Orthopaedics in HK

Welcome to the website of the Public Information Committee of the Hong Kong College of Orthopaedic Surgeons

The Hong Kong College of Orthopaedic Surgeons (HKCOS) is the statutory body responsible for setting the standards of professional orthopaedics training, accrediting professional orthpaedics education programmes and conducting professional qualifying exams. The College also works alongside the Hong Kong Orthopaedic Association to serve and support the interests and aims of the Hong Kong orthopaedic community, both domestically and across the world.

The College's training programmes are recognized as world class as is the surgical work carried out within Hong Kong's specialist orthapedic centres. The Department of Orthopedic Surgery at the University of Hong Kong is particularly well known for its groundbreaking work in spinal deformity, children's orthopedics and upper limb surgery while the contributions from the Department of Orthopedics & Traumatology at the Chinese University of Hong Kong are also internationally recognized, especially with its preeminent work in vascularized grafts, sports surgery and physiology and children's deformity. Hong Kong surgeons have been making a significant contribution to worldwide orthopedics for more than 50 years and continue to do so today.

The history of the Hong Kong College of Orthopaedic Surgeons

The HKCOS was founded in 1993, with the formation of the Hong Kong Academy of Medicine. The HKCOS became one of 12 colleges under the Academy umbrella and was one of the first specialty colleges to be established. The roots of the College, however, stretch back to 1951 when Hong Kong University establishment a specialist orthopedic unit at Queen Mary Hospital.

The formal training of orthopaedic surgeons in Hong Kong came a decade later, with the inception of the Department of Orthopaedic Surgery in 1961 while the Hong Kong Orthopaedic Association, formed in 1965, started to organize the academic and social affairs for the Orthopaedic fraternity in Hong Kong. It is a role it continues today.

Hong Kong's first orthopaedic training programmes followed the practice of the United Kingdom in terms of the training and accreditation of specialised doctors, where orthopaedic trainees have to pass stringent exit exams, followed by a period of overseas practice.

Initially, from the 1960s to 1984, orthopaedics training fulfilled the requirements of the UK's Fellow of the Royal College of Surgeons exam. From 1985 to 1991, the Australasian College took up the role of organising the exit exams. From 1991 to 1996, this role was replaced by the HKCOS. From 1997 to the present day, the HKCOS has been sharing this responsibility with the Royal College of Surgeons of Edinburgh.

With the development of new concepts and techniques in orthopaedic medicine worldwide, such as sub-specialisation, minimally invasive procedures and computer-assisted surgery, the HKCOS is constantly evolving and updating its training curriculum to reflect these radical changes.

Due to the rapid development in this field, the HKCOS feels it is essential for orthopaedic surgeons to continue to upgrade their knowledge and skills. To this end, it provides training for continuous professional development to all registered orthopaedic surgeons practicing in Hong Kong.

Who are orthopaedic specialists?

An orthopaedic surgeon is a physician devoted to the diagnosis, treatment, prevention and rehabilitation of injuries, disorders and diseases of the body's musculoskeletal systems. This system includes bones, joints, ligaments, muscles, nerves and tendons.

While orthopaedic surgeons are familiar with all aspects of the musculoskeletal systems, many orthopaedists specialise in certain areas, such as the foot and ankle, hand, shoulder and elbow, spine, hip or knee. Orthopaedic surgeons may also choose to focus on specific fields like paediatrics, trauma, reconstructive surgery, oncology (bone tumours) or sports medicine.

Education and training

To practice in Hong Kong, an orthopaedic specialist must have undertaken at least 12 years of professional education and training: five years' medical school and a year's medical residence followed by two years' General Basic Surgical Training. He or she has to pass a qualification examination before being qualified for a four-year professional training programme with the Hong Kong College of Orthopaedic Surgeons.

Upon finishing the training programme, he or she must pass a stringent assessment test before being recognised as an orthopaedic specialist.

After registration as a specialist, the Medical Council of Hong Kong requires a registered surgeon to complete at least 90 credits of continuing medical education every three years. Therefore, all orthopaedic surgeons need to attend seminars and specialist workshops relevant to their practice on a regular basis in order to keep themselves abreast with the latest medical technologies, knowledge and skills. This helps ensure the patients receive the best and latest professional service possible.

What kind of diseases do orthopaedic surgeons treat?

Orthopaedic Surgeons treat patients of all ages (newborns, children, athletes, the middle-aged and the elderly) with conditions that range from bone and joint disorders and fractures to disease or tears of the muscles, ligaments and tendons in all regions of the body. It is essential that patients and their families develop partnerships with their physicians. This will help ensure that decisions about medical treatments honor the patients' wants, needs, preferences and values. Orthopaedic surgeons respect the value of diversity and are committed to serving communities and individuals with unique needs.

An orthopaedic surgeon treats many musculoskeletal conditions without surgery, by using medication, exercise and other rehabilitative or alternative therapies. If necessary, he/she may also recommend surgical treatment if the patient does not respond to other treatments.

Some of the conditions and diseases an orthopaedic surgeon treats include:

1. Abnormalities of the fingers and toes
2. Back pain, ruptured disks, sciatica and scoliosis
3. Tumors in bones and soft tissues, muscular dystrophy and cerebral palsy
4. Club foot, bunions, bow legs, knock knees and unequal leg length
5. Fractures and dislocations
6. Growth abnormalities
7. Osteoarthritis
8. Osteoporosis and geriatric bone fractures
9. Rheumatoid arthritis
10. Sports and work-related injuries
11. Tendon injuries, pulled muscles, bursitis and torn cartilage
12. Torn ligaments, sprains and strains
13. Infectious diseases affecting the bones and muscles, such as spinal tuberculosis.

What types of surgeries do orthopaedic surgeons perform?

Based on the patient's needs, an orthopaedic surgeon would perform the appropriate type of surgery. Common ones include:
1.Arthroscopy: a procedure using special cameras and equipment to visualise, diagnose and treat problems inside a joint.
2. Fusion: a welding process by which bones are fused together with bone grafts and internal devices (such as metal rods) to heal into a single solid bone.
3. Internal fixation: a method to hold the broken pieces of bone in proper position with metal plates, pins or screws while the bone is healing.
4. Joint replacement (partial, total and revision): an arthritic or damaged joint is removed and replaced with an artificial joint called prosthesis.
5. Osteotomy: the correction of bone deformity by cutting and repositioning the bone.
6. Soft tissue repair: the mending of soft tissue such as torn tendons or ligaments. 
7. Decompressive surgery: to reduce pressure on the spinal cord, spinal nerve roots and peripheral nerves.

What can patients expect from orthopaedic surgeons?

In general, visits with an orthopaedic surgeon start with a personal interview, physical examination and review of previous records or tests. This may be followed by additional diagnostic exams, such as blood tests, X-ray or other images like computed tomography scan (CT scan) or magnetic resonance imaging (MRI). For most orthopaedic conditions and injuries, there may be more than one form of treatment. The orthopaedic surgeon will discuss treatment options with the patient to mutually determine the plan best suited for his/her health and lifestyle.

Prevention is better than cure, and early detection of musculoskeletal problems always helps to speed up recovery. If you experience any musculoskeletal symptoms or have sustained an injury, please consult your general practitioner, who will be able to refer you to a registered orthopaedic specialist for proper investigation and treatment.