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Annual Report 2018

Download the annual report 2018 as a PDF here. All basic information will be found in the document.

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Patient outcomes

The AO began with a problem: how to improve patient outcomes. This is the priority for everyone at and involved with the AO. The AO covers different specialist areas, brought together into one global network, one powerhouse of excellence focused on improving patient outcomes.

In 2018 the AO celebrated the first 60 years of its history. This milestone offered the AO time to take stock and contemplate on the challenges the AO founders faced as they worked to gain acceptance for their new approaches—which are now the gold standard in the surgical treatment of fractures and musculoskeletal disorders.

A living legacy

In the AO's 60th anniversary year, the decision was made to create a CHF 15 million Jubilee Fund, provided over five years, to safeguard the AO's legacy and ensure ever more people around the world have access to appropriate, timely care.

This Jubilee Fund channels a grant of CHF 10 million to supporting the launch of a World Health Organization (WHO) global initiative to improve emergency and trauma services in multiple countries around the world. The Global Emergency & Trauma Care Initiative will make simple, affordable, life-saving interventions available to ensure timely care for all people in need.

“No one should die for the lack of access to emergency care, an essential part of universal health coverage,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus in a statement. “We have simple, affordable and proven interventions that save lives. This initiative will ensure that millions of people around the world have access to the timely, life-saving care they deserve.”

Image courtesy of the WHO.

A contract signing ceremony marking this significant agreement was held on-stage in the Congress Center Davos as part of an event to mark the AO Foundation's 60th anniversary. AO Foundation President Robert McGuire and the WHO's Etienne Krug participated. Speaking on-stage at the event, McGuire said “We are proud to launch this collaboration with WHO, addressing a neglected public health issue which is fully in line with our mission and expertise.”

The other CHF 5 million of the Jubilee Fund is to be spent on AO initiatives in low- and middle-income countries over the same five-year term.

Navigating complexities

The health care environment today is more complex than ever before. Clinicians have many more treatment options than in the past, and patients have higher expectations regarding outcomes and the relationship they will have with those who treat them. However, how to measure outcomes in orthopedics is still poorly understood, and the existing literature is confusing and is not comparable.

AOTrauma's Research Clinical Priority Program (CPP), Clinical Outcome Measurements of Fracture Treatment, aims to address this issue. This program, launched in 2018, recognizes the critical need today for an approach to assessing patient outcomes that can be applied internationally. With a global network of over 215,000 health care professionals, the AO is the ideal place to carry out this research.

Working with 16 external partners that are leaders in the field as well as AO Research Institute Davos (ARI), AO Clinical Investigation and Documentation (AOCID), and the AO Technical Commission (AOTK) System, AO Trauma is following in the spirit of the AO's founders in this program that will produce guidelines to allow orthopedic surgeons to best direct fracture treatment, aftercare, and rehabilitation. In 2018, a consortium was established to work on patient outcomes and a CPP was defined and officially launched, with an initial term of five years.

Dr Marilyn Heng

This is in step with the continuing advance of patient centered care in all disciplines of medicine—including orthopedics. Technological solutions are part of the answer—as can be seen in soles inserted into shoes to monitor weight and activity, but for optimum personalization this goes in hand with standardized and localized approach to patient reported outcomes. Headed by Dr Marilyn Heng at Massachusetts General Hospital, United States, this consortium is broader and involves more international partners than similar projects that the AO has previously led.

Watch AO Foundation past-president Niklaus Renner explore the AO's lasting impact on patient outcomes.

Building partnerships—to improve patient care

The AO understands that engagement with partners within and beyond its global network of over 215,000 health care professionals is central to its continued ability to respond to significant clinical problems.

AO Technical Commission Director Claas Albers, Business Unit Lead SPI (Surgical Process Institute, Digital Surgery) Felix Wandel, AO Foundation President-Elect Florian Gebhard, and AO Education Institute Director Urs Rüetschi. 

