Specialty Update   |    
What's New in Orthopaedic Rehabilitation
Nader Hebela, MD1; Douglas G. Smith, MD2; Mary Ann Keenan, MD1
1 Department of Orthopaedic Surgery, University of Pennsylvania, Two Silverstein, 3400 Spruce Street, Philadelphia, PA 19104
2 Harborview Medical Center, University of Washington, 325 9th Avenue, Box 359798, Seattle, WA 98104.
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Specialty Update has been developed in collaboration with the Council of Musculoskeletal Specialty Societies (COMSS) of the American Academy of Orthopaedic Surgeons.

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Nov 01;86(11):2577-2581
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Orthopaedic rehabilitation is a unique subspecialty of orthopaedic surgery that focuses on improving the functional outcome for individuals with musculoskeletal disability with use of surgical and nonsurgical management. Orthopaedic rehabilitation focuses on the musculoskeletal system as a whole as well as on the linkages and couplings between bones, joints, muscles, and the nervous system. This subspecialty encompasses patients of all ages, a broad range of anatomic locations, and a variety of musculoskeletal dysfunctions. Orthopaedic rehabilitation comprises all of the traditional orthopaedic subspecialties, including amputation surgery, prosthetic and orthotic management, neuromuscular diseases, and the variety of neurologic disorders that defy easy classification.
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    Domizio Livio SUVA
    Posted on January 26, 2005
    What's new in Orthopaedic Rehabilitation. Amputation Surgery and Prosthetics
    Orthopaedic Surgery Service, University Hospital of Geneva, CH-1211 GENEVA Switzerland

    To the Editor:

    We read with great interest the paper concerning What’s New in Orthopaedic Rehabilitation by Hebela et al. (2004;86:2577-2581), and in particular the section concerning “Amputation Surgery and Prosthetics”. The authors conclude that “understanding the issues facing amputees may play a more important role than the level of amputation in determining function”. However, they do not describe how the physicians could use this knowledge to enhance recovery of their patients.

    As the authors state, there is no direct correlation between the level of lower extremity amputation and the patients’ perceived level of function. Other authors (1) have reported several variables related to the prosthesis and patient social interaction, as well as psychological factors that are correlated to a patient’s perceived level of function. A better understanding of what a patient needs after amputation may represent the first step of a patient-centered educational program (2). The orthopaedic surgeon, as part of an interdisciplinary team, may use such data to determine therapeutic objectives that are compatible with the patients’ reality, and to understand what each patient must learn to satisfactorily progress through a rehabilitation program. This means that simply giving information to the patient about surgery, rehabilitation or the prosthesis may well be insufficient, and that this approach should be modified in order to allow for true patient learning, thus helping him to reach as much autonomy as possible.


    1. Green GV, Short K, Easley M. Transtibial amputation. Foot Ankle Clin. 2001;6:315-327.

    2. Assal JP. Revisiting the approach to treatment of long term illness: from the acute to the chronic state. A need for educational and managerial skills for long term follow-up. Patient Educ Couns. 1999;37:99- 111.

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