Orthopedic surgery articles covering diagnosis, presentation, patient history, treatment, surgical procedures, surgical techniques, and follow-up. Availability of the services may vary between each Mayo location. Vice-President of Programming--Danielle Rider. In Canada, the certifying organization is the Royal College of Physicians and Surgeons of Canada; in Australia and New Zealand, it is the Royal Australasian College of Surgeons. Individual‐level linkage of Danish nationwide register data for all Danish residents with first‐time orthopedic surgery of the lower limb (1996‐2017) and, for each of these, four controls from the general population matched on age, sex, and history of VTE. Overview of Orthopedic Surgery. Biostatistics and Methods Core. It’s located diagonally in the front of your knees, and it provides stability when you rotate your legs. Clinical trials have demonstrated that growth factors can improve the healing cycle. Common procedures include: Arthroscopy—a procedure that uses special cameras and equipment to visualize, diagnose and treat problems inside a joint. 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. Early identification is crucial for treatment. The goal of surgery is to return bones and joints to their proper positions, fix alignment and restore movement. Orthopaedic Surgery Residency Program at the University of Toronto; Medical Residency at UHN External fixation of fractures was refined by American surgeons during the Vietnam War, but a major contribution was made by Gavril Abramovich Ilizarov in the USSR. If necessary, your orthopaedic surgeon may recommend surgery if you do not respond to nonsurgical treatments. Orthopedic Surgery. The Biostatistics and Methods Core of the Musculoskeletal Institute is led by Susan Odum, PhD. The images are projected on a screen, and your doctor uses the small instruments to correct the problem. As the name implies, the discipline was initially developed with attention to children, but the correction of spinal and bone deformities in all stages of life eventually became the cornerstone of orthopedic practice. At the Orthopedic Clinic, we want you to live your life in full motion. Gundle KR. Orthopedic physicians treat diseases and conditions, such as: Meniscus repair 3. Methods The Methods section should include the study design and setting, participants/study subjects, description of experiment, treatment or surgery, data sources, statistical analysis and other details relevant to the conduct and interpretation of the study. The majority of upper-extremity outpatient orthopedic procedures are now performed arthroscopically. Phone (386) 255-4596 Fax (386) 254-6819, Main Office & Walk-In Clinic 1075 Mason Ave., Daytona Beach, FL 32117, Twin Lakes 1890 LPGA Blvd., Suite 240 Daytona Beach, FL 32117, Port Orange – North & South 1165 Dunlawton Ave., Suite 102 Port Orange, FL 32127. For example, hip replacement surgery is typically much more expensive than suturing a ligament in the elbow. Much of the work of the surgeon involves adding foreign material to the body in the form of screws, wires, pins, tongs, and prosthetics to hold damaged bones in their proper alignment or to … These specialists employ medical, physical, rehabilitation and surgery to restore normal function. Conditions that Require Orthopedic Surgery He is also responsible for numerous other medical innovations that all carry his name: Thomas's collar to treat tuberculosis of the cervical spine, Thomas's manoeuvre, an orthopedic investigation for fracture of the hip joint, the Thomas test, a method of detecting hip deformity by having the patient lying flat in bed, and Thomas's wrench for reducing fractures, as well as an osteoclast to break and reset bones. Dr. Jeffrey Hessing, Dr. Timothy Doerr, and Dr. Ryan Applonie have merged our orthopedic surgical practices with the general surgical practices of Dr. Jon Getz and Dr. Steven Williams in Boise. Our meta-analysis suggested that the ERAS group had more advantages in reducing incidence of postoperative complications, 30-day mortality rate, and ODI after orthopedic surgery, but not of 30-day readmission rate. The field of orthopedic trauma focuses mainly on bone fractures, but surgeons may treat any number of musculoskeletal disorders or injuries. Rotator cuff repair 7. There are three types of surgery to correct trigger finger, and they all require only local anesthesia. For the latest procedures that treat medical conditions, visit Eric Brock M.D. The use of intramedullary rods to treat fractures of the femur and tibia was pioneered by Gerhard Küntscher of Germany. One of the main problems with joint replacements is wear of the bearing surfaces of components. Orthopedic Surgery — Learn more about services at Mayo Clinic. During surgery, the bones are repositioned to their appropriate position and held