Thomas P. Sculco, MD, founder of the International Society of Orthopaedic Centers, and ISOC’s administrative director, Ilsa Klinghoffer

When Thomas P. Sculco, MD, was starting out, he spent months working in several European hospitals, something that was, and still is, pretty unusual for a young American doc. “I wanted to see how things were done in different environments so I could learn and bring those perspectives into my own practice,” says Sculco, who now is surgeon-in-chief at the Hospital for Special Surgery, a large academic- and research-focused orthopedics, rheumatology, and rehabilitation hospital in New York.

So it shouldn’t come as a surprise to find him as the driving force behind the creation of the International Society of Orthopaedic Centers. ISOC’s meetings bring together musculoskeletal specialists from the largest academic and research-focused orthopedic centers in the world to exchange ideas and cutting-edge practices, and to collaborate on finding ways to improve patient care, physician education, and research-based programs. The ultimate goal, he says, is to generate best practices that have been tested in these large facilities, and then share these benchmarks to improve orthopedic care worldwide.

Though the society is only four years old and the ink is still drying on its official nonprofit-status papers, the three meetings ISOC has already held have set it well on its way toward reaching that admittedly lofty goal.

REALLY, ANOTHER MEETING?

One thing that’s not in short supply is meetings for orthopedic surgeons. There’s the annual meeting of the American Academy of Orthopaedic Surgeons, which draws tens of thousands each year. Then there are the societies for those who specialize in spines, and hips, and knees, and hands, and shoulders. Do we really need yet another meeting?

Most definitely, says Claudio Mella, MD, current ISOC chairman and coordinator for international activities with the Clinica Alemana in Santiago, Chile. “The other meetings are for learning new treatments and scientific advances. ISOC does not provide specific instruction about, for example, how to put in a screw. It’s about developing strategies that will let us improve education and scientific activities.”

“We have different aims than other meetings,” says Beat Simmen, MD, PhD, chairman of upper extremity and hand surgery at the Schulthess Klinik in Zurich. “Of course, techniques are a part of it—when doctors get together, they will talk about what they do and how to do it better. But we focus on the larger picture: how politics and economics affect what we do, and how we can stay ahead of all that to improve the main things at the core of our daily work—education, patient care, and research.” Simmen, who is a past ISOC chairman, explains that because orthopedics is such a large and fast-growing segment of national health budgets, there is increasing pressure on orthopedic surgeons and orthopedic institutions around the world to document not only what they are doing but also the efficiency and efficacy (as measured in the cost of “quality life years”) of their work. There is a growing need to develop quality-management systems that can accomplish this, but the financial and manpower costs involved are high. Another key challenge in orthopedics today is the need to standardize processes and procedures within the orthopedic community. “These questions are at the core of ISOC,” says Simmen.

To tackle these strategic issues, ISOC keeps the meetings small and intimate (Sculco says the goal is to keep the number of participants to 60 or fewer, but definitely no more than 75). “The interaction is very different if you have 50 people in the room instead of 500,” says Sculco. “We wanted this to be a think tank where we could have open discussion and interaction between the different centers that would result in consensus on the best way to handle our various challenges.”

The format also is designed to foster idea generation and collaboration rather than simply to disseminate knowledge. Explains ISOC board member Fabio Catani, MD, professor of orthopedic surgery with the University of Bologna-Istituto Ortopedico Rizzoli, Bologna, Italy, “In the standard scientific symposium, most of the time is dedicated to lectures. At ISOC, discussion is the most important thing.” While each member center has the opportunity to present on what it is doing clinically, Mella says the lecture topics are chosen specifically for their ability to drive the creation of new projects and new clinical protocols and to stimulate larger discussions. Sculco, who serves as ISOC’s executive director, adds that what is presented at ISOC has to be “the most cutting-edge, the most traumatic, or the most exciting scientific or clinical research endeavors of each member institution.”

Sculco adds, “Here you have the biggest players [in orthopedic surgery] around the table, a group of very talented and very experienced people trying to resolve the issues we share and to learn from each other. It isn’t something you can do at the hip or knee society, because it’s bigger than hips or knees. It’s the entire field of orthopedics.”

CULTIVATING CULTURAL AWARENESS

Claudio Mella, MD, current ISOC chairman and coordinator for international activities with the Clinica Alemana in Santiago, Chile

This strategic approach also is why the meeting rotates to different member institutions around the world: The first was held in May 2007 at the Hospital for Special Surgery in New York City, the second was held in October 2008 at the Schulthess Klinik in Zurich, and the third was held this past May at the Istituto Ortopedico Rizzoli. The next meeting is scheduled to be held at the Clinica Alemana de Santiago in fall 2011. This rotation around the world allows participants to see firsthand how another member organization functions and what best practices it has instituted, says Sculco.

ISOC meetings also include a social and cultural component designed to foster informal communication, professional partnerships, and even friendships among the participants, as well as to provide the cultural backdrop and understanding of the forces that shape the environment in which that particular institution operates. At the 2007 meeting in New York, for example, participants got to know each other over dinner at the Knickerbocker Club on the first evening. The two days of scientific sessions, explorations of the structure and management of HSS, and roundtable discussions on academic training were broken up with lunch at the Museum of Modern Art and a ballet performance at the Metropolitan Opera House. When in Zurich at the Schulthess Klinik, cultural components included a trip to the Zurich Opera and a meal at a private art collection. In Italy, participants visited the Ferrari museum and enjoyed a piano concert.

“We were able to continue working to resolve what we talked about during the meetings in a more relaxed way, and we founded friendships. Many things are easier when you are friends,” says Simmen. “We are developing the networks that will help us accomplish our goals.” Adds Mella, “It can be difficult to pick up a phone and speak in my not-perfect English, but it’s quite different if I sit down at a table and Dr. Sculco says, ‘Hey, Claudio, can you tell us a bit about this?’ When you can speak more spontaneously, a lot of good ideas can arise.”

Also, Mella says, every medical system reflects the society in which it functions, so it is useful to see both how the institution itself is set up—you may find things that will help you organize your own institution a little better—and the societal framework of the host center.