December 2004 Bulletin

East meets West in the classroom

Physicians come together to advance joint replacement knowledge in China

By Kathleen Misovic

Last September, the AAOS brought the latest information on hip and knee reconstruction to Chinese orthopaedic surgeons in the first multinational medical meeting held in Beijing, China.

The AAOS instructional course lecture program on total joint reconstruction was held September 22-24, 2004 in conjunction with the Fourth Scientific Congress of the Chinese Speaking Orthopaedic Society (CSOS). The idea for the joint sponsorship of the program came about when Academy member Gwo-Jaw Wang, MD, president of the Kaohsiung Medical University in Taiwan, contacted the AAOS International Committee about putting together an educational program on joint reconstruction. Dr. Wang is a former member of the committee.

The program was four years in the planning stage and originally scheduled to be held in 2003, but was postponed for a year because of the SARS epidemic, said Lynne Dowling, director of the AAOS international department. But the delay didn’t dampen enthusiasm.

“We had hoped for a minimum of 300 to 400 Chinese orthopaedic surgeons to participate, but we had more than 600,” Dowling said.

A rapt audience

The high attendance rate matched the high level of interest. The AAOS faculty was struck by the dedication of the Chinese participants.

“You could really feel the tremendous amount of attention from the audience. They stayed to the bitter end; there wasn’t the typical ‘end of the day’ exit,” said Russell E. Windsor, MD, a program faculty member from the Hospital for Special Surgery in New York City who is also first vice president of the Knee Society. “They were so involved in the question-and-answer sessions they could have gone on longer.”

“The lectures were well-attended from beginning to end and there were lots and lots of questions,” said Miguel E. Cabanela, MD, chair of the AAOS International Committee and a faculty member from the Mayo Clinic in Rochester, Minn. “I was amazed by the level of attention from the audience.” Efficient planning and a good working relationship between the American and Chinese faculty were other aspects of the meeting that kept it running smoothly.

“The program was very well-organized from beginning to end,” said faculty member Bernard N. Stulberg, MD, chair of the AAOS Orthopaedic Device Forum and director of the Center for Joint Reconstruction at the Cleveland Orthopaedic and Spine Hospital.

“All the material was translated into Chinese, including the slides and videos. People who knew both English and Chinese were on-hand to translate during both the educational and the question-and-answer sessions,” said Dr. Cabanela.

Member Miguel Cabanela, MD, and Lynne Dowling, director, international department, stand in the foreground of the Great Wall of China.

About 600 Chinese orthopaedic surgeons attended the total joint program held at the Crowne Plaza Hotel Beijing North.

Catching up quickly

The course enabled Chinese participants to benefit from learning about joint reconstruction and replacement at an advanced stage of the technology, without having to go through the trial-and-error that was prevalent 25 or 30 years ago.

“It was a privilege to help them learn where the technology came from and where it’s going,” said Dr. Stulberg. “And it was nice to have an opportunity to help them avoid the problems that we had to solve.”

AAOS faculty came to China not knowing what to expect as far as orthopaedic proficiency. They were heartened by what they found.

“They were more advanced than I previously thought,” said Dr. Windsor. However, he and the other faculty members noticed that both professional experience and device availability vary widely between the large cities and the rural areas.

“There is a drop off in technical proficiency in the smaller towns,” said Dr. Windsor. “But sooner or later they will be up to par in many areas once there is a way to allow them greater access to devices.”

One aspect of health care technology the Chinese already share with their American counterparts is the love of gadgets. “Chinese orthopaedic surgeons have the same technical orientation, the same gadget leanings, as Americans,” Dr. Cabanela said. “They loved the little video vignettes of surgery techniques; they just couldn’t get enough of any talks with videos.”

Dr. Stulberg predicted that economic issues, such as insurance, would be the last aspect of Chinese health care to catch up to Western standards. “Patients still pay for their implant devices right now,” he said. “The technology is there, but they’re still sorting out how it can be delivered to the population that would benefit from it.”

Celebrating along the Great Wall

Not all of the conference took place inside classrooms with lectures and videos. The Great Wall of China provided the backdrop for an open-air ceremony at sunset with food and fireworks. “It was the first time a ceremony was allowed at the Great Wall for a medical convention from the West,” Dr. Cabanela said.

In their limited spare time, the AAOS faculty and staff toured the attractions of Beijing and sampled the local culture.

“I managed to climb the Great Wall,” said Dr. Windsor, whose daughter had already been to China and made a similar climb. “I visited the Forbidden City; that’s where you learn a lot about the people and the culture. It was fascinating.”

Dr. Cabanela wished he had more than half a day available to tour the city. “I went touring around Beijing and saw Tiananmen Square and the Summer Palace as well as the Forbidden City. It was worth spending more time there, but I only had six hours.”

In the end, the AAOS faculty came away looking forward to their next opportunity to visit mainland China and other countries.

“The Chinese were very gracious and took good care of us,” said Dr. Cabanela. “They seemed very happy to have us.”

“The feedback we received indicated was that the Chinese were very impressed with the entire program,” said Dr. Windsor. “I hope we will return and do something similar in three to four years.”

Members interested in teaching and doing other volunteer work with international programs should contact Olga Foley in the international department at (847) 384-4167 or

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