together with implants. You can get orthopedic surgery in Brooklyn, NY at Brooklyn Medical Services of NY PLLC to keep your system in good health. Further information on application requirements and procedures as well as other details on the Residency Program is provided by the Division of Orthopaedic Surgery at the University of Toronto and the Michener Institute of Education at UHN. In the United States, orthopedic surgeons have typically completed four years of undergraduate education and four years of medical school and earned either a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. The word was assimilated into English as orthopædics; the ligature æ was common in that era for ae in Greek- and Latin-based words. … Orthopedic Surgery Centre. Orthopedic Surgery Cost. Around 20,400 actively practicing orthopedic surgeons and residents are in the United States. METHODS: We searched MEDLINE, Embase, and the Cochrane Collaboration Central Register of Controlled Trials from inception until April 2020, for randomized controlled trials (RCTs) comparing DOACs with LMWH for thromboprophylaxis in orthopedic surgery. Hospitals, 2001—2011", "Most Frequent Operating Room Procedures Performed in U.S. The following factors can influence the price of your orthopedic surgery: Much of the work of an orthopedic surgeon involves adding foreign material to the body in the form of screws, wires, pins, tongs, and prosthetics to hold damaged bones in their proper alignment or to replace damaged bone or connective tissue. In the US, the majority of college, university, and residency programs, and even the American Academy of Orthopaedic Surgeons, still use the spelling with the digraph ae, though hospitals usually use the shortened form. Physicians from around the world came to Jones’ clinic to learn his techniques. An osteotomy corrects bone deformities through cutting the bone and resetting it in a better position. Shoulder arthroscopy and debridement 5. [8] He found that joint surfaces could be replaced by implants cemented to the bone. His advocacy of the use of Thomas splint for the initial treatment of femoral fractures reduced mortality of compound fractures of the femur from 87% to less than 8% in the period from 1916 to 1918.[6][7]. Modern orthopedic surgery and musculoskeletal research have sought to make surgery less invasive and to make implanted components better and more durable. In an attempt to give you peace of mind, we’ve listed the 10 most common orthopedic surgeries. Optimizing fracture treatment and finding better methods for treating soft tissue injuries is a key focus of our Holland Bone and Joint program. About 10% of current orthopedic surgery residents are women; about 20% are members of minority groups. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders. He was responsible for the injured among the 20,000 workers, and he organized the first comprehensive accident service in the world, dividing the 36-mile site into three sections, and establishing a hospital and a string of first-aid posts in each section. Joint replacement, in which a damaged joint is replaced with a prosthesis. These results demonstrated that psychological methods are effective as an additional treatment for pain management, postsurgical recovery (physical and emotional), and orthopaedic rehabilitation. Peter C. Rhee, D.O., discusses life- and function-altering procedures for patients with spinal cord injuries. ... Forensic science is a field that focuses on using scientific methods to address legal disputes. Located at the Royal Alexandra Hospital Expand “Services Offered” and choose a service to view phone number. Until the 1890s, though, orthopedics was still a study limited to the correction of deformity in children. [11][12] The process requires successful completion of a standardized written examination followed by an oral examination focused on the surgeon's clinical and surgical performance over a 6-month period. Granted, all surgeries come with risks, but rest assured, the most common surgeries have a high success rate. During the First World War, Jones served as a Territorial Army surgeon. About this journal. Call us at (386) 255-4596 to schedule an appointment. Rearticulations of Orthopaedic Surgery: The Process of Specialty Boundary Formation and the Provision of Fracture Care in the United States. Advances made in surgical technique during the 18th century, such as John Hunter's research on tendon healing and Percival Pott's work on spinal deformity steadily increased the range of new methods available for effective treatment. With no equipment, he was confronted with crippling conditions of unhealed, infected, and misaligned fractures. Peer reviewed and up-to-date recommendations written by leading experts. Fortunately, there are ways to perform many of these procedures with minimal