October 2004 Bulletin

Across the president’s desk

AAOS serves as a global forum for orthopaedic surgery

Dr. Robert W. Bucholz, MD
The Academy must reassess and redefine itself constantly as both the general medical and the orthopaedic surgical marketplaces evolve. Perhaps no component of the specific orthopaedic marketplace is changing more rapidly than that of the international orthopaedic community. The globalization of the orthopaedic industry, instantaneous worldwide communication and exponential growth in orthopaedic research abroad demand that the AAOS expand and strengthen its interactions and collaborations with our international colleagues. In this column, I will describe the rationale for, and our response to, the growth of our international initiatives.

Rationale for international growth

Historically, many seminal surgical procedures in our specialty originated abroad. Such revolutionary techniques as total joint arthroplasty, intramedullary nailing of long bone fractures and arthroscopy were founded on innovative work by orthopaedic surgeons from outside the United States. More recently, new technologies in cartilage transplantation, bone morphogenetic proteins, numerous promising biomaterials and spinal arthroplasty are being driven by our international brethren. As a result of burdensome regulations by the U.S. Food and Drug Administration restricting clinical trials here, much orthopaedic clinical research can now be conducted quicker and cheaper abroad. This trend toward globalization of the next generation of orthopaedic research and innovations will only accelerate.

Only 10 percent of the estimated 175,000 practicing orthopaedic surgeons in the world are American. International orthopaedists possess little more than a passing interest in the U.S. health care system and our numerous legislative and regulatory issues. They do, however, have a profound, increasing interest in the scientific and educational opportunities available. They crave the chance not only to benefit from the wide array of American educational offerings, but also to share their expertise and clinical achievements. The AAOS, the largest and most innovative orthopaedic professional society in the world, should logically serve as the proper forum for such international exchange.

Recent AAOS international efforts

The International Committee, led by immediate past-chair Bruce D. Browner, MD, and newly appointed chair Miguel E. Cabanela, MD, and the international department directed by Lynne Dowling have been instrumental in expanding the number and scope of international programs. Since the 1997 Bylaws change that introduced a new international affiliate member (IAM) category to the Association, the number of IAMs has steadily grown to more than 2,800 members. Orthopaedic surgeons from 103 countries are now members of the AAOS. Valued member benefits spurring this growth include a subscription to the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), access to Orthopaedic Knowledge Online (OKO) and waiver of the registration fee for the AAOS annual meeting.

The AAOS International Continuing Medical Education (CME) program, initiated in South America in the mid 1980s and formalized globally in 1995, has had a phenomenal reception. Various national orthopaedic associations cover almost all meeting and speaker expenses so that AAOS-identified American orthopaedic surgeons can teach courses, which are usually piggybacked to the national association annual meetings.

Over the last few years, an average of 500 to 600 registrants at each of the four to six annual programs have benefited from these courses. The demand for these jointly sponsored courses exceeds our current capacity to provide speakers. Several national associations—including those of Brazil, Argentina, Egypt and Thailand—have sponsored several programs.

The sale of translations and international distribution of AAOS publications have skyrocketed in the last few years. In collaboration with several international societies, popular texts such as the Orthopaedic Knowledge Updates, Essentials of Musculoskeletal Care and the Monograph series have been translated into several languages. JAAOS is now available in Spanish, Portuguese, Italian, Korean, Turkish, and soon, Chinese.

Fifteen international societies have translated and posted on their own association Web sites patient education materials copied from the AAOS patient education Web site, Your Orthopaedic Connection (http://orthoinfo.org). For a nominal fee, OKO is now made available by 23 different international societies to their general membership. Other societies, such as the Brazilian Orthopaedic Association, have promoted AAOS IAM to their membership.

Several societies routinely approach their national orthopaedic industry representatives to sponsor their members’ participation in AAOS Orthopaedic Learning Center (OLC) courses. In 2002, the AAOS, through the Corporate Advisory Council, also initiated a program to sponsor four orthopaedic surgeons from developing countries annually for an OLC course of their choice.

AAOS Annual Meeting enhancements

The AAOS Annual Meeting will remain the focal point of our many international efforts for the foreseeable future. Although international attendance at our Annual Meeting is quite venue-sensitive, it has averaged more than 3,500 attendees for the last five years. Although this number represents approximately 25 percent of all physician attendees, the international orthopaedists account for 38 percent of all AAOS product sales at the meeting.

A number of programs introduced over the last five years have enhanced the user-friendliness of the Annual Meeting to our international guests. Presidents of international orthopaedic associations are not only recognized at the opening ceremonies, but invited to join AAOS leaders at an International Presidents’ breakfast. The Presidents of the Caurosel Group (British, Canadian, Australian, New Zealand, and South African orthopaedic societies) join the AAOS Presidential Line at both a formal dinner and a business meeting to discuss issues of common interest. All international affiliate members are listed in the final program and invited to an exclusive reception.

Educationally, the number of targeted international offerings has grown. An annual international orthopaedic symposium with international speakers and global, cutting-edge topics and issues is highly attended. The Academy News, published and distributed daily during the Annual Meeting, contains multiple articles of international interest. In San Francisco last March, a new pre-meeting skills course designed exclusively for internationals was well received and will be repeated in Washington, D.C.

Starting in 2005, a guest nation program will highlight the orthopaedic research and achievements of one nation in posters and presentations. Spain will be our first guest nation. The AAOS will continue to offer international societies free exhibit space and meeting rooms. The International Business Office offers useful information to all international attendees and assistance to international course directors in their development of CME programming. Several international presidents have chosen to translate and use AAOS Annual Meeting materials for orthopaedic education and their own association’s annual meeting.

The future

The presence of international orthopaedic surgeons at our Annual Meeting and other educational programs enriches their scientific and educational value for all. We have much to learn from our international colleagues. Given the day-to-day and year-to-year hectic routine of orthopaedic practice, there are precious few opportunities for meaningful international exchange. The Academy leadership is committed to identifying and supporting innovative programs of mutual benefit to the fellowship and our international colleagues.

Robert W. Bucholz, MD


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