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AAOS Now

Published 2/1/2016
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Karen Pubentz

OREF Celebrates 60 Years of Promoting Excellence in Orthopaedics

Foundation efforts helped drive development of modern orthopaedics
The Orthopaedic Research and Education Foundation (OREF) marked its 60th anniversary in September, kicking off a celebration that will culminate with a number of special events during the 2016 AAOS Annual Meeting in Orlando, Fla. During its 60-year history, OREF has provided more than $142 million in funding to more than 4,700 individuals and institutions—funding that has enabled thousands of orthopaedic surgeons to pursue a professional research career.

In 1955, the foundation that was formed by orthopaedic surgeons for orthopaedic surgeons had more modest financial goals. Through a survey conducted shortly after its incorporation, the organization identified 67 research projects in need of an estimated $500,000 in financial support. The Board of Trustees set about securing those funds by appealing to colleagues, and in its first fundraising campaign, raised nearly $100,000 in contributions. Although corporate contributions would come to be an important source of funding, the foundation's trustees strongly believed (as they do now) that the individual surgeon, whether in community practice or at a research institution, is the most critical source of support. The OREF and its mission would survive and grow only if orthopaedic surgeons found value in orthopaedic research.

In addition to funding research, the foundation was focused on helping orthopaedics achieve the degree of scientific rigor and scholarship in its research efforts that would garner the same respect from government and private funding resources enjoyed by other areas of medicine. In so doing, the foundation would enable its stakeholders to compete with other physicians for research dollars and opportunities.

With these goals as its mission, OREF was officially incorporated on Sept. 3, 1955. The idea for it, however, had come about years earlier through informal conversations about challenging patient cases (see accompanying interview with Joseph S. Barr Jr, MD) and perceived gaps in the specialty's knowledge of musculoskeletal function, disease, and healing that stymied surgeons' efforts to provide better and more effective treatment options and outcomes to their patients. Alfred R. Shands Jr, MD, and several colleagues, including Joseph S. Barr Sr, MD, and Harold A. Sofield, MD, began to envision an organization that would increase the body of orthopaedic knowledge through the development of a more unified and scientific approach to research. There also was growing recognition that as the practice of orthopaedics became more nuanced and sophisticated, the need for very specialized knowledge would also increase. As Dr. Shands noted, "For orthopaedics to take its place alongside other fields of medicine in the area of research and to meet its responsibilities for investigation is more important than ever."

These realizations led to a formal proposal to create an orthopaedic research foundation at a meeting of the Orthopaedic Committee of the National Research Council in May 1952. In January 1954, a Planning Committee was formed, composed of representatives from AAOS, the American Orthopaedic Association (AOA), the Orthopaedic Research Society, and the Skeletal System Committee of the National Research Council. The committee members decided that AAOS and AOA should be the sponsoring organizations for OREF, and they elected three members from each to comprise the new foundation's first Board of Trustees. These members included Dr. Barr, James A. Dickson, MD, Francis M. McKeever, MD, Dr. Shands, Dr. Sofield, and Philip D. Wilson, MD. Over time, several themes that would come to define the role of OREF in orthopaedic research emerged from these planning meetings:

The scientific approach—If orthopaedics was to grow into its rightful place in the medical community, the scientific approach must be the foundation for all research funded by the Foundation.

The value of research—The basis for the evolving scientific approach was the need for high-quality basic and clinical research.

Surgeon researchers—There was a fervent belief that the research most likely to have an impact on the specialty could best be identified and completed by orthopaedic surgeons. Therefore, the basic criteria for receiving funding would include having an orthopaedic surgeon as the principal or co-principal investigator on any project.

Surgeon support—A key tenet of the foundation's mission has always been that the research it funds must be free of any influence or pressure related to the funding source. The surest way to ensure this purity was for the specialty to support its own research through generous financial support of the foundation by all orthopaedic surgeons, regardless of whether they were actively involved in research.

Support for research and the researcher—Many OREF grant recipients leverage the experience they gain through their OREF grant to secure additional funding later in their careers for research that can lead to significant advances in knowledge or patient care.

Basic science versus clinical impact—OREF firmly believes that both basic science and clinical research are critical to efforts to keep orthopaedics at the forefront of medicine.

Today, OREF continues to live out its mission of advancing excellence in orthopaedics by nurturing and supporting orthopaedic researchers. With the improvements in health and longevity that research in other areas of medicine have brought about, it is more important than ever for orthopaedics to lead the way in ensuring that patients continue to enjoy optimal musculoskeletal function and mobility throughout their lives. As Dr. Shands stated in OREF's first Annual Report, "Vitality and strength in any field of medicine can be directly measured by the amount of its activity in research and education. Progress cannot be made without sound programs of investigation, good teaching of the student, and adequate training of the resident. In order to more adequately provide for this vitality and strength, and to set the stage for greater progress in orthopaedic surgery, an Orthopaedic Foundation for research and education was organized." The mission of the foundation 60 years later has been tweaked and updated, but is unchanged in reflecting the goals and principles of its founders. That it has grown more successful with each passing year in its ability to fund research is testament to its immense value to the practice of orthopaedics and the vision and foresight of both its founders and those orthopaedic surgeons today whose faithful support sustains it.

Karen Pubentz is senior director of marketing communications for OREF. She can be reached at pubentz@oref.org

A Case for Improvement
In the spring of 2015, OREF was fortunate to sit down with Joseph S. Barr Jr, MD, an OREF Ambassador and donor, and son of OREF founding trustee Joseph S. Barr Sr, MD, and hear firsthand about his father's involvement in the formation of OREF and the foundation's value to the field of orthopaedics.

"My dad was an orthopaedic surgeon. He settled in Boston and practiced orthopaedics with Frank Ober, who was a very well-known orthopaedic surgeon. He joined the Navy in World War II, was chief at Bethesda Naval Hospital, and at the end of the war, moved back to Boston, where he became professor and chief at Massachusetts General Hospital. About that time in his life, he began to see that we were struggling [with understanding patient progress]. We were writing papers about the last 10 broken hips we took care of and always, 60 percent did well and the others didn't.

"Al Shands was a very close friend of my dad's. He was at Delaware at the DuPont Institute, and he and his wife, my dad, and my mother were very close friends. They began to get into the idea of research and that we had to do basic orthopaedic research. It couldn't just be case studies and whatnot; it had to be more than that. Along with four or five other orthopaedic surgeons they founded OREF to support orthopaedic research and, particularly, to fund investigators."

Near the end of the interview, we asked Dr. Barr about the value of OREF and its mission to orthopaedics. "Look at what you do, arthroscopy, total joints, etc. Thirty years ago, you weren't doing that. My chief used to say, 'the surgery I do now … I only trained for 10 percent of it.' There are so many new things going on and I'm trying to make people understand that what you're doing today is what OREF has funded. If that hadn't happened, you might not be doing arthroscopy today or total joints or what have you."