Orthopedic Surgical Services Research Articles

The comprehensive value of the modern vascular surgeon to the orthopedic surgery service

ObjectiveOrthopedic surgery is among the highest compensated specialties in modern practice. Vascular surgeons are consulted frequently during orthopedic operations, however, the comprehensive value of the vascular surgery service to the safe delivery of orthopedic care has not been characterized previously. MethodsElectronic medical records were retrospectively queried for all operations performed by orthopedic surgeons requiring operative vascular surgical consultation from June 2013 to December 2023. Data were collected on case-specific details, reasons for consultation, and total charges. Work relative value units were calculated for each primary orthopedic procedure using the Centers for Medicare and Medicaid Services physician fee schedule. ResultsA total of 952 operative vascular surgery consultations were required over the study period. Consults were requested by 56 orthopedic surgeons across all eight orthopedic subspecialties at our institution. Operative vascular consultation was requested across 108 different procedure types. A total of 94 consults (9.9%) were emergent, intraoperative requests, with the remaining 858 consults (90.1%) occurring in the preoperative setting. The most common causes for consultation included surgical exposure (n = 832 [87.4%]), inadvertent bleeding (n = 44 [4.6%]), need for bypass (n = 12 [1.3%]), and acute limb ischemia (n = 11 [1.2%]). Total charges for all operative consultations exceeded $91.5 million, and the calculated total work relative value units for all primary orthopedic procedures was 19,384.5. A total of 54 cases (5.7%) occurred after hours, on a weekend, or both. ConclusionsVascular surgeons are integral to the provision of orthopedic surgical services, inclusive of all orthopedic subspecialties, for both the prevention and treatment of iatrogenic vascular injury. The around-the-clock availability of a vascular surgeon enables the orthopedic surgery department to generate significant revenue for the hospital system. These findings are important to the ongoing discussions regarding the value and compensation of the modern vascular surgeon.

Utility of data linkage for orthopaedic service planning in the paediatric population with cerebral palsy at Starship Children's Hospital.

To determine the accuracy of orthopaedic surgical procedure coding (ICD-10-AM/ACHI/ACS) for children with cerebral palsy (CP) at Starship Children's Hospital, use data linkage with the New Zealand Cerebral Palsy Register (NZCPR) to obtain demographic and clinical information for children with CP requiring orthopaedic surgical services in the Auckland District Health Board catchment area, and to determine if trends in the clinical and demographic data are useful for future service planning for children with CP. Surgical admission data for children with CP aged 0-18 years at the time of their first procedure were extracted from Auckland District Health Board records for 2013-2018, and information on demographics and Gross Motor Function Classification System level were obtained from the NZCPR. The ICD-10-AM/ACHI/ACS codes for surgery/intervention were matched with the operation notes in the electronic health records using NHI numbers and assessed for accuracy. During the study period, 261 paediatric patients with CP underwent orthopaedic procedures, which could be grouped broadly into five categories (spine, upper limb, lower limb, Botulinum-A toxin injection only, and other) with a coding accuracy of 95%. Clinical and demographic data could be obtained from the NZCPR for 232 (88.9%) of the 261 patients. Using orthopaedic surgical procedure codes, we could identify broad categories of procedures received by children with CP and the demographic and clinical characteristics of these children, which will assist with service planning and identify trends in care delivery.

Association between spine injury and opioid misuse in a prospective cohort of Level I trauma patients.