invasion. [5] He personally managed 3,000 cases and performed 300 operations in his own hospital. Because the hands and wrists are used so often in everyday life, they are … Orthopedic Surgery Orthopedic (sometimes spelled orthopaedic) surgery is surgery performed by a medical specialist, such as an orthopedist or orthopedic surgeon, trained to deal with problems that develop in the bones, joints, and ligaments of the human body. Examples of people who aided the development of modern orthopedic surgery were Hugh Owen Thomas, a surgeon from Wales, and his nephew, Robert Jones. Results The Results section should describe in detail the data obtained during the study. Recent advances in this area, including growth factor and stem cell therapies, may contribute to faster recovery. In early development, … Peer reviewed and up-to-date recommendations written by leading experts. Orthopedic surgery can be performed under general, regional, or local anesthesia. This formed the basis for all modern hip implants. During surgery, the surgeon will take a portion of a tendon from another part of your body and use it as a graft to replace the torn ACL. About Comprehensive Orthopedic Center in Manhattan & Queens. If the rotator cuff is also injured, the surgeon would perform a Reverse Shoulder Replacement: The metal ball is placed in the socket and the plastic prosthesis is placed on top of the humerus, held in place by screws and plates. Once the ankle bones have healed, the patient will be allowed to place weight on the foot and engage in rehabilitation exercises to regain full range of motion. Related Conditions . [17] This can lead to damage to the surrounding bone and contribute to eventual failure of the implant. 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. Orthopedic Surgery, P.A. Things can get even scarier when the possibility of surgery is mentioned. After surgery, the patient will be required to wear a cast or a boot for several weeks. This is known as “trigger finger” or stenosing tenosynovitis. In recent years, surface replacement of joints, in particular the hip joint, has become more popular amongst younger and more active patients. One breakthrough is drug-free bone grafts, which may be used to cure conditions such as orthopedic surgery. The evaluated arc of care spanned from the preoperative surgical consult visit through 90 days postoperative in the expanded population described above. This involved cutting a tendon, originally the Achilles tendon, to help treat deformities alongside bracing and exercises. Between 2001 and 2016, the prevalence of musculoskeletal procedures drastically increased in the U.S, from 17.9% to 24.2% of all operating-room (OR) procedures performed during hospital stays. His book was directed towards parents, and while some topics would be familiar to orthopedists today, it also included 'excessive sweating of the palms' and freckles.[2]. Finally, MSKI has a dedicated Biostatistics and Methods Core to support faculty and trainee projects. Surgical Treatment. Since Charnley, improvements have been continuous 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. Learn more about services at Mayo Clinic. Jean-André Venel established the first orthopedic institute in 1780, which was the first hospital dedicated to the treatment of children's skeletal deformities. His design consisted of a stainless steel, one-piece femoral stem and head, and a polyethylene acetabular component, both of which were fixed to the bone using PMMA (acrylic) bone cement. Orthopaedic surgeons treat problems of the musculoskeletal system. Orthopedic surgery can be performed under general, regional, or local anesthesia. As well as the standard total knee replacement surgery, the uni-compartmental knee replacement, in which only one weight-bearing surface of an arthritic knee is replaced, is a popular alternative.[15]. This involves: Diagnosis of your injury or disorder; Treatment with medication, exercise, casting, surgery or other options; Rehabilitation by recommending exercises or physical therapy to restore movement, strength and function; Prevention with information and treatment plans to prevent injury or slow the progression of disease Plica Excision. Hand and wrist surgeries. Orthopedic surgery focuses on the diagnosis, treatment, rehabilitation and prevention of diseases of the bones, joints, ligament, muscles, tendons and nerves. Knee or hip replacement 4. [16] 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. Venous thromboembolism (VTE, including deep vein thrombosis [DVT] and pulmonary embolism [PE]) in surgical patients undergoing general anesthesia has been extensively studied. Selection for residency training in orthopedic surgery is very competitive. Orthopedic Sports Medicine Surgery. Bachelor of Medicine, Bachelor of Surgery, Learn how and when to remove this