What Does an Orthopedic Surgeon Do

Orthopedic surgeons diagnose, treat, and manage conditions affecting the musculoskeletal system — bones, joints, cartilage, ligaments, tendons, muscles, and nerves. The scope of the specialty extends well beyond the operating room; a significant portion of orthopedic practice involves non-operative care, rehabilitation coordination, and long-term disease management. Understanding what orthopedic surgeons actually do helps patients, referring physicians, and health system administrators navigate care pathways more precisely.

Definition and scope

An orthopedic surgeon is a physician who has completed medical school, a minimum 5-year residency in orthopedic surgery accredited by the Accreditation Council for Graduate Medical Education (ACGME), and — in most subspecialty practices — an additional 1-year fellowship. Board certification is administered by the American Board of Orthopaedic Surgery (ABOS), which sets written and oral examination standards and requires ongoing recertification under a Maintenance of Certification (MOC) framework. The full pathway from medical school through board certification is detailed on the Orthopedic Board Certification page.

The specialty covers the full breadth of the musculoskeletal system, which in an adult comprises 206 bones, over 360 joints, and more than 600 skeletal muscles. Conditions treated span traumatic injuries (fractures, dislocations, ligament ruptures), degenerative diseases (osteoarthritis, degenerative disc disease), inflammatory conditions, congenital and developmental disorders, oncologic lesions involving bone and soft tissue, and sports-related injuries.

Orthopedic surgeons operate within a regulated credentialing environment. The Joint Commission (TJC) hospital accreditation standards require that surgical privileges be granted based on documented training and demonstrated competency, and the Centers for Medicare and Medicaid Services (CMS) Conditions of Participation (42 CFR §482.22) mandate medical staff credentialing processes that govern which procedures any individual surgeon may perform.

For a broader look at how regulatory requirements shape orthopedic practice, the regulatory context for orthopedics resource provides structured coverage of applicable statutes and agency frameworks.

How it works

The clinical workflow of an orthopedic surgeon follows a structured sequence:

1. History and physical examination — systematic assessment of pain location, mechanism of injury, functional limitation, and prior treatment. This forms the diagnostic foundation before any imaging is ordered.
2. Diagnostic imaging and testing — plain radiographs (X-ray) are typically the first-line imaging tool; MRI is used to evaluate soft tissue structures; CT scanning provides detailed bony anatomy; EMG/nerve conduction studies address nerve involvement. Each modality is matched to a specific diagnostic question.
3. Non-operative treatment initiation — the majority of orthopedic conditions are managed without surgery. Physical therapy, bracing, corticosteroid injections, and activity modification are prescribed and monitored before surgical options are considered.
4. Surgical planning and execution — when operative intervention is indicated, the surgeon selects the appropriate procedure (arthroscopic, open, or minimally invasive), obtains informed consent per institutional protocols, and performs the operation with a credentialed surgical team.
5. Postoperative management and rehabilitation — the surgeon directs recovery, including wound care, weight-bearing restrictions, physical therapy referral, and implant or hardware monitoring where applicable.
6. Long-term follow-up — chronic conditions such as osteoarthritis or post-traumatic arthritis require periodic re-evaluation, with the threshold for escalation determined by functional decline and imaging evidence.

The distinction between surgical and non-surgical orthopedics is a meaningful one. A 2020 analysis published in the Journal of the American Academy of Orthopaedic Surgeons found that non-operative care accounts for roughly 60 percent of orthopedic office encounters across the specialty, reflecting the primary-care-like role orthopedic surgeons play for musculoskeletal complaints.

Common scenarios

Orthopedic surgeons encounter a concentrated set of high-frequency conditions across clinical settings:

• Fracture management — from closed reduction and casting for stable fractures to internal fixation with plates, rods, and screws for displaced or unstable patterns. Fractures, types, healing, and complications covers the clinical classification system in detail.
• Joint replacement — total knee and total hip arthroplasty are among the most performed elective surgical procedures in the US. CMS data indicate that over 1 million total knee replacement procedures are performed annually in the United States.
• Rotator cuff and shoulder pathology — rotator cuff tears range from partial-thickness lesions managed with physical therapy to full-thickness ruptures requiring arthroscopic repair.
• Spinal conditions — herniated discs, spinal stenosis, and degenerative spondylolisthesis are addressed by spine-trained orthopedic surgeons; spinal fusion surgery is the operative intervention for instability or persistent neurologic compromise.
• Sports injuries — ACL tears and meniscus tears represent a large volume of sports-related orthopedic surgery, particularly in the 15–45 age demographic.
• Pediatric conditions — developmental dysplasia of the hip, scoliosis, and growth plate injuries require subspecialized expertise covered under pediatric orthopedics.

Decision boundaries

Orthopedic surgery intersects with adjacent specialties at clearly defined boundaries. The orthopedic surgery vs. sports medicine comparison outlines how non-surgical sports medicine physicians and orthopedic surgeons divide responsibility for athlete care.

Three primary decision boundaries govern when orthopedic surgical care is appropriate versus when another specialist should lead:

Orthopedic surgery vs. rheumatology — inflammatory joint diseases such as rheumatoid arthritis are primarily managed by rheumatologists using disease-modifying antirheumatic drugs (DMARDs). Orthopedic surgeons intervene when joint destruction has progressed to the point where arthroplasty or synovectomy is required.

Orthopedic surgery vs. neurosurgery — both specialties perform spinal surgery. In most academic medical centers, orthopedic spine surgeons manage degenerative and deformity cases, while neurosurgeons address intradural pathology, tumors, and complex vascular lesions near the cord.

Operative vs. non-operative threshold — the American Academy of Orthopaedic Surgeons (AAOS) publishes Clinical Practice Guidelines that define evidence-based indications for operative versus non-operative management across high-volume conditions. These guidelines are publicly available through the AAOS at aaos.org/cpg.

The overview of orthopedic subspecialties provides a classification of the eight recognized subspecialty fellowship pathways, each with its own scope boundary relative to general orthopedics. The full specialty landscape, including how patients and referring clinicians navigate to the right provider, is accessible from the orthopedics authority home.

References

• Accreditation Council for Graduate Medical Education (ACGME) — Orthopaedic Surgery Program Requirements
• American Board of Orthopaedic Surgery (ABOS) — Certification and MOC
• American Academy of Orthopaedic Surgeons (AAOS) — Clinical Practice Guidelines
• The Joint Commission — Hospital Accreditation Standards
• Centers for Medicare and Medicaid Services — 42 CFR §482.22, Medical Staff Conditions of Participation
• CMS — Medicare Fee-for-Service Claims Data on Joint Replacement Volume

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