Objective:To explore patient and treatment factors explaining the association between spine injury and opioid misuse.Design:Prospective cohort study.Setting:Level I trauma center in a Midwestern city.Participants:English speaking patients aged 18 to 75 on Trauma and Orthopedic Surgical Services receiving opioids during hospitalization and prescribed at discharge.Exposure:Spine injury on the Abbreviated Injury Scale.Main outcome measures:Opioid misuse was defined by using opioids: in a larger dose, more often, or longer than prescribed; via a non-prescribed route; from someone other than a prescriber; and/or use of heroin or opium. Exploratory factor groups included demographic, psychiatric, pain, and treatment factors. Multivariable logistic regression estimated the association between spine injury and opioid misuse when adjusting for each factor group.Results:Two hundred eighty-five eligible participants consented of which 258 had baseline injury location data and 224 had follow up opioid misuse data. Most participants were male (67.8%), white (85.3%) and on average 43.1 years old. One-quarter had a spine injury (25.2%). Of those completing follow-up measures, 14 (6.3%) developed misuse. Treatment factors (injury severity, intubation, and hospital length of stay) were significantly associated with spine injury. Spine injury significantly predicted opioid misuse [odds ratio [OR] 3.20, 95% confidence interval [CI] (1.05, 9.78)]. In multivariable models, adjusting for treatment factors attenuated the association between spine injury and opioid misuse, primarily explained by length of stay.Conclusion:Spine injury exhibits a complex association with opioid misuse that predominantly operates through treatment factors. Spine injury patients may represent a subpopulation requiring early intervention to prevent opioid misuse.

The Unmet Need for Orthopaedic Services Among American Indian and Alaska Native Communities in the United States.

Historic and present-day marginalization has resulted in a high burden of disease and worse health outcomes for American Indian and Alaska Native (AI/AN) communities in the United States. Musculoskeletal disease is the leading cause of disability for the general population in the U.S. today. However, few have examined musculoskeletal disease burden and access to orthopaedic surgical care in the AI/AN communities. A high prevalence of hip dysplasia, arthritis, back pain, and diabetes, and a high incidence of trauma and road traffic-related mortality, suggest a disproportionately high burden of musculoskeletal pathology among the AI/AN communities and a substantial need for orthopaedic surgical services. Unfortunately, AI/AN patients face many barriers to receiving specialty care, including long travel distances and limited transportation to health facilities, inadequate staff and resources at Indian Health Service (IHS)-funded facilities, insufficient funding for referral to specialists outside of the IHS network, and sociocultural barriers that complicate health-system navigation and erode trust between patients and providers. For those who manage to access orthopaedic surgery, AI/AN patients face worse outcomes and more complications than White patients. There is an urgent need for orthopaedic surgeons to participate in improving the availability of quality orthopaedic services for AI/AN patients through training and support of local providers, volunteerism, advocating for a greater investment in the IHS Purchased/Referred Care program, expanding telemedicine capabilities, and supporting community-based participatory research activities.

The orthopedic patient and limb amputation: impact of traditional beliefs on acceptance in Port Harcourt, Nigeria

Background: Aim of the study was to ascertain the awareness on surgical limb amputation and establish the existence of traditional beliefs that impacts on acceptance of surgical limb amputation in tertiary healthcare facilities in Port Harcourt. Surgical limb amputation is a form of treatment recommended in conditions of dead, dying, dangerous limb or damn nuisance, in which the appendage is removed surgically and permanently from the rest of the body.Methods: A cross-sectional descriptive study was carried out among patients and patients’ relatives in the two government-owned tertiary health care facilities that offered orthopedic surgical services in Port Harcourt using self-administered questionnaires. Data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0.Results: Safe removal of a disease limb from the rest of the body was considered by 217 respondents (93.1%) as the meaning of limb amputation. Some community beliefs on amputated limb were: risk of incomplete body in the “next world”, burying of persons with amputated limb in the evil forest when they die, stigmatization as outcasts in some communities. Eighty-two respondents (35.2%) opined that traditional bone setters should be encouraged to continue their work.Conclusions: There was high awareness on limb amputation among respondents. Though expressed by few respondents, the twin factors of patronage of traditional bone setters and the practice of community stigmatization of amputees / social isolation among others explains patients decline of offer of limb amputation in the care of orthopedic patients in our society.

