The Most Difficult Orthopedic Surgery: Ranking the Challenging Procedures

Choose the orthopedic surgery you think is the most difficult!

Author: Gregor Krambs
Updated on Apr 14, 2024 06:39
Welcome to StrawPoll's most riveting ranking yet - "What is the most difficult orthopedic surgery?" We understand that the world of orthopedics can be a complex and fascinating one, and that's why we've put together this intriguing poll, featuring a diverse range of challenging surgeries. From the delicate intricacies of spinal fusions to the precision required for joint replacements, we've got it all! But we need your help - we want to know which surgery you think tops the list in terms of difficulty. Cast your vote, join the conversation, and if you think we've missed an option, don't hesitate to suggest it. Dive into the captivating world of orthopedic surgery and help us determine the ultimate ranking!

What Is the Most Difficult Orthopedic Surgery?

  1. 1
    Spinal Cord Injury
    Lemarivir · CC BY 3.0
    Spinal cord injuries are the most difficult and most complicated orthopedic surgeries. These types of surgeries require a high level of skill and expertise. The surgery involves removing a part of the spinal cord that has been damaged and replacing it with a healthy one. The surgery is delicate and requires a lot of precision.
    Spinal Cord Injury refers to damage or trauma to the spinal cord, resulting in the loss of sensation and motor function below the level of injury. It can be caused by various factors such as trauma from accidents, falls, or sports injuries, as well as non-traumatic causes like tumors, infections, or degenerative diseases. Spinal Cord Injury is a complex condition with significant impact on a person's mobility, independence, and overall quality of life.
    • Types of Injury: Complete (total loss of sensation and motor function) or Incomplete (partial loss of function)
    • Level of Injury: The specific vertebrae where the injury occurs, determining which body parts are affected.
    • Neurological Classification: Based on the American Spinal Injury Association (ASIA) Impairment Scale.
    • Paraplegia vs. Tetraplegia: Paraplegia refers to the impairment of motor or sensory function in the lower limbs, while Tetraplegia (formerly known as Quadriplegia) involves impairment in all four limbs.
    • Rehabilitation: Intensive physical therapy and rehabilitation programs are crucial for maximizing functional recovery and improving quality of life.
  2. 2

    Joint Replacement Surgery

    Sir John Charnley
    Joint replacement surgery is also a complex orthopedic surgery. This procedure involves replacing a damaged or worn-out joint with an artificial one. The surgery requires a lot of skill and experience to perform.
    Joint replacement surgery is a surgical procedure in which an arthritic or damaged joint is replaced with an artificial joint called a prosthesis. This surgery is commonly performed for joints such as the hip, knee, shoulder, and elbow. The aim of joint replacement surgery is to relieve pain, improve joint function, and enhance the quality of life for individuals suffering from severe joint conditions.
    • Prosthesis Material: Metal, ceramic, or plastic
    • Surgical Approach: Minimally invasive or traditional open surgery
    • Anesthesia: General or regional anesthesia
    • Joint Mobility: Restores natural joint movement
    • Recovery Time: Varies, but typically several weeks to months
    Joint Replacement Surgery in other rankings
  3. 3

