Trauma and orthopaedic surgeon in Latviathe trauma unit, the joint replacement queue and costs

A trauma and orthopaedic surgeon diagnoses and treats disease and injury of the bones, joints, muscles, tendons and ligaments.

• Fractures, dislocations, bruises and sprains
• Tendon and muscle injuries
• Osteoarthritis and joint pain
• Meniscal and cruciate ligament damage
• Foot deformities
• Joint replacement and revision surgery
• Spinal injuries

The Hospital of Traumatology and Orthopaedics states that it treats limb and spine injuries caused by mechanical forces: wounds, abrasions, bruises, fractures, dislocations, muscle, tendon and ligament tears, and mechanical damage to joint structures.

Rīgas 1. slimnīca notes that diagnosing and treating traumatic injuries and orthopaedic deformities in newborns, children and adolescents falls within the paediatric surgeon's competence.

This is one of the longest queues in Latvian healthcare, so it is worth understanding how it works.

Before joint replacement, hip or knee disease is first treated conservatively. The consultation with a replacement specialist follows once conservative treatment is no longer effective.

When your place comes up, you receive a letter and take it to your own surgeon to agree the operation date.

• Six years of medical study and a doctor's degree, at RSU or the University of Latvia.
• Residency in traumatology and orthopaedics. Programme page: RSU residency programme.
• Many specialists train further abroad and belong to international organisations including AO.
• In practice doctors sub-specialise, for example in knee and shoulder arthroscopy, hip and knee replacement, pelvic fracture surgery or foot surgery.
• The certificate is valid for 5 years. Recertification requires 250 continuing education points plus a 48.38 EUR fee.
• Entry in the practitioners register must be renewed every 5 years.

• Acute or planned. A fresh injury belongs at the trauma unit, not on a waiting list.
• Referral. A referral is needed for a state-funded consultation, though some providers do not require one for a private visit.
• Conservative treatment first. Veselības centrs 4 states that surgery is the last step, and that modern methods can in some cases postpone hip replacement.
• Experience with the specific operation. Doctor profiles often state how many operations a year they perform and what they specialise in.
• Queue or payment. If waiting is not acceptable, there are two routes: pay to accelerate the queue, or go fully private.

• Bring earlier investigation results. Veselības centrs 4 specifically asks for X-ray and MRI results.
• The doctor reviews the symptoms, previous injuries, investigations already done and treatment so far.
• Treatment can happen during the visit itself, for example pain-relieving injections or medication placed into the joint space.
• If there is fluid in the joint, its colour and viscosity can tell the doctor about damage inside the joint.
• An individual treatment and recovery plan follows, with further tests ordered as needed.

In the public system, with a referral, a specialist visit costs 4.00 EUR. For joint replacement within the state queue, the patient pays the co-payments set in Cabinet Regulation No. 555: 10.00 EUR per inpatient bed day and 31.00 EUR for the operation, except for exempt categories.

• Patient co-payment for a specialist visitPrice EUR: 4.00Source: NVD
• Co-payment for the operationPrice EUR: 31.00Source: TOS, Cabinet Regulation No. 555
• Inpatient care, per bed dayPrice EUR: 10.00Source: TOS, Cabinet Regulation No. 555
• Accelerating the queuePrice EUR: 50 per cent of the state-allocated fundingSource: TOS
• Surgery outside the state queuePrice EUR: full cost per price listSource: TOS
• Patient co-payment for a child under 18Price EUR: 0.00Source: NVD

The specialty body is the association "Latvijas traumatologu ortopēdu asociācija", registration number 40008003645, board chair Mārtiņš Malzubris, ltoa.lv.

Spinal surgery is represented by the Latvian Society of Spine Surgeons, registration number 40008205525, contact Kaspars Ruks.

Certificates are issued by the Certification Council of the Latvian Medical Association. The sector regulator is the Health Inspectorate.

If you have doubts about the quality of care, raise them first with the provider's management. If that does not resolve it, a written submission goes to the Health Inspectorate no later than two years after the alleged infringement, and is reviewed within 30 days, extendable to four months in complex cases. The procedure is set out on the Health Inspectorate site.