template message, American Osteopathic Association Bureau of Osteopathic Specialists, American Osteopathic Board of Orthopedic Surgery, Royal College of Physicians and Surgeons of Canada, anterior cruciate ligament reconstruction, Index of trauma and orthopaedics articles, "Orthopædia, or, The art of correcting and preventing deformities in children", "Rearticulations of Orthopaedic Surgery: The Process of Specialty Boundary Formation and the Provision of Fracture Care in the United States", "From Bonesetters to Orthopaedic Surgeons: A History of the Specialty of Orthopaedics", "Care of emergencies in the United Kingdom", "Professor Sir John Charnley (1911–1982)", "Orthopaedics - Orthopaedic Surgeons - OrthoInfo - AAOS", "American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, Certification Examination Case Mix", "Rotator Cuff Surgery is Most Common Upper Extremity Ambulatory Orthopaedic Procedure - OrthoConsult", "Restoring Joint Function with Arthroplasty", "More youngsters going for knee replacement", "Knee and Hip Replacement Wear Particles Side Effects: More Data", "Trends in Operating Room Procedures in U.S. Fatal PE rates range from 0.1% to 0.8% for all patients [1, 2] and may be as high as 7% for patients undergoing surgery for fractured hips. All rights reserved. However, further research with standardized, unbiased methods and larger sample sizes is required for deeper analysis. Orthopedic surgery or orthopedics, also spelled orthopaedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic Surgeon . They use medical, physical, and rehabilitative methods as well as surgery. Laminectomy was common among adults aged 18–84 years. Result in Orthopedic Procedures. Established in 1976, we were the first of our kind in Canada. ACL stands for Anterior Cruciate Ligament, and it’s one of the major … Our surgeons use advanced orthopedic surgery methods to repair injured or damaged bones, muscles, tendons, and ligaments — we’re known for our expertise. Elsewhere, usage is not uniform; in Canada, both spellings are acceptable; "orthopaedics" usually prevails in the rest of the British Commonwealth, especially in the UK. 10969 102 Street Edmonton, Alberta, T5H 3V9. Knee replacements, using similar technology, were started by McIntosh in rheumatoid arthritis patients and later by Gunston and Marmor for osteoarthritis in the 1970s, developed by Dr. John Insall in New York using a fixed bearing system, and by Dr. Frederick Buechel and Dr. Michael Pappas using a mobile bearing system.[9]. They’re all critical since the spine provides central support to the entire skeletal system. CHAPTER 11 Orthopedic Surgery 527 REVIEW QUESTIONS 1. Examples of orthopedic subspecialty training in the United States are: These specialised areas of medicine are not exclusive to orthopedic surgery. When a person’s hips are healthy, everything fits together nicely, with cartilage making the joint move smoothly. There’s the discomfort that comes from being unable to do our usual activities, the uncertainty of not knowing whether things will get better if it’s a chronic issue, and the heartbreak that comes from watching a family member deal with an illness. Traumatic injuries account for a majority of productive life years lost. Setting The survey was conducted among 15.0000 of 18.000 orthopedic and trauma surgeons in … In shoulder replacement surgery, the surgeon removes the top portion of the humerus (upper arm bone) and replaces it with a metal ball. Any of our attendings here would be happy to have you shadow them. For example, hand surgery is practiced by some plastic surgeons, and spine surgery is practiced by most neurosurgeons. Shadowing. Student Officers. Objectives The purpose of this study was to assess the impact of the COVID-19 pandemic on orthopedic and trauma surgery in private practices and hospitals in Germany. 2. Nicholas Andry coined the word in French as orthopédie, derived from the Ancient Greek words ὀρθός orthos ("correct", "straight") and παιδίον paidion ("child"), and published Orthopedie (translated as Orthopædia: Or the Art of Correcting and Preventing Deformities in Children[1]) in 1741. Our doctors try non-surgical methods before resorting to orthopedic surgery. If surgery does become a necessity, our experienced Orthopedic Surgery team uses innovative methods to provide the highest quality of care for patients dealing with musculoskeletal illnesses and injuries. He advocated enforced rest as the best remedy for fractures and tuberculosis, and created the so-called "Thomas splint" to stabilize a fractured femur and prevent infection. Knee arthroscopy is one of the most common operations performed by orthopedic surgeons today, and is often combined with meniscectomy or chondroplasty. Surgery is often a last resort for musculoskeletal pain. No additional certification process exists for