What do you see as the major challenges for the field of orthopaedic surgery? management of many human diseases related to the musculoskeletal system. If you look at all of the forecasts, much of what we do is being shifted to the outpatient setting, with more procedures being done in ambulatory-care centers and fewer being done inpatient at large hospitals. This requires a restructuring. As care becomes more distributed, the challenge is to maintain cohesion within the department even as we are moving to these outside facilities. It is important to maintain that cohesion because only by operating as a team can we successfully adapt to the changes in health care while incorporating technological advances into our practice at the same time as we are striving to keep costs down. It’s a significant challenge, and one that requires a team approach. The leadership at UCLA supports this approach. What do you imagine the field will look like in five-to-10 years? Beyond working as a team, how do you deal with this challenge of advancing technologies and rising costs? That’s where we’ve seen a lot of effort focused on looking at approaches like bundling and total medical expenditures for chronic problems such as arthritis of the knee, as we are doing at UCLA. You might, for example, develop a center to address knee problems that spans from childhood through adulthood. Orthopaedics is one of the few fields that touches all age groups, and it also touches on almost all the other fields within the health care system. This presents us with unique opportunities to affect many lives through these types of initiatives. What are the department’s research priorities? We are fortunate to be strong in clinical research, translational research and basic science research, and the advantage is that these can complement one another. One of the areas where we’re finding more and more useful information is in studying patient outcomes and looking at the experience of patients — their quality of life and how they view their experience going through our system. That is very important and something we will continue to focus on. All of our basic-science research projects under the direction of Dr. John Adams have a translational aspect or focus to them. We hope to have significant impact on the In orthopaedics, there are many different implants that are used in the spine, in arthroplasty, in hip and knee replacements, and even in oncology. With these, we replace certain bones with metal or plastics. With many of the new biologics and the work that’s being done with stem cells, there’s a great desire to use the patient’s own cells to reproduce some of these devices. You might, for instance, create a scaffolding around which you would develop a bone, or some other means to treat the patient using biologics as opposed to utilizing the devices we have now. There also continues to be a move toward minimally invasive surgery in many areas of orthopaedics, such as spine surgery and arthroplasty. Robotics will be used in these efforts. I think we will see more improvement in these techniques, and with that, decreased lengths of hospitalizations. What should referring physicians know about the UCLA Department of Orthopaedic Surgery? We offer the complete portfolio of cases, from the simplest to the most complex, within all of the orthopaedic subspecialties. That’s a unique capability: to have a place where people are skilled at something as simple as carpal tunnel release but that also performs hand transplants. It also is extremely valuable to be part of an institution where there is so much expertise outside of our specialty. If a patient has comorbidities, such as cardiovascular issues, even a relatively simple procedure can become complex. If a transplant patient is going to need a knee replacement, the actual surgery might not be that complicated, but certainly the management of the patient perioperatively will be. Having the wide range of experts in orthopaedics coupled with the broad access to experts in other fields is something you only really find at a top medical institution. Francis J. Hornicek, MD, PhD 9 UCLA Physicians Update