An Analysis of Orthopedic Surgical Services Provided to Syrian Refugees in a Health Center Away from the Syria District

Background: The Arab Spring, a wave of demonstrations and protests that hadtaken place in the Arab world since December 18, 2010, had also affected Syria. Thenumber of Syrian refugees who have migrated to Turkey is over 3.5 million.Objective: The aim of this study was to evaluate the demography, clinical featuresand invoice amounts of Syrian refugee patients who were operated in an orthopedicand traumatology clinic of a healthcare institution far from the Syria district region.Materials and Methods: For this purpose, 329 Syrian patients who underwentsurgery in the field of orthopedics and Traumatology between June 2011 and 2018were enrolled in the study. The records of Syrian refugees have been retrospectivelyexamined.Results: Male applicants (76.3%) were more than females (23.7%).%). It was observedthat the highest number of applications were in the field of microsurgery (21.3%),followed by trauma (20.7%) and pediatric orthopedics (14.6%), respectively. Includingthe non-emergency trauma patients, 90% of the patients underwent elective surgerieswhile 10% underwent emergency surgeries. It was determined that the average invoiceamount was 4987 TL (min: 207 TL, max: 87541 TL) and the highest cost was in thefield of vertebral surgery (average 19384 TL). The rate of emergency applications hasshown a significant increase in 2016 and later (2016-2017-2018) compared to 2015 andbefore .Conclusion : The main Syrian refugees patient profile of the health centers far fromthe war zone is composed of elective cases and their costs.Key words: Health Services Accessibility–Hospital Costs–Orthopedic Procedures–Refugees–Syria

Standardized, Patient-specific, Postoperative Opioid Prescribing After Inpatient Orthopaedic Surgery.

Opioid-related mortality has increased over the past 2 decades, leading to the recognition of a nationwide opioid epidemic and prompting physicians to reexamine their opioid prescribing practices. At our institutions, we had no protocol for prescribing opioids upon discharge after inpatient orthopaedic surgery, resulting in inconsistent and potentially excessive prescribing. Here, we report the results of the implementation of a patient-specific protocol using an opioid taper calculator to standardize opioid prescribing at discharge after inpatient orthopaedic surgery. The opioid taper calculator is a tool that creates a patient-specific opioid taper based on each patient's 24-hour predischarge opioid utilization. We implemented this taper for patients discharged after inpatient orthopaedic surgery at our two institutions (Boston Medical Center and Lahey Hospital and Medical Center-Burlington Campus). We compared discharge opioid quantities between orthopaedic patients postimplementation and quantities prescribed preimplementation. We also compared discharge opioid quantities between orthopaedic and nonorthopaedic surgical services over the same time period. Nine-months postimplementation, a patient-specific taper was used in 74% of eligible discharges, resulting in a 24% reduction in opioids prescribed at discharge, along with a 35% reduction in variance. Over the same time frame, a smaller reduction (9%) was seen in the opioids prescribed at discharge by nonorthopaedic services. The most notable reductions were seen after total joint arthroplasty and spinal fusions. Despite this reduction, most patients (65%) reported receiving sufficient opioids, and no substantial change was observed in 30-day postdischarge opioid prescription refills after versus before protocol implementation (1.58 versus 1.71 fills per discharge). Using the opioid taper calculator, a patient-specific taper can be successfully used to standardize opioid prescribing at discharge after inpatient orthopaedic surgery without a substantial risk of underprescription. Level II.

Policy and Ethical Considerations for Widespread Utilization of Generic Orthopedic Implants.

In 2015, the United States spent $3.2 trillion on healthcare, representing 18% of the nation’s gross domestic product [1]. As prices continue to climb, physicians, healthcare policymakers, and industry leaders alike have sought varied means to lower costs while maintaining the quality of care. Coverage expansion, shifts toward bundled care payments, and the implementation of Medicare Payment Reform (Medicare Access and Children’s Health Insurance Program Reauthorization Act of 2015 [MACRA]) are indicative of shifting dynamics in the American healthcare system prioritizing outcomes, value, and cost-containment over the fee-for-service model [2], [3]. Orthopedic implant expenditures are considerable in the overall cost of care for surgical patients. The cost of total joint arthroplasty implants between 1996 and 2006 increased an estimated 130%. Implant and medical device costs comprise up to 60% of hospital reimbursements for primary procedures [4]. Most implants are proprietary in nature and vary substantially in their price and features depending on the industry manufacturer [5], [6], [7]. Control of implant costs is thus a necessary focus for cost containment in orthopedic surgery. To that end, as patents on many brand name implants begin to expire, “generic” implants present a unique opportunity to improve the value of orthopedic care. Although generic drugs have been used for decades in the pharmaceutical industry, the use of generic implants has only recently been considered in the field of orthopedic surgery [8], [9], [10]. In the pharmaceutical sector, an estimated $33 billion has been saved by Medicare in the United States through utilization of generic medications [11]. There could be potential for an analogous substantial reduction in healthcare expenditures via the use of generic orthopedic implants. There is some literature describing the favorable economic possibilities for use of generic orthopedic implants [9], [10], [12]. However, the ethical issues, policy implications, and potential unanticipated consequences of such a paradigm shift have not been investigated. This article discusses the pros and cons of generic implant usage from economic, clinical, and ethical perspectives.

Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study

The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published global trends regarding surgical access in Sub-Saharan Africa. As the global health community must develop innovative solutions to address the rising burden of musculoskeletal disease and support the advancement of universal health coverage, increasing access to orthopaedic surgical services will play a central role in improving health care in the world's developing regions.

Strategic management in hospitals – Theory and practice: Orthopedic and spine services

The healthcare sector in the United States has been constantly changing for the last two decades. Hospitals and physicians have to deliver a high quality of measurable care for competitve prices. The information in this article has been taken mainly from the public information of various hospitals to create a simulated real-life scenario by using the underpinnings of the industrial organisation (I/O), the resource-based view (RBV) and network theories of strategy. a comprehensive view of strategic managemnet of orthopedic and spine surgical services in hospitals has been presented. Hospitals may use the strategy mapping to attain a sustainable competitive advantage. Information and data have been modified to suit the overall strategy design.

Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries.

The sequelae of acute musculoskeletal conditions, especially injuries and infections, are responsible for significant disability in low- and middle-income countries. This study characterizes the availability of selected musculoskeletal surgical services at different tiers of the health system in a convenience sample of 883 health facilities from 24 low- and lower-middle-income countries. Selected data points from the World Health Organization's (WHO) tool of situational analysis of surgical availability were extracted from the WHO's database in December, 2013. These included infrastructure, physical resources and supplies, interventions, and human resources. For a descriptive analysis, facilities were divided into two groups based on number of beds (<100, 100-300, and >300) and level of facility (primary referral, secondary/tertiary, and Private/NGO/Mission). Statistical comparison was made between public and Private/NGO/Mission facilities based on number of beds (≤100, 100-300, and >300) using a Chi-Square analysis, with statistical significance at p < 0.05. Significant deficiencies were noted in infrastructure, physical resources and supplies, and human resources for the provision of essential orthopedic surgical services at all tiers of the health system. Availability was significantly lower in public versus Private/NGO/Mission facilities for nearly all categories in facilities with ≤100 beds, and in a subset of measures in facilities with between 100 and 300 beds. Deficiencies in the availability of orthopedic surgical services were observed at all levels of health facility and were most pronounced at facilities with ≤100 beds in the public sector. Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if we are to reduce the burden of death and disability from a variety of emergent health conditions. There were no sources of funding.

Performance of the orthopedic surgical services of the General University Hospital Gregorio Mara&amp;#241;&amp;#243;n on the 11th of March terrorist outrage in Madrid

Background: In recent years, we have witnessed dreadful terrorist attacks that increasingly affect us. Catastrophes imply physical damage and grievous bodily harm that can strain the capacity of available hospitals to provide quality healthcare. Materials and Methods: The authors describe and analyze the performance of the orthopedic surgery department at a university hospital faced with a terrorist attack that injured 1167 and killed 192 people. Results: The injuries are characterized by severity and tissular damage spreading, including deep wounds, blast injuries, and burns. Conclusions: The review of analyses of previous catastrophes, described by our colleagues in different studies, can be very useful inorder to avoid mistakes in the future.

How can qualitative research be utilised in the NHS when re-designing and commissioning services?