    Pediatric Orthopedic Surgery

    Dr. Robert B. Salter
    Pediatric orthopedic surgery is another challenging type of surgery. Children have different bone structures and require special care during the surgery. The surgery may involve correcting deformities, treating fractures, and other conditions.
    Pediatric Orthopedic Surgery is a specialized branch of orthopedic surgery focused on the diagnosis, treatment, and management of musculoskeletal conditions and injuries in children and adolescents. It involves both surgical and non-surgical techniques to improve the function and quality of life of pediatric patients with orthopedic disorders.
    • Expertise: Pediatric orthopedic surgeons undergo extensive training and have specific expertise in the unique orthopedic conditions and growth patterns of children.
    • Diagnosis and evaluation: Comprehensive evaluation and accurate diagnosis of pediatric orthopedic conditions are crucial to develop appropriate treatment plans.
    • Growth-related conditions: Pediatric orthopedic surgery often deals with conditions related to skeletal growth abnormalities, such as scoliosis, limb length discrepancies, and congenital deformities.
    • Trauma and fracture management: Treating fractures and traumatic injuries in children requires specialized techniques to ensure proper healing and growth.
    • Developmental disorders: Pediatric orthopedic surgery addresses congenital or developmental disorders like clubfoot, hip dysplasia, and spinal deformities like spina bifida.
  4. 4
    Limb reconstruction surgery involves correcting deformities and restoring the function of the limbs. The surgery requires a lot of skill and expertise, and the recovery period can be long and challenging.
    Limb Reconstruction Surgery is a complex orthopedic procedure aimed at correcting bone deformities, length discrepancies, and non-unions in limbs. It involves a combination of techniques such as osteotomies, distraction osteogenesis, external fixators, and internal fixation devices to restore functionality and improve the alignment of the affected limb.
    • Procedure Types: Limb lengthening, deformity correction, non-union treatment
    • Technique: Combination of osteotomies, external fixators, distraction osteogenesis
    • External Fixation: Use of external frames for stabilization and bone alignment
    • Ilizarov Apparatus: Invention of a specialized circular external fixator
    • Gradual Lengthening: Bone segments are gradually pulled apart with the help of the fixator
  5. 5

    Hand Surgery

    Sterling Bunnell
    Hand surgery involves correcting deformities and restoring the function of the hand. The surgery requires a lot of precision and expertise, and the recovery period can be long and challenging.
    Hand surgery is a specialized field of orthopedic surgery that focuses on the surgical and non-surgical treatment of conditions affecting the hand, wrist, and forearm. It involves a range of complex procedures that address various injuries, deformities, and diseases in the hand region.
    • Complexity: High
    • Precision: Critical
    • Fine motor skills: Essential
    • Knowledge: Extensive anatomy understanding
    • Dexterity: Essential
    Hand Surgery in other rankings
  6. 6

    Trauma Surgery

    Dr. Emil Kocher
    Trauma surgery involves treating injuries caused by accidents, falls, and other incidents. The surgery can be complex and may require multiple procedures to restore the function of the affected area.
    Trauma surgery is a specialized field of orthopedic surgery that focuses on the treatment of injuries caused by traumatic incidents such as accidents, falls, or sports injuries. It involves the surgical management of fractures, dislocations, and soft tissue injuries.
    • Complexity: High
    • Emergency nature: Most cases are emergencies
    • Scope: Addresses a wide range of injuries
    • Multidisciplinary approach: Collaboration with other specialists is common
    • Risk: Involves high-risk procedures
  7. 7

    Sports Medicine

    Dr. Robert Nirschl
    Sports medicine involves treating injuries caused by sports activities. The surgery may involve repairing torn ligaments, tendons, and muscles. The surgery requires a lot of skill and expertise, and the recovery period can be long and challenging.
    Sports Medicine is a specialized branch of orthopedic surgery that focuses on the treatment and prevention of injuries related to sports activities. It involves the diagnosis, treatment, and rehabilitation of athletes and active individuals to help them regain full functionality and return to their sport or physical activity. Sports Medicine encompasses a wide range of surgical procedures and non-surgical interventions to address various musculoskeletal issues resulting from sports-related injuries.
    • Arthroscopy: The use of a small camera (arthroscope) to visualize, diagnose, and treat joint injuries without the need for large incisions.
    • Ligament Reconstruction: Reconstruction of damaged ligaments, such as the anterior cruciate ligament (ACL) in the knee, to restore stability and function.
    • Cartilage Restoration: Techniques to repair or regenerate damaged cartilage, such as microfracture, osteochondral autograft transplantation, or autologous chondrocyte implantation.
    • Tendon Repair: Surgical repair of torn tendons, including procedures like rotator cuff repair or Achilles tendon repair.
    • Fracture Management: Treatment of bone fractures using various methods, including open reduction and internal fixation (ORIF) or casting.
  8. 8