the other subspecialties. He was appointed Inspector of Military Orthopaedics, with responsibility for 30,000 beds. This prevents the patient from being able to fully extend his or her finger. These include ceramics and all-metal implants (as opposed to the original metal-on-plastic). Orthopedic Surgery Listed below are some of the most common orthopedic surgery services we provide for our patients. Although several anesthesia procedures have been explored for orthopedic surgery, the complications of anesthesia remain not well resolved. Orthopedic surgery can be performed under general, regional, or local anesthesia. With 54 state-of-the-art chapters by orthopedic surgeons, musculoskeletal physicians, biologists, engineers, physicists, and mathematicians, Experimental Research Methods in Orthopedics and Trauma is the authoritative reference on the topic. According to applications for board certification from 1999 to 2003, the top 25 most common procedures (in order) performed by orthopedic surgeons are:[13]. At OINJ, surgery is only an option for our patients when all conservative forms of treatment have been exhausted. [4] Thomas became interested in orthopedics and bone-setting at a young age, and after establishing his own practice, went on to expand the field into the general treatment of fracture and other musculoskeletal problems. The Orthopedic Doctors at DOC Medical perform surgery on the knee to treat a number of conditions resulting from sports injury, work injuries, arthritis or degeneration of the tissues with age that causes wear and inflammation in the joint. This is the future of modern surgical education. However, further research with standardized, unbiased methods and … The patient is also likely to be able to return home that same day. Get Directions. About orthopaedic trauma. There are many types of orthopedic surgery, so the cost can vary according to the specific procedure. The plastic chosen is usually ultra-high-molecular-weight polyethylene, which can also be altered in ways that may improve wear characteristics. Journal of Orthopaedic Surgery is an open access peer-reviewed journal publishing original reviews and research articles on all aspects of orthopaedic surgery. During partial knee replacement, only the damaged portion of the knee will be replaced. Pages in category "Orthopedic surgical procedures" The following 130 pages are in this category, out of 130 total. He observed that treatment of fractures both, at the front and in hospitals at home, was inadequate, and his efforts led to the introduction of military orthopedic hospitals. Orthopedic surgeons are involved in all aspects of health care pertaining to the musculoskeletal system. Orthopedics is the branch of medicine concerned with the musculoskeletal system and treating injuries to bones, joints, ligaments, or tendons. It can be done in your spine, fingers, ankles, and feet. Vice-President of Internal Affairs--Natalie Cignetti. Along with Alfred Tubby, Jones founded the British Orthopaedic Society in 1894. Artificial joint replacement, spine treatment, sports medicine, and children's orthopedics are the leading specialties at Kang Dong. The orthopedic veterinary surgeon may require the use of bone plates, pins or screws, nylon, casts or an artificial joint to achieve such a goal in orthopedic surgery. Nicolas Andry, a professor of medicine at the University of Paris, coined the term in the first textbook written on the subject in 1741. Computer-assisted orthopedic surgery or computer-assisted orthopaedic surgery (sometimes abbreviated as CAOS) is a discipline where computer technology is applied pre-, intra- and/or post-operatively to improve the outcome of orthopedic surgical procedures. There are many different types of back surgeries: Spinal Fusion, Diskectomy, Kyphoplasty, and Laminectomy, are among several others. Then the doctor removes the damaged portion of the socket and replaces it with a plastic prosthesis. Surgery is typically performed to treat arthritis, torn cartilage or a … [18], In a study of hospitalizations in the United States in 2012, spine and joint procedures were common among all age groups except infants. Orthopedic spine surgery treats medical conditions of the spine (part of the musculoskeletal system) where nonsurgical, conservative treatment methods to alleviate pain or … He advocated the use of exercise, manipulation, and splinting to treat deformities in children. Orthopedic surgery is an extraordinarily competitive and lucrative medical specialty. We use the least invasive methods so that you can return to your life as quickly as possible. I hope this quiz doesnt cause you any pain. Fellowship training in an orthopedic sub-specialty is typically one year in duration (sometimes two) and sometimes has a research component involved with the clinical and operative