️ End-stage osteoarthritis or rheumatoid arthritis.
• ✔️ Avascular necrosis (AVN) of the femoral head.

Common Procedures:

• ✔️ Total Knee Replacement (TKR) – Metal & polyethylene prosthesis.
• ✔️ Total Hip Replacement (THR) – Ceramic, metal, or polyethylene components.
• ✔️ Shoulder Arthroplasty – Reverse or anatomical replacements.

Complications:

• ✔️ Infection (prosthetic joint infection – PJI).
• ✔️ DVT/PE (requires anticoagulation).
• ✔️ Implant loosening or failure.

Spine Surgery

Indications:

• ✔️ Herniated Disc causing nerve compression.
• ✔️ Spinal Stenosis with claudication symptoms.

Techniques:

• ✔️ Discectomy: Removes herniated disc material.
• ✔️ Laminectomy: Relieves spinal cord compression.
• ✔️ Spinal Fusion: Uses screws and bone grafts to stabilize the spine.

Complications:

• ✔️ Nerve injury (<1% risk).
• ✔️ Failed Back Surgery Syndrome (FBSS).

Prognosis and Success Rates

• ✔️ Total Knee Replacement: 90-95% success rate, lasting 15-25 years.
• ✔️ Hip Replacement: 92% success rate, lasting 20 years.
• ✔️ Spinal Fusion: 85% success rate for pain relief and stability.
• ✔️ ACL Reconstruction: 90-95% success rate, with full return to sports in 6-12 months.
💡 Germany’s specialized rehabilitation programs ensure superior functional recovery.

Conclusion: The Future of Orthopedic Care

These trusted sources provide evidence-based medical information, latest clinical research, and international guidelines for orthopedic diseases and surgery.