In 2018, the AO signed a memorandum of understanding with the Surgical Process Institute (SPI). Based in Leipzig, Germany, SPI's goal is to improve treatment quality and patient safety by reducing variation in surgical standards and approaches, meaning that wherever patients are treated they will be able to expect the same high level of quality. This is in line with the AO's mission of promoting excellence in patient care and outcomes in trauma and musculoskeletal disorders.

Together, the AO and SPI will work to transform the surgical experience by bringing together AO's surgical content and principles and SPI's technology. This starts with an initial assessment of the scope of work involved in digitizing AO standards and aligning workflows with SPI.

The real-world goal of this will be to digitize AO standardized procedures using SPI technology so that they are available to surgeons in the operating theater when they are most needed. As part of this work, the AO will also explore surgical performance comparability, and will develop metrics to measure performance and to detect difficult steps.

Expanding our horizons

In an increasingly complex medical device field, it can be difficult for small businesses or individual innovators to bring their innovations to the market. The AO Development Incubator (AODI) helps clear a path through this complex environment for innovators, wherever they are.

Working with the Queensland University of Technology, Australia, on biphasic plating and with the AO Research Institute Davos (ARI) on the AO Fracture Monitor, the AO Development Incubator helps bring inventions into clinics, in cooperation with institutions around the world. For the AO's global network, AO Development Incubator offers innovators a clear route to develop their innovative ideas to the highest standards so they can have a positive impact on patient outcomes. Today, the AO Development Incubator evaluates over 100 innovation ideas from more than 50 countries each year.

Back to our roots

Patient case documentation was an essential part of the AO founders' work to standardize treatment and improve patient outcomes. Today, AO Clinical Investigation and Documentation (AOCID) leads the AO's work in clinical studies and clinical evidence. In 2018, AO Clinical Investigation and Documentation ran 66 studies in 37 countries, and enrolled about 1,100 new patients, resulting in a total of 4,500 patients in the monitoring phase.

Sixty years ago, the founders pioneered documentation involving physical patient files, medical cards, and X-rays. They worked to collect information relating to patient outcomes in a standardized way. Built on these solid foundations, the AO now collects magnitudes more data via digital technology.

In today's highly regulated environment, the AO plays a unique role that is distinct from, and complementary to, industry. It provides an environment open to academic research that offers the scientific freedom to explore without fearing failure.

The AO Registry established in collaboration with OBERD in 2018 was set up to meet the need in our surgeon community for the standardized, comprehensive collection of patient outcomes—both those defined externally and those reported by the patients themselves.

The analysis of real-world data is essential in the AO's continued advances in improving treatments for trauma and musculoskeletal disorders.

Responding to changing needs

With its strong focus on educating surgeons to help them make better informed decisions as regards patient treatments, AO Recon continued to respond to a growing need of ageing populations requiring more and better treatments of degenerative joint diseases.

AO Recon skills station Principles of Total Hip and Knee Arthroplasty, Dubai
AO Recon Skills Lab station at AO Recon Course—Principles of Total Hip and Knee Arthroplasty in Dubai, UAE

Since its foundation in 2014, AO Recon has organized over 70 events reaching close to 11,000 surgeons across the world with leading arthroplasty experts as faculty. More than a third of all educational events it held in 2018 took place in Asia Pacific, a region where the call for high-class education makes it a high priority for AO Recon.

Practical exercises at AO Recon Course—Complex Total Hip and Knee Arthroplasty, Singapore

When it comes to creating and shaping the educational content, patient problems and best patient outcomes are the starting point of the AO curriculum development process.

The desired results determine the preceding steps; necessary competences are derived, from which specific learning objectives are defined. Thus, an AO Recon curriculum course follows a systematic and holistic approach and is consistently patient-centered.

With the support of the AO Education Institute, AO Recon has developed three such curricula: two hip and knee courses, one on primary arthroplasty and one on complex and revision cases, and—in cooperation with AO Trauma—a course on periprosthetic fracture management. A fourth one, addressing shoulder-specific issues, is on its way.

