The prevalence of disabling musculoskeletal conditions and the demand for orthopedic surgery in the twenty-first century

Abstract

The majority of hospitalizations and indications for surgery for musculoskeletal conditions result from degenerative diseases of the spine and major lower extremity joints. Spinal surgery, which follows careful selection criteria, typically results in pain relief, improved function, and improved quality of life which is maintained over long term periods of observation.Complications following spinal surgery are affected by age of the patient, anatomic location of disease and the surgical approach. Older patients with preexisting comorbidities, posterior approaches to the cervical spine and anterior approaches to the thoracolumbar spine are associated with higher risks of postoperative complications. Rapid growth in the demand for total hip and total knee arthroplasty has occurred over the past decade reflecting aging of the population as well as the success and safety of these procedures. Morbidity and mortality following total hip replacement (THR) and total knee replacement (TKR) are rare and the incidence of complications and death has decreased over time. Thromboembolic events have been reduced with adoption of routine prophylaxis protocols. Myocardial infarction occurs in approximately 3 % of patients and stroke in 0.5 %, and patients over 70 years of age appear to be at greater risk.