Patient experience is acknowledged as a key quality metric of healthcare quality and can be used to identify problems with healthcare delivery, to drive quality improvements and to inform commissioning of services that promote patient choice. In this article, the contribution of qualitative research studies to inform the redesign and patient-focussed commissioning of services is considered, illustrated with particular reference to elective orthopaedic surgical services. To fully embrace the concept of patient and public involvement (PPI) and to embed it in service delivery, health service design and informing commissioners to purchase healthcare that truly meets patient need and expectations, qualitative research has an increasingly important role to play. Through well-conducted qualitative research exploring patients' experiences, their knowledge and experiences of conditions can be utilised for the benefit of others and the impact of the patient voice truly heard when designing and commissioning healthcare services.

Non-Emergent Orthopaedic Injuries Sustained by Soldiers in Operation Iraqi Freedom

The majority of soldiers deployed to the theater of combat operations return safely after completion of the deployment. Many of these soldiers sustain non-emergent musculoskeletal injuries that initially are treated nonoperatively and ultimately require surgery following their combat tour. A prospective evaluation of the orthopaedic surgery consultations and surgical procedures required by soldiers returning from a full combat deployment was performed. Demographic information (including age and sex) as well as information on the mechanism of injury, the reason for orthopaedic consultation, and the procedures performed was collected for each soldier. The overall incidence of non-emergent orthopaedic injuries was calculated, and multivariate Poisson regression analysis was utilized to determine the effect of age and sex on the type of orthopaedic injury sustained. There were 3787 soldiers who returned from combat operations at the end of a fifteen-month deployment without having been medically evacuated. There were 731 orthopaedic surgical consultations for the evaluation of a non-emergent musculoskeletal complaint, and 140 orthopaedic operations were performed as a result. An age of thirty years or more was an important risk factor for requiring an orthopaedic consultation (p < 0.0001). The most common surgical procedures were performed for shoulder stabilization, for superior labrum anterior to posterior lesion repair, for the treatment of internal derangement of the knee, and for the treatment of foot deformity. Nineteen percent of all soldiers who completed a combat deployment required an orthopaedic surgical consultation on return, and 4% of soldiers required orthopaedic surgery. More than half of the surgical procedures involved the knee or shoulder. This represents a large burden of care for returning soldiers on orthopaedic surgical services and has important implications for future resource utilization.

Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. All hospitals in 5 states located in communities that met the criteria for a rural town according to the Rural Urban Commuting Area codes were included. A survey with topics including community and hospital demographics, orthopedic surgical workforce and demand, surgical services, and the perceived benefit of orthopedic services was sent to the hospital administrators. Of the 223 rural hospitals surveyed, 145 completed the survey. Of those completing the survey, 30% had at least one full-time orthopedic surgeon, 25% did not provide any orthopedic surgical services, 65% never had an orthopedic surgeon on ER call, 33% were recruiting an orthopedic surgeon, 52% stated that it is more difficult to recruit an orthopedic surgeon vs a general surgeon, and 71% of the administrators acknowledged a need for additional orthopedic surgical services in their community. For those hospitals that did not have a full-time orthopedic surgeon, members of those communities traveled a mean distance of 55 miles for emergency orthopedic surgical care as reported by the hospital administrators. There are many rural communities that have limited access to orthopedic surgical services. While many of the rural hospital administrators feel that there is a need for additional orthopedic surgical services in their communities, it is difficult to recruit orthopedic surgeons to these areas.

