Lund’s advances include hip dysplasia research, joint registries

The university is home to the Swedish knee registry and the Bone and Joint Decade.

The University of Lund’s 85-year-old department of orthopaedics stands at the crossroads of innovative orthopaedic research, comprehensive training and evidence-based clinical practice.

Prior to 1924, orthopaedics was practiced in Lund, but through another department. It now has the largest orthopaedic department in Sweden.

“The long tradition of pursuing the same scientific and clinical activity is a keystone in Lund,” said Lars Lidgren, MD, PhD, academic head of the department.

The tradition of linking clinical, scientific and academic endeavors is strong in Sweden, particularly so in Lund’s orthopaedic department where the approach has been maintained for more than 50 years, said department member Karl-Göran Thorngren, MD, PhD, president of the European Federation of National Associations of Orthopaedics and Traumatology.

Lidgren and Thorngren are members of the Orthopaedics Today Europe Editorial Board.

The central block of medical facilities in Lund, Sweden, includes the department of orthopaedics, biomedical and biomechanical centers, and a national musculoskeletal competence center.

“The department has been one of the most successful and influential worldwide,” said Stuart B. Goodman, MD, PhD, of Stanford University Medical Center, Palo Alto, U.S.A. “The surgeons there have made many historic contributions, including describing hip dysplasia, the surgical treatment of tumors, foot and ankle conditions, athletic injuries, etc.”

Lund is also the home of the Swedish knee registry, which has set the standard for all others, Goodman said.

Göran Bauer, MD, (right) and Peter Frandsen, MD, participate in a dissertation ceremony in Lund, Sweden, in 1989. Bauer's gown is from the Hospital for Special Surgery in New York, where he was research head in the 1960s before he returned to Lund and became department head from 1969 to 1989.

Radiostereometric analysis (RSA) was developed in Lund. Orthopaedic surgeons at the university have used the technique in at least 200 implant fixation and fracture studies.

There are approximately 260 employees in the department today, including about 50 physicians who last year performed nearly 5,500 operations in Lund and at its affiliated hospital in Trelleborg. Together with nursing and allied health personnel, they treated 60,000 patients on an outpatient or emergency basis, said Pelle Gustafson, MD, PhD, the department’s clinical director.

Orthopaedic hospital

In 1914, Gunnar Frising, MD, was appointed first lecturer head of the orthopaedic clinic at Lund. In 1929, construction was completed on a 150-bed tertiary orthopaedic hospital.

Lidgren said the building contained a school for those children who had to stay at the hospital several months to a year.

The department’s outpatient clinic was established in the 1920s, Gustafson noted.

Clinical leadership

Exemplifying the Lund tradition of continuity of scientific and clinical activities, Håkan Brattström, MD, (right) passed the rheumatology surgery tradition to Lars Lidgren, MD, PhD, (center). Urban Rydholm, MD, (left) now leads that area. Images: Department of Orthopaedics, Lund University

Gunnar Wiberg, MD, succeeded Frising as head of the department in 1945 — a position he held until 1969. Göran Bauer, MD, who was on staff for 10 years at the Hospital for Special Surgery in New York, became the next department head in 1989, followed by Lidgren.

Wiberg’s hip dysplasia research was a key development. He identified the hip center-edge or CE angle. In 1942, he and two American surgeons performed the first disc herniation surgery in Sweden, Lidgren said.

Bauer was a good scientist recognized for introducing bone-seeking isotopes. He was Lidgren’s clinical mentor and a leader with stimulating intellect.

“Bauer started the first national quality registry in the world in 1975,” said Lidgren, who now heads the national knee arthroplasty registry.

Department member Björn Strömqvist, MD, heads the national spine registry, which was started in 1992, and Thorngren oversees the Swedish hip fracture registry.

Research tradition

Bauer reorganized the department into subspecialty areas, including hips, knees and spine, “which was not so common at that time in Sweden or in Europe. I think that made the level of knowledge higher and the experiences more refined,” Thorngren said. The department led the way in adopting evidence-based treatments, he added.

“We try to choose evidence-based care. This is now common everywhere, but we were rather early with this,” he said.

The faculty of the Department of Orthopaedic Surgery at Lund University are shown in 1969 outside the original orthopaedic hospital built in 1929. It included a school and 150 beds and was the largest orthopaedic unit in Sweden.

Lund is also well-known for its orthopaedic research tradition.

“Some of the most prominent research has been in the area of hip fractures, osteoarthritis of the knee, orthopaedic biomaterials, infection and bone healing,” Goodman said.

New programs

The current focus is on delivering quality while working more economically and efficiently — a common theme in today’s health care market, Gustafson said.

In the last few years, Lund adopted a lean health care management philosophy.

“This could result in shorter lead times and stays and more effective use of our resources,” he said.

In other efforts, “The idea of the Bone and Joint Decade emanated from Lund under the direction of Lars Lidgren,” Goodman noted. Lidgren still heads the international effort to promote musculoskeletal health.

For more information:

• Stuart B. Goodman, MD, PhD, can be reached at Stanford University Medical Center, 450 Broadway St., M/C 6342, Redwood City, CA 94063, U.S.A.; +1-650-721-7629; e-mail: goodbone@stanford.edu.
• Pelle Gustafson, MD, PhD, Lars Lidgren, MD, PhD, and Karl-Göran Thorngren, MD, PhD, are in the Department of Orthopaedics, University Hospital, S-221 85 Lund, Sweden. Gustafson can be reached at +46-46-17-3569; e-mail: Pelle.Gustafson@med.lu.se. Lidgren can be reached at +46-46-15-1500; e-mail: lars.lidgren@med.lu.se. Thorngren can be reached at +46-46-17-2053; e-mail: karl-goran.thorngren@med.lu.se.