    Foot and Ankle Surgery

    Dr. Robert W. Mendicino
    Foot and ankle surgery involves treating injuries and conditions that affect the foot and ankle. The surgery may involve correcting deformities, treating fractures, and other conditions. The surgery requires a lot of precision and expertise.
    Foot and Ankle Surgery is a highly specialized orthopedic surgery that focuses on diagnosing and treating conditions and injuries affecting the foot and ankle. It involves complex procedures aimed at restoring the function and relieving pain in these areas.
    • Specialization: Foot and ankle surgeons undergo extensive training and education to specialize in this field.
    • Comprehensive Evaluations: Surgeons conduct thorough evaluations to accurately diagnose foot and ankle problems.
    • Various Conditions: Foot and ankle surgery treats a range of conditions like fractures, sprains, arthritis, deformities, and tendon disorders.
    • Minimally Invasive Techniques: Surgeons utilize minimally invasive techniques whenever possible to reduce scarring and promote faster recovery.
    • Fusion Procedures: Foot and ankle surgeons perform fusion procedures to join bones together and stabilize the affected area.
    Foot and Ankle Surgery in other rankings
  9. 9

    Orthopedic Oncology

    Dr. Henry J. Mankin
    Orthopedic oncology involves treating bone and soft tissue cancers. The surgery can be complex and may require multiple procedures to remove the cancerous tissue.
    Orthopedic Oncology is a specialized field of orthopedic surgery that focuses on the diagnosis, treatment, and management of musculoskeletal tumors, including both benign and malignant tumors. It involves the comprehensive care of patients with bone and soft tissue tumors, utilizing a multidisciplinary approach to provide the best possible outcomes for patients.
    • Multidisciplinary approach: Orthopedic oncology involves collaboration with other specialists such as oncologists, radiologists, pathologists, and radiation therapists to develop a personalized treatment plan for each patient.
    • Tumor diagnosis and staging: Orthopedic oncologists are highly skilled in diagnosing musculoskeletal tumors, determining their stage, and assessing the extent of cancer spread, enabling tailored treatment strategies.
    • Limb-sparing techniques: Orthopedic oncology aims to preserve limbs whenever possible by employing advanced surgical techniques, such as limb-salvage surgery, to remove tumors while maintaining functionality and cosmesis.
    • Prosthetic reconstruction: In cases where limb preservation is not feasible, orthopedic oncologists are experts in prosthetic reconstruction, facilitating mobility and improving the quality of life for amputees.
    • Joint replacement: Orthopedic oncology includes joint replacement procedures for patients with bone tumors affecting joints, allowing for improved mobility and pain relief.
  10. 10
    Spinal deformity surgery involves correcting spinal deformities such as scoliosis. The surgery requires a lot of skill and expertise, and the recovery period can be long and challenging.
    Spinal deformity surgery, also known as spinal fusion or scoliosis surgery, is a complex orthopedic procedure performed to correct abnormal curvature of the spine. The surgery involves removing damaged or degenerated discs, realigning the vertebrae, and fusing them together using bone grafts or implants. It is typically used to treat conditions like scoliosis, kyphosis, or spondylolisthesis, which can cause severe pain, limited mobility, and deformity if left untreated.
    • Surgical Approach: There are several approaches to spinal deformity surgery, including anterior, posterior, and lateral approaches. The specific approach depends on the location and severity of the deformity.
    • Correction Techniques: Different techniques, such as segmental correction, translation, rotation, and derotation, are used to correct the spinal deformity and restore proper alignment.
    • Instrumentation: Spinal deformity surgery often involves the use of specialized spinal instrumentation systems, such as rods, screws, hooks, and wires, to provide stability and support during the fusion process.
    • Bone Grafts: Bone grafts, either harvested from the patient (autograft) or sourced from a donor or synthetic material (allograft or synthetic graft), are used to facilitate bone fusion and solidify the spinal structure.
    • Length of Surgery: Spinal deformity surgery is a lengthy procedure, often lasting several hours or more, depending on the complexity of the case.

