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Schulthess Klinik operates through a tradition of interdisciplinary cooperation
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For 128 years, physicians at the Schulthess Klinik have remained dedicated to the clinic’s core mission: to keep patients moving.
Focusing only on the locomotor system, surgical and nonsurgical specialists at the clinic function in a culture of interdisciplinary collaboration.
Wilhelm Schulthess founded the clinic in 1883 as a private orthopaedic institute for children in Zurich. At that time, the focus was on conservative treatment — specifically for scoliosis.
“In these early years, the therapeutic possibilities were merely conservative and surgical measures were mostly considered as being too dangerous for a principally not life-threatening disease,” Norbert Gschwend, MD, former chief of the Schulthess Klinik, told Orthopaedics Today Europe. “General anesthesia and blood or liquid infusions were rather risky undertakings.”
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Image: Schulthess Klinik |
In researching scoliosis, Schulthess developed various devices for diagnosing and treating the spinal deformity. “A specialty of the ‘old’ Schulthess Klinik was the functional treatment of scoliosis,” Dieter Grob, MD, a former consultant in the clinic’s spine department, told Orthopaedics Today Europe. One device was a loom-like machine that allowed patients to create corrective pressure on the deformity with their own muscle activity.
“The results were not overwhelming, but the concept is still nowadays recognized in conservative treatment of scoliosis,” Grob said.
From private institute to nonprofit
After Schulthess’ death in 1917, his son-in-law and daughter succeeded him at the clinic. Eugene Hallauer and Claire Hallauer Schulthess continued offering conservative treatment, although they also began treating adult patients.
In 1935, the couple converted the private institute into a nonprofit organization. Claire Hallauer Schulthess established a school to educate handicapped women and nurses. Perhaps their greatest achievement, Gschwend said, was to establish a vocational school for physically disabled children — many afflicted with severe congenital deformities or paralysis related to poliomyelitis.
When Gschwend assumed control of the clinic in 1962, orthopaedics was changing rapidly to embrace surgical treatments. He endorsed the trend of operative intervention, especially for rheumatoid arthritis and scoliosis.
“One of the most significant accomplishments for patients with inflammatory diseases is the focus on ‘rheuma- orthopaedics,’ the specialization in surgical techniques and strategies for patients with multiple joint and tendon damage due to inflammatory diseases such as rheumatoid arthritis,”
Ines Anne Kramers-de Quervain, MD, chief of rheumatology and rehabilitation, told Orthopaedics Today Europe.
Through his work at the University-Hospital Balgrist, Zurich, and stints at several leading orthopaedic centers in London, Rochester, Minn., USA, New York, USA, and Iowa City, Iowa, USA, Gschwend learned one very important lesson: “The future of orthopaedics, in Switzerland especially, belonged to a well-functioning teamwork of super-specialized orthopaedic surgeons working together with rheumatologists,” Gschwend said.
As a result, he subdivided the medical staff at the clinic according to individual body regions. He expanded the staff to include a spine surgeon, Heiner Scheier, and a rheumatologist, Hubert Baumgartner.
“Unlike other European hospitals — where the steep hierarchy with one person at the top dominated — the introduction of specialties such as hip and knee, spine, upper extremities and foot, with a relatively extensive autonomy, allowed faster development and evolution with excellent quality,” Grob said.
Although the departments are subdivided, they all operate in a culture of interdisciplinary cooperation. Depending on the patient, members of the orthopaedic surgery department consult closely with rheumatology, neurology, physical medicine, and other departments.
This team-based approach to patient care continues to this day.
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“Thanks to a subspecialization of the surgeons, each intervention is performed on a high level of expertise and with a high case load for each surgeon,” Kramers-de Quervain said.
Tradition of design innovations
In the early days of Gschwend’s tenure, more patients began to visit the clinic with polyarthritis, a disease so destructive that joint replacement was the only treatment option. Realizing that the available artificial joints were inadequate, Schulthess physicians were driven to develop their own designs like the GSB (Gschwend-Scheier-Bahler) knee and elbow implants.
Clinic physicians continue this tradition of implant design innovations, developing prostheses such as the Promos shoulder prosthesis, the Innex knee prosthesis (Zimmer) and the Mobility artificial ankle joint (DePuy).
Strict quality control and personal follow-up of all patients is critical. “Schulthess Klink [physicians] have a longstanding tradition to follow their results — with an established outcome control system,” Kramers-de Quervain said.
The control systems used, the Quomuex (shoulder and upper extremity) and the Spine Tango, are internationally recognized registers that help determine the efficacy of different treatment modalities, Grob said. Much of the development work on both registers was completed at the clinic. Patients also participate in the quality control process by offering their opinions on the effectiveness of certain treatments, he said.
Staff always seeking improvements
Clinic staff strive constantly to improve treatment methods. For example, surgeons are now able to monitor spinal cord function during the procedure, which, depending on the location, permits the monitoring of at-risk nerves.
New highly potent medications have improved polyarthritis treatment, Kramers-de Quervain said. “Thanks to those medications and a more aggressive medical treatment strategy, severe joint damage can be prevented in many cases, which reduces the need for orthopaedic interventions,” she said. “On the other hand, there still are progressive destructive forms of arthritis needing surgery. Due to the immunosuppressive nature of the medication, these people are at a higher risk for infections, which gives a particular challenge to the orthopaedic intervention. The close collaboration between the rheumatologists and the surgeons [is] even more important.”
The future seems bright for the Schulthess Klinik, said Rafael Velasco, MD, chief of pediatrics. The clinic has grown steadily over the years. In 1995, the clinic expanded with a new 120-bed facility; growth has been so significant that another new building is planned. New departments have been added, such as pediatrics and sports medicine, which have required additional staff. When Velasco first took over the pediatrics department, he was the only physician; the department now includes three pediatric surgeons.
And just recently, the clinic became home to a Fédération Internationale de Football Association (FIFA) Medical Centre and is a FIFA Medical Assessment and Research Centre. Additionally, the clinic has been designated as a Swiss Olympic Medical Centre. – by Colleen Owens
References:
- Schulthess Klinik. History of the Schulthess Clinic. Accessed: Feb. 19, 2011.
- Norbert Gschwend, MD, can be reached at a.n.gschwend@bluewin.ch.
- Dieter Grob, MD, can be reached at dieter.grob@kws.ch.
- Ines Anne Kramers-de Quervain, MD, can be reached at Lengghalde 2, 8008 Zürich; +41 44 385 74 33; e-mail: ines.kramers@kws.ch.
- Rafael Velasco, MD, can be reached at Lengghalde 2, 8008 Zürich; +41 44 385 7420; e-mail: Rafael.velasco@kws.ch.
