Advances in Pediatric Orthopedics: Then and Now

Advances in Pediatric Orthopedics: Then and Now

The field of pediatric orthopedics has undergone a remarkable transformation over the years, and the evolution of Hospital for Special Surgery (HSS) tells the story.

HSS had its beginnings in a kindhearted doctor’s home to help destitute children with disabilities during the Civil War. Dr. James Knight opened the 28-bed hospital in his New York City brownstone in 1863.Back then, the best these poor children could hope for was relief of their symptoms … and someone who cared. Dr. Knight’s treatment philosophy focused on sunshine and fresh air, along with diet, exercise and gentle rehabilitation. Children did not have surgery in the hospital’s early days.

How times have changed! Today, medical and surgical advances afford children with severe orthopedic problems a quality of life far out of reach for past generations. It is not an exaggeration to say that we’re in a golden age of pediatric orthopedics. Extraordinary advances in technology, techniques and safety have brought tremendous benefits to patients.

It may come as a surprise to learn that 45 years ago, less than a dozen orthopedic surgeons in the U.S. were known to work almost exclusively with children. Today, training in Pediatric Orthopedic Surgery is widely offered as a subspecialty focusing on care for patients ranging in age from newborns to teenagers. Always ahead of the curve, HSS established one of the first fellowship programs in Pediatric Orthopedic Surgery in 1972.

The field started to gain ground as a major subspecialty in the early 1990s. Since then, over the past 10 or 15 years, some pediatric orthopedic surgeons have become even more specialized, focusing on areas such as pediatric spine surgery, pediatric sports medicine, cerebral palsy and treatment for hip conditions. This “super-specialization” is the norm at HSS and ensures the highest level of care.

One of the reasons for the greater specialization is that the technical aspects of what we’re now able to accomplish – the ability to correct major orthopedic problems and deformities – has gotten so much better, and this requires much greater technical expertise on the part of the surgeon.

Children are not small adults, so you can’t use the same surgical technique on a growing child or adolescent that you would use on a grown-up. The surgery must be done to the highest technical standards, and that has driven the ‘super-specialization’ in pediatric orthopedics.

Some of the advances are nothing short of amazing. They include magnetic lengthening rods used in scoliosis surgery that can “grow” with the patient. A spinal problem that once required an operation every six months over many years now entails just one surgery using the special rods. They are lengthened quickly and painlessly in the doctor’s office with an electromagnet that is placed on the child’s back.

Technical innovations have gone hand-in-hand with major advances from a safety standpoint. At HSS, highly sophisticated equipment in the operating room closely monitors the spinal cord and nerves during delicate scoliosis surgery and other complex procedures.

As the field evolves, it’s up to pediatric orthopedic surgeons to stay current on the latest research and advances. They must learn about and assess new procedures, techniques and equipment, and devote a substantial amount of time to education and training. This very philosophy at HSS has enabled us to remain a leading center for orthopedic care for all ages.

Dr. Roger Widmann has been a member of the Pediatric Orthopaedic Surgery Service at Hospital for Special Surgery since 1995 and the Chief of the Pediatric Orthopaedic Surgery Service since 2004. He is the Director of Pediatric Orthopaedic Trauma at New York Hospital, and is a member of the Scoliosis Service at Hospital for Special Surgery.

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