Missing your favorite orthopedic surgery?


Ranking factors for difficult orthopedic surgery

  1. Complexity of the procedure
    This includes the number of steps involved, the technical skill required, and the precision needed to perform the surgery. Complex procedures may involve multiple surgical teams working together, the use of advanced technologies or instruments, and meticulous planning and preparation.
  2. Anatomical location
    Some body areas can be more challenging to access or operate on due to their deep location, proximity to critical structures, or limited visibility. For example, surgeries involving the spine or joints like the hip or knee can be challenging due to the surrounding nerves, blood vessels, and other structures.
  3. Patient factors
    The patient's age, overall health, and any underlying medical conditions can significantly impact the difficulty of an orthopedic surgery. Patients with poor health or multiple comorbidities are at a higher risk for complications and may require more complex surgical planning and post-operative care.
  4. Surgical outcomes
    The difficulty of a surgery may be influenced by the desired outcome, which can include pain relief, improved function, or correction of a deformity. Some procedures are known for having a lower success rate or a higher risk of complications, making them more difficult to perform and manage.
  5. Duration of the surgery
    Longer surgeries can present more challenges, such as increased blood loss, greater potential for complications, and increased fatigue for the surgical team.
  6. Recovery and rehabilitation
    Some surgical procedures require an extended recovery period or intensive rehabilitation, which can add complexity to the overall surgical process. Additionally, some patients may have difficulty adhering to post-operative care plans, further complicating the recovery process.
  7. Experience and expertise of the surgeon
    The level of expertise and experience of the surgeon can significantly impact the difficulty of the procedure. Surgeons who specialize in a particular area of orthopedic surgery and have extensive experience are typically better equipped to handle more difficult cases.
  8. Availability of resources
    The availability of advanced surgical technology, instrumentation, and skilled support staff can influence the difficulty of a particular orthopedic surgery. Facilities with limited resources may have more difficulty executing complex procedures safely and effectively.
  9. Risk of complications
    Certain orthopedic surgeries are known for having higher rates of complications, such as infections, nerve damage, or failure of the procedure. In these cases, the difficulty of the surgery is not only in the execution but also in the management of potential complications.

About this ranking

This is a community-based ranking of the most difficult orthopedic surgery. We do our best to provide fair voting, but it is not intended to be exhaustive. So if you notice something or surgery is missing, feel free to help improve the ranking!


  • 160 votes
  • 10 ranked items

Voting Rules

A participant may cast an up or down vote for each surgery once every 24 hours. The rank of each surgery is then calculated from the weighted sum of all up and down votes.


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More information on most difficult orthopedic surgery

Orthopedic surgery is a specialized field of medicine that deals with the diagnosis, treatment, and prevention of musculoskeletal disorders. These disorders can range from common conditions such as arthritis and back pain to more complex injuries and deformities that require surgical intervention. Orthopedic surgeries are among the most challenging and complex procedures performed by medical professionals. When it comes to ranking the most difficult orthopedic surgeries, there are several factors to consider. The complexity of the procedure, the level of skill and experience required by the surgeon, and the potential risks and complications associated with the surgery are all important considerations. Some of the most difficult orthopedic surgeries include joint replacement surgeries such as hip and knee replacements, spinal surgeries such as spinal fusion and disc replacement, and surgeries to correct deformities such as scoliosis and limb length discrepancies. These surgeries require a high level of precision and expertise, and the recovery process can be lengthy and challenging. Despite the challenges, orthopedic surgeries are often necessary to improve quality of life and restore mobility and function for patients suffering from musculoskeletal disorders. With advances in technology and surgical techniques, orthopedic surgeons continue to push the boundaries of what is possible in this complex and challenging field.

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