RT Journal
A1 Sarmiento, Augusto
T1 On Rise and Decline
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2009
FD November 1
VO 91
IS 11
SP 2740
OP 2742
DO 10.2106/JBJS.I.00830
UL http://dx.doi.org/10.2106/JBJS.I.00830
AB 
In 1776, the year when America declared its independence, Edward Gibbon released his book The Decline and Fall of the Roman Empire. He concluded, rightly or wrongly, that the fall of the empire was mainly due to barbarian invasions and the spread of Christianity. Since Gibbon's day, many others have observed that great nations and institutions, after reaching the pinnacle of power and success, gradually decline because of internal degradation. Arnold Toynbee, another British historian, is reported to have said, "An autopsy of history would show that all great nations commit suicide." I am using these pronouncements to create an analogy with the condition of the orthopaedic discipline. The metaphor is based on observations on the manner in which our profession appears to be showing symptoms suggestive of decline.