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Survey: European surgeons face mounting caseload and economic pressures in 2009
Orthopaedics Today Europe Editorial Board members said the worldwide economic crisis will have an impact orthopaedic medicine.
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We asked some members of the Orthopaedics Today Europe Editorial Board to tell us what they feel is the most important issue(s) orthopaedic surgeons in Europe will face in 2009 and 2010. Here are their responses.Robert Trace
Managing Editor
José Mário Beça, MD; Porto, Portugal: I think there are a few main issues that orthopaedic surgeons in Europe will face over the next year or two. First is the study of cartilage problems, including their etiology and treatment. It is our goal to understand the reasons for the pain and other symptoms that patients tell us they have. We need to develop a better understanding of the effects that growth factors have as a treatment for cartilage lesions.
Second, we need to ask: Are there other factors that cause ACL rupture? I think there is a genetic link to several intrinsic and extrinsic risk factors that have nevertheless been implicated in these injuries. It is important for me and other surgeons to find an “anti-gene” that anuls the effect of the gene that causes the rupture of ACL.
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Per Kjaersgaard-Andersen, MD; Aarhus, Denmark: We will face increased pressure to organize the structure of orthopaedics in more countries. We will also face an increased caseload of elderly patients who demand either elective surgery or who will come to us with complex osteoporotic fractures.
Karl Knahr, MD; Vienna: The health economy will become the most important issue for orthopaedic surgeons. So far – at least in our country – there was only a minor economic pressure that was due to some more-expensive treatment options for our patients. This may change more dramatically as soon as the breakdown of overall economics overlaps with a decrease in financial support for health care.
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Giancarlo Puddu, MD; Rome: I think the most important issue will be growth factors and mesenchymal cells, and gaining a better understanding of what we can do with them, as well as comparing new research findings with our early results.
Per Renström, MD, PhD; Stockholm: There is no easy answer, but I have a few thoughts.
First, there are a number of patient-related problems that involve diagnoses where the full picture is not really understood. For example:
- The increasing number of failed ACL reconstructions are resulting in too many ACL revisions. The propaganda for double-bundle ACL repair may make this worse as the surgeons often do not fully understand the one-bundle technique. The double-bundle technique is difficult and should be done by a selected group of skillful surgeons, not by everybody. Major education is needed.
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- The “real” role of hip arthroscopy. Groin and hip pain continue to be a major problem in sports. Diagnoses come and go, so we need science and follow-up. Some surgeons do hundreds of sports hernia repairs, but do not follow up what they do.
- Articular cartilage injury and early degenerative joint disease. It is fantastic that we have so many research activities out there on the subject. However, we need to find a working solution for treatment through arthroscopy. Once that happens, the role of injections, scaffolds and focal resurfacing will become clearer.
- The growing problem of posterior shoulder instability and pain, especially in the athlete.
- The huge number of ACL injuries in the young female team athlete. Prevention is the key. We need to understand neuromuscular function better as a whole.
- In rehabilitation, we still do not have valid criteria for return to sport, which will be an increasing issue.
- Computer-assisted surgery. Navigation in total knee replacement, unicompartmental knee replacement and knee osteotomy will probably be an issue for some time.
Second, education/training is a major issue, particularly in term of quality, because the economy in our universities is shrinking.
Third, research financing is limited and is concentrated in certain popular areas. Currently, it benefits the already-rich. What people forget is that all good research started small, and if it is successful, it grows larger. The critical mass to generate good research is somewhere between six and 10 researchers.
Finally, it is getting more difficult to get quality reviewers for peer-reviewed articles in our main journals. The journals will probably have to start paying something back.
For more information:
- José Mário Beça, MD, can be reached at Rua Carlos Malheiro Dias 185, 4200-152 Porto, Portugal; e-mail: clinica@clinica-mbeca.com.pt.
- Per Kjaersgaard-Andersen, MD, can be reached at Department of Orthopaedics, Vejle Hospital, DK-7100 Vejle, Denmark; +45-7940-5716; e-mail: pka@dadlnet.dk.
- Karl Knahr, MD, can be reached at Orthopedic Hospital Vienna-Speising, Speisingerstr. 109, A-1130 Vienna, Austria; +43-1-80-182-242; e-mail: karl.knahr@oss.at.
- Giancarlo Puddu, MD, can be reached at Clinica Valle, Via G. De Notaris, 2B, 00197 Rome, Italy; +39-06-855-2982; e-mail: Giapu@tin.it.
- Per Renström, MD, can be reached at the Section of Sports Medicine, Ortopediska kliniken, Karolinska sjukhuset, SE-171 76 Stockholm, Sweden; +46-8-517-767-57; e-mail: per.renstrom@telia.com.