Surgeon on the street

I am impressed that training in evidence-based medicine among the newest generation of orthopaedists has given them the scientific preparation, along with acquired and evaluated clinical experience, to define the quality and value of their orthopaedic practice. These new surgeons can select among new products, services, procedures, and care pathways wisely and defend their decisions with their patients, payors, and regulators. It is a tribute to strong orthopaedic residency and fellowship training and explicit direction from senior AAOS leadership. The next version of medical care clearly depends on physicians being able to prove their capability and the good results reported by their patients, and these surgeons are prepared.
Michael Warren Keith, MD; Cleveland, OH

Both the prevention of ankle arthritis and improvement in the treatment of ankle arthritis before a fusion or total ankle arthroplasty is performed are needed. In trauma and fragility fractures, procedure-specific plates and screws whose constructs are tailored to the specific bone mineral density found in foot and ankle fractures will have a great impact, as will improvements in implant design and function to decrease wear and failure after a total ankle replacement. New developments in prevention of Charcot arthropathy and collapse in the foot and ankle in patients with diabetes; improvements in prevention of diabetic ulcers; and treatment of diabetic foot ulcers and Charcot arthropathy will also be important.
Laura M. Gehrig, MD; Bismarck, ND

One of the greatest drivers of rapid innovation in the next two decades will be the formation of large-scale collaborative, interdisciplinary, multi-institutional, and programmatically driven research networks, like the Armed Forces Institute for Regenerative Medicine and the American Hip and Knee Registry. These evolving systems for clinical and translational research will place new demands for leadership and management upon us as investigators, but will open tremendous new opportunities to identify and advance optimal clinical practices and to accelerate the rate of development and responsible competitive assessment of new therapies to the great benefit of our patients.
George Muschler, MD; Cleveland, OH

I think in the near future, with the cost-benefit debate on health care, that there will be more breakthroughs in the field of hip and knee arthroplasty and emphasis on performing the operation better to improve outcomes.

I believe that breakthroughs in computer-assisted techniques and computer modeling will allow surgeons to customize arthroplasty surgery on a patient-specific basis, which will allow higher patient satisfaction rates, especially in total knee arthroplasty.
William M. Mihalko, MD, PhD; Memphis, TN