Don't Tread on My Specialty Hospital

In previous articles, I described how general service hospitals (GSHs) have worked to thwart the rise of specialty hospitals to preserve the former’s market control. I received some comments that are emblematic of the arguments made by GSHs in response to specialty hospitals. Many of these arguments have been around for some time and have been addressed, in part, in a report by then secretary of the Department of Health and Human Services (HHS) Michael Leavitt. Using the secretary’s findings, when available, and my thoughts as well, I respond to these arguments. Specialty hospitals, frequently physician owned, focus on a specific medical field—often lucrative fields such as orthopedics, cardiology, surgery, and women’s care. GSHs, in contrast, are full-service entities and are generally “nonprofit” institutions. GSHs claim to make their most profit from cardiac, orthopedic, and general surgical services. GSHs often argue that competitive arguments should not be used to justify specialty hospitals because the health care market is highly regulated—and therefore not competitive—and consumers are often ill informed. Market competition, however, does exist and should be considered in the health care field. Hospitals routinely put out television and print advertisements promoting quality, services, and physicians. This is a direct appeal to consumers—using competitive market forces for business. Moreover, consumers often access beneficial and informative data on hospital quality; insurance companies often post comparative hospital data on their Web sites; Medicare provides comparative data among medical facilities; and legislation has promoted betterinformed health care consumers. And all of this is good if it’s done properly. GSHs also argue that physician owners of specialty hospitals excessively refer patients to their own institutions relative to their peers at GSHs. The secretary of the HHS administration disagrees with the assertion that:

Corrosion Behavior of Surface-Treated Implant Ti-6Al-4V by Electrochemical Polarization and Impedance Studies

Implant materials for orthopedic and heart surgical services demand a better corrosion resistance material than the presently used titanium alloys, where protective oxide layer breaks down on a prolonged stay in aqueous physiological human body, giving rise to localized corrosion of pitting, crevice, and fretting corrosion. A few surface treatments on Ti alloy, in the form of anodization, passivation, and thermal oxidation, followed by soaking in Hank solution have been found to be very effective in bringing down the corrosion rate as well as producing high corrosion resistance surface film as reflected from electrochemical polarization, cyclic polarization, and Electrochemical Impedance Spectroscopy (EIS) studies. The XRD study revealed the presence of various types of oxides along with anatase and rutile on the surface, giving rise to high corrosion resistance film. While surface treatment of passivation and thermal oxidation could reduce the corrosion rate by 1/5th, anodization in 0.3 M phosphoric acid at 16 V versus stainless steel cathode drastically brought down the corrosion rate by less than ten times. The mechanism of corrosion behavior and formation of different surface films is better understood from the determination of EIS parameters derived from the best-fit equivalent circuit.

Perioperative β-Blockade, Discontinuation, and Complications

Perioperative β-Blockade, Discontinuation, and Complications

The costs of trauma caused by seizures: can they be reduced?

This study surveyed admissions of patients with trauma caused by seizures from a population of over 400000 to a Regional Neurosurgery, Plastic Surgery, Orthopaedic Surgical Services and a short-stay ward. Information on duration of epilepsy, seizure type, antiepileptic drugs (AEDs) and the co-existence of other neurological or psychiatric factors was reviewed and the hospital costs calculated.Twelve patients (eight males, four females, aged 28 to 78 years) had 13 admissions with 14 injuries caused by seizures during the period August 1995 to November 1998 (1% of the total admissions with the diagnosis of epilepsy). Seven had head-injuries, four had limb fractures or dislocations, two had burns and one had severe lacerations. The average duration of stays were between 1 day (short-stay ward) and 9–24 days for the three major services. The direct healthcare costs of this small group were high (£49421) or £3802 per traumatic incident. Clinical review suggested that the trauma could have been prevented by alternative care in seven patients at the most optimistic.Epilepsy is uncommon as a cause of severe trauma, the seizures may be difficult to prevent and the direct healthcare costs are high.

Hospital for Special Surgery

On May 1, 1999, the Hospital for Special Surgery was 136 years old. To present a history that does adequate justice to the many people, who have been or still are involved in the making of it, is an impossible task. Nevertheless, this document is important because the hospital, first under the name of Ruptured and Crippled and then under that of Special Surgery has played such an important role in the development of orthopaedics and rheumatology in America during the past century. The reader must forgive an orthopaedic bias to this account and also realize the limitation of space that makes it at best fragmentary and incomplete. The account begins with a description of the hospital's current situation, physical layout and governance. A terse history of the hospital's origin and subsequent development follows, which includes a more specific description of the growth of its orthopaedic surgical services. Finally, separate records of the 112-year-old Postgraduate Orthopaedic Educational Program and 44-year-old Research Division are presented.