December 2003 Bulletin

Future research for clinical orthopaedic practice

Necessary for advancement of musculoskeletal treatment and care

By William C. McMaster, MD

The history of orthopaedic surgery is filled with innovations and improvements that help the clinical practitioner deliver patient care. Orthopaedic surgeons, actively involved in both providing patient care and performing clinical and basic research, have produced seminal developments that measurably improved the quality of life for millions.

Orthopaedic surgeons such as Watson-Jones, Smith-Peterson, Charnley, Phemister, Urist, Insall, and O’Connor were faced with daunting clinical challenges for which there were no ready answers. Motivated by that necessity, they went to the laboratory and devised solutions that ushered in a new era in the treatment of musculoskeletal disease. They engineered technologies and protocols for other orthopaedic surgeons that substantially benefit their patients and enhance practice economics.

Securing funding
In recent years, funds for musculoskeletal research have become harder to secure. Decreasing reimbursements and increased costs of doing business are affecting both private and academic practice environments. It is harder now for promising young orthopaedists interested in an academic career and doing research to survive economically.

Unless they can devote time to research unencumbered by the pressures of clinical practice, they will be unable to develope future innovations. Many choose not to enter academic careers at all, or turn to private practice after years of struggling to succeed financially as researchers. This can have unintended consequences for our surgical specialty.

Without significant investments in research and development, the orthopaedic profession may find that future musculoskeletal innovation will be developed by individuals in other disciplines and oriented to other interests. Ceding control to others will have enormous consequences for our patients and a direct economic impact on our own practices.

Funding future research
The AAOS recognizes this possibility and, in conjunction with the Orthopaedic Research and Education Foundation (OREF), it has developed the Clinician Scientist development track in orthopaedic surgery.
The OREF funds several Career Development Awards. These multiyear seed grants have proven to be successful springboards to obtaining grants from the National Institutes of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH/NIAMS) that sustain a major time commitment by an orthopaedic surgeon researcher.

OREF also provides a variety of educational opportunities. The OREF and the American Orthopaedic Association (AOA) cosponsor a practice management symposium at their yearly resident conference. OREF assists state orthopaedic societies with funds for speakers at their annual meetings. Its grant application-writing course has been very successful in increasing the prospects for NIH grants to orthopaedic surgeons.

The value of supporting research
Many orthopaedic leaders recognize the value of supporting research support. Some of today’s most prominent researchers received funding from OREF early in their careers. In fact, the current AAOS Presidential line, as well as the immediate past president, have each received research funding from OREF earlier in their careers.

Industry also has been very generous. Individual orthopaedic surgeons and organizations have contributed to the annual campaign to support ongoing grant requests and have joined the Shands Circle to endow the research mandate of OREF in perpetuity. As a result, OREF funded $3.2 million of research in the 2003 cycle and has awarded over $52 million since its inception. Recently, a successful endowment campaign added nearly $40 million to continued research funding.

Unfortunately, financial suppport from the AAOS fellowship is not as strong. Less than 15 percent give annually to OREF. But failure to invest in research and development threatens the continued growth in basic knowledge and technology needed to sustain and expand this specialty. After all, advancements in orthopaedics and the development of new devices and protocols begin with research and directly affect your daily practice.
OREF was established nearly 50 years ago by a few farsighted orthopaedic surgeons who recognized the need for an entity to promote musculoskeletal research by orthopaedic surgeons. To commemorate its 50th anniversary and emphasize the global importance of the Bone and Joint Decade, OREF will soon embark on a second endowment fund campaign. This effort will require access to public resources outside of orthopaedics to be successful. However, if the profession cannot demonstrate its commitment through participation and support of OREF, it is unlikely the public will be convinced to join.

Next steps
The AAOS should assume a leadership position in broadcasting the value, for all of its members, of such an investment in future of orthopaedics. Steps might include:

Such an arrangement benefits both organizations, their respective memberships and the orthopaedic patient population. OREF benefits from increased exposure to funding resources for important peer-reviewed research; the AAOS demonstrates that it is encouraging quality research by orthopaedic surgeons for the benefit of orthopaedic practices and their constituent patients.

The AAOS also can display moral leadership by encouraging fellows to give back to their profession. We have an obligation to those who built this discipline to ensure a viable environment for future generations. Without that, we cannot safely say that the future of orthopaedic surgery is truly in our own hands.

William C. McMaster, MD, is in clinical practice in Orange, Calif., a clinical professor of orthopaedic surgery at the University of California, Irvine, chief, orthopaedics at Long Beach VAMA, member of the AAOS council of research, and secretary, trustee, Board of Orthopaedic Research and Education Foundation. He can be reached at (714) 633-2111 or via e-mail at

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