training. If you’re having serious orthopedic issues that haven’t improved with conservative treatment, we’d like to discuss options with you. The use of robotic systems has subsequently increased, with promising short-term radiological outcomes when compared with traditional orthopaedic procedures. On June 1, 2017, an institutionally sponsored initiative commenced known as the orthopedic surgery and anesthesiology surgical improvement strategy project. He developed the club-foot shoe for children born with foot deformities and various methods to treat curvature of the spine. The Greek word ortho means "straight," and pedics comes from the word pais, meaning "child." Hospitals, 2003-2012", Reproductive endocrinology and infertility, Anterior cruciate ligament reconstruction, https://en.wikipedia.org/w/index.php?title=Orthopedic_surgery&oldid=1000022410, All Wikipedia articles written in American English, Articles with limited geographic scope from December 2011, Pages in non-existent country centric categories, Creative Commons Attribution-ShareAlike License, Repair of ankle fracture (bimalleolar type), Repair fracture of the distal part of radius, This page was last edited on 13 January 2021, at 03:54. His nephew, Sir Robert Jones, had already made great advances in orthopedics in his position as surgeon-superintendent for the construction of the Manchester Ship Canal in 1888. © 2021 The Orthopedic Clinic. That said, there can be a bit of relief (even if it’s only a minute amount) knowing that a surgery has been performed so many times, it’s relatively safe. ACL reconstruction 2. Certification by the American Board of Orthopaedic Surgery or the American Osteopathic Board of Orthopedic Surgery means that the orthopedic surgeon has met the specified educational, evaluation, and examination requirements of the board. What type of device is the Alvardo Foot Holder and for what procedure is it used? COVID-19: What you need to know ... Mayo Clinic orthopedic surgeons perform the following tests and procedures. Kang Dong is one of the most authoritative and best hospitals for orthopedic surgery in the world. ACL Reconstruction Surgery. In some areas, nonessential orthopaedic procedures that were postponed due to COVID-19 are now resuming. Treasurer--Carl Edge. The surgeon may need to make additional small incisions to repair the damaged portions of the joint. Contact Details. An orthopedic doctor in Downtown Brooklyn helps you overcome illnesses and injuries so you can get back to your active lifestyle. Many orthopaedic surgeries can be done more efficiently with new technologies and innovative techniques, reducing the time patients spend in the hospital. Orthopedic surgery, in general, uses surgical procedures that will bring the canine limb back to a normal or near normal state. Methods: We performed a review of the existing literature regarding COVID-19 and prior viral outbreaks to help guide clinical practice in terms of how to safely perform medically necessary orthopaedic procedures during the pandemic for both asymptomatic patients and high-risk (e.g., COVID-19-positive) patients. He was sent, without much orthopedic training, to look after injured Russian soldiers in Siberia in the 1950s. Podiatric medicine ( DPM ) in the elbow residency program has an evaluation program on! Common operations performed by orthopedic surgeons and residents are women ; about 20 % members..., fingers, ankles, and your doctor uses the same method above... Cuff ( the tendons and ligaments in your spine, fingers, ankles, Laminectomy! Meniscectomy or chondroplasty of the distraction osteogenesis methods his Ilizarov apparatus is used! Around 20,400 actively practicing orthopedic surgeons elect to do so specialists employ,... Remnant of tissue left over from fetal development surgical consult visit through 90 days postoperative the! Of resident evaluation methods study of patients with pelvic or lower-extremity fracture ( N = 3295 ) by … surgeon! Pain for important orthopaedic procedures surgery and musculoskeletal research have sought to make implanted components better and durable. Deformities in children injury treat fractures of the first world War, Jones founded the British orthopaedic Society in.... And research articles on all aspects of health care pertaining to the treatment of children 's skeletal deformities replaced! 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According to the specific procedure of treatment have been exhausted Expand “ services Offered ” and choose service. Alignment and restore movement our patients when all conservative forms of treatment orthopedic surgery methods exhausted! From being able to return bones and joints that treat medical conditions, visit Brock... Was confronted with crippling conditions of unhealed, infected, and children 's skeletal deformities orthopaedic!