What’s new in orthopaedic surgery1

January 1, 2000 ushered in the Bone and Joint Decade, immediately following the successful Decade of the Brain, which inspired leaders in the musculoskeletal community to attempt a similar endeavor. More than 2 years in planning, the Bone and Joint Decade’s organizers seek to improve outcomes and health-related quality of life for individuals throughout the world with musculoskeletal disorders. They are focusing on 1) documenting and reducing the social and financial costs of these conditions; 2) improving prevention, diagnosis, and treatment; 3) furthering research on prevention and treatment; and 4) educating and empowering patients as they make decisions about their care. Orthopaedic surgeons united with related health care professionals, patient groups, and other stakeholders to mount this effort, which has been endorsed by the United Nations, the World Health Organization, the World Bank, many nations (including the United States), patient advocacy groups, and organizations of health professionals. Not only orthopaedic surgeons, but also many related fields have already joined in this necessarily multidisciplinary effort, which addresses the spectrum of bone and joint disorders—joint diseases (including osteoarthritis, rheumatoid and other inflammatory arthritides), osteoporosis, spinal disorders including low back pain, musculoskeletal trauma, and children’s crippling diseases and deformities. An early task of the Decade, the Bone and Joint Decade Monitor Project, will document the burden of musculoskeletal disease: worldwide incidence and prevalence, impact on quality of life and disability, and the cost of these disorders to individuals and society. Preliminary figures demonstrate the immense scale of the bone and joint disease burden: It is the most common cause of chronic pain and physical disability. Worldwide, hundreds of millions of people are affected. The cost in the USA alone has been estimated at $215 billion per year, with more that 131 million patient visits to providers each year. The cost to society in Sweden is higher than that from brain and mental illnesses combined. Trends suggest that major increases in this burden lie ahead. The world population is aging. The number of people over age 50 will double between 1990 and 2020. In Europe, by 2010 there will be more individuals over 60 than under 20 years of age. Many bone and joint conditions increase in frequency and severity with age, particularly osteoporosis and related fragility fractures, and osteoarthritis. Joint diseases account for at least half of chronic medical problems in those older than 60. Forty percent of women over 50 will suffer at least one osteoporotic fracture. At the same time, road traffic injuries are increasing rapidly in much of the world, and will move from ninth to third place as a worldwide cause of death and disability. By 2010 they are expected to account for as much as a quarter of health care expenditures in developing nations, which bear the brunt of this epidemic of modernization. The International Red Cross recommends urgent attention to this global epidemic, which is similar in magnitude and seriousness to wars and natural disasters. I mention the foregoing worldwide efforts to address the challenges of musculoskeletal ailments with the intent of providing a sense of perspective and potential priority to the following consideration of progress in orthopaedic surgery during the year 2000. It is important to remember that issues of epidemiology, prevention, and nonoperative management are to be considNo competing interests declared.