An orthopaedic surgeon is a doctor who specializes in diagnosing, treating, and surgically repairing problems with the musculoskeletal system: your bones, joints, muscles, ligaments, tendons, and nerves. These specialists handle everything from broken bones and torn ligaments to joint replacements and spinal conditions. While the name includes “surgeon,” a significant part of their work involves non-surgical treatments like physical therapy, bracing, injections, and exercise programs.
What Orthopaedic Surgeons Treat
The range of conditions is broad. On the injury side, orthopaedic surgeons manage fractures (broken bones in the arm, leg, ankle, wrist, hip, and collarbone), dislocations of the shoulder, hip, knee, or elbow, and ligament tears like ACL injuries and torn meniscus. Sports injuries, including rotator cuff tears, tennis elbow, golfer’s elbow, and patellar tendon tears, are a major part of the workload.
Beyond acute injuries, these specialists treat chronic and degenerative conditions. Osteoarthritis, the “wear and tear” form of arthritis, is one of the most common reasons people see an orthopaedic surgeon, especially when it affects the hip or knee. Other conditions include carpal tunnel syndrome, herniated discs, spinal stenosis, bursitis, bone spurs, frozen shoulder, and nerve injuries. Some orthopaedic surgeons also treat bone and soft tissue tumors.
Joint replacement is one of the field’s highest-volume procedures. The American Joint Replacement Registry has tracked over 4.3 million hip and knee replacements across the United States, with individual surgeons averaging about 65 primary knee replacements and 44 primary hip replacements per year.
Surgery Is Not Always the First Option
Despite the title, orthopaedic surgeons frequently recommend non-surgical approaches first. For hip and knee osteoarthritis, the standard starting point is patient education, exercise programs (including aerobic, strengthening, and flexibility work), anti-inflammatory medications, and weight management. Knee osteoarthritis may also be treated with steroid or hyaluronic acid injections into the joint.
For low back pain, initial treatment typically involves pain relief through injections, heat therapy, and medication, followed by active exercise therapy for longer-lasting symptoms. Lumbar disc herniations are a good example of how conservative care dominates: 60% to 90% of patients with a herniated disc recover successfully without surgery. Physical therapy plays a central role in nearly all orthopaedic care, both before and after any surgical procedure. Braces, orthotic devices, and custom shoe inserts are also commonly prescribed for conditions ranging from foot problems to spinal deformities.
How They Diagnose Problems
Orthopaedic surgeons rely heavily on imaging to evaluate injuries and plan treatment. Standard X-rays remain the most common and fastest tool, useful for identifying fractures, bone alignment issues, and joint degeneration. CT scans provide detailed three-dimensional views of bone and are used for complex fracture assessment, surgical planning, and guiding robotic surgery systems. Newer weight-bearing CT scanners can image joints while you’re standing, showing how bones and joints behave under your actual body weight.
MRI is the go-to tool for soft tissue problems. It provides detailed images of cartilage, ligaments, and tendons, making it essential for diagnosing things like labral tears, ligament damage, and cartilage loss. Ultrasound is used less often but can assess tendons and ligaments in real time during an office visit. A physical exam, including testing your range of motion, strength, and joint stability, typically comes before any imaging is ordered.
Training and Certification
Becoming an orthopaedic surgeon requires a minimum of 13 years of education after high school. That breaks down into four years of college, four years of medical school, and a five-year orthopaedic surgery residency. The final two years of residency must be completed at a single program. Many surgeons then pursue an additional one to two years of fellowship training to specialize further.
Board certification through the American Board of Orthopaedic Surgery is voluntary but widely regarded as a mark of competence. The process involves a written exam of roughly 320 questions covering all of orthopaedics, followed by an oral examination. Before sitting for the oral exam, a surgeon must have been in practice for at least 17 months, and the board collects peer reviews from other surgeons, hospital leadership, anesthesia staff, and operating room nurses who have observed the candidate’s work.
Orthopaedic Subspecialties
After residency, many surgeons narrow their focus through fellowship training. The major subspecialties include:
- Sports medicine: treating athletic injuries from recreational through professional levels, including ligament reconstruction and cartilage repair
- Joint replacement: hip and knee replacements for arthritis and other degenerative conditions
- Spine surgery: treating scoliosis, spinal deformities, herniated discs, and spinal injuries using both non-operative and surgical techniques
- Hand and upper extremity: conditions like carpal tunnel syndrome, trigger finger, nerve injuries, and complex fractures of the hand and elbow
- Foot and ankle: fractures, arthritis, and deformities of the lower extremity
- Pediatric orthopaedics: childhood conditions including hip dysplasia, scoliosis, clubfoot, and growth plate fractures
- Orthopaedic trauma: complex fractures and injuries, often from high-energy events like car accidents or falls
- Orthopaedic oncology: bone and soft tissue tumors
Orthopaedic Surgeon vs. Rheumatologist
These two specialists overlap in what they treat but differ sharply in how they treat it. An orthopaedic surgeon is a surgical specialist, trained to operate when conservative measures fail. A rheumatologist is a medical specialist who manages conditions primarily through medication and other non-surgical therapies, with particular expertise in inflammatory and autoimmune disorders like rheumatoid arthritis, lupus, and gout.
If your joint pain started after an injury, or if you have a condition that may eventually need surgical correction like a worn-out knee, you’ll typically be referred to an orthopaedic surgeon. If your joint pain appeared without an injury and is accompanied by fatigue, fever, rash, or morning stiffness, those are signs of an inflammatory condition better suited to a rheumatologist. In many cases, both specialists work together. A rheumatologist might manage the underlying autoimmune disease while an orthopaedic surgeon handles any structural damage that results from it.