Patient reported outcomes to deliver better care

In 2018, AO Spine continued its work through the AO Spine Knowledge Forums to improve patient outcomes. One key advancement was the development and validation of a patient reported outcome tool in the treatment of spine cancer, namely the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ2.0). This health-related quality of life tool will have meaningful impact for the well-being of spine cancer patients because it aims not only to evaluate their quality of life but to improve it.

2nd AOSpine Advanced Level Live Tissue Training, Acibadem University, Istanbul
2nd AO Spine Advanced Level Live Tissue Training, Acibadem University, Istanbul
New clinical tools and resources available for spine surgeons in 2018
  • AO Spine Injury Classification system (Upper Cervical, Subaxial, Thoracolumbar, and Sacral)
  • AO Spine Masters Series—the complete 10 volume book series

AO Spine encourages clinicians to use and build the SOSGOQ2.0 into their practices as a way of evaluating which patients improve and which do not. It will enable greater clarity over key questions in treatment and recovery such as the definition of “meaningful change” from the patient perspective and enhance the ability to predict patient outcomes.

The SOSGOQ2.0 is available in English and is currently being validated in Dutch and Hungarian. It has been translated into German, and there is interest in translating it into Russian, Thai, and Turkish. It has also been integrated in OBERD, a company with which the AO has partnered and which is supporting patient-reported outcomes data collection system in orthopedics.

AO Spine's goal is to see this become the standard patient-reported outcome measure for spine cancer patients to ultimately improve their quality of life. AO Spine knows that all of its efforts to innovate in education and deliver outstanding research, treatment guidelines, and new measurement tools work together to benefit patient outcomes.

AOSpine Simulation Course, Minimally Invasive Cockpit Surgery, Dubai
AO Spine Simulation Course, Minimally Invasive Cockpit Surgery, Dubai

Published in 2017, the AO Spine-developed clinical practice guidelines for acute spinal cord injury and degenerative cervical myelopathy were presented and launched at the 2018 Global Spine Congress. These guidelines ensure appropriate management and define treatment strategies to help clinicians improve patient outcomes by making evidence-informed decisions. The year 2018 also saw this initiative backed by SCIRE, and further interest expressed by the World Federation of Neurological Societies (WFNS) and the Rick Hansen Institute (RHI).

The AO Spine Patient and Clinician Reported Spine Trauma Outcome Measures (AOPROST and AOCROST) currently under development aim to create and validate a multidisciplinary, universally applicable, outcome tool for spinal trauma patients that brings together the patient perspective and that of the health care professionals. This is much-needed recognition of the increasingly central decision-making role patients play in treatment, as the relationship patients expect with their health care providers today is very different from that seen five, ten, or 60 years ago.

From the past to the future—strategies for success

The AO Strategy Fund was created to expand the AO's opportunities to improve patient outcomes in the fields of trauma and musculoskeletal disorders. There are several brilliant ideas about how to advance patient care being developed outside the AO. The AO Strategy Fund exists to help create a pathway to bring these new ideas into the organization. There are echoes in this of the disruptive thinking that drove the AO's founders 60 years ago.

In 2018, AO VET collaborated with the AO Strategy Fund on a project that is set to benefit the entire AO and the broader scientific community: the creation of a comprehensive database that will allow scientists to more effectively choose models for fracture research. This will help the development of new treatments and make it possible to improve patient outcomes. Importantly, it also minimizes the need for the use of animals in this process.

Dr Carl Kirker-Head, Chair, AOVET International Board
Dr Carl Kirker-Head, Chair, AO VET International Board

This database brings together over 4,000 journal articles—published from the 1970s to today—describing animal use in fracture research. Each year there are around 250 papers published in this field, and the database is built to grow. This offers researchers a single entry point to the comprehensive archive of research in this field.

This AO VET and AO Strategy Fund initiative is part of the AO's commitment to digital transformation and expanding the value it offers its members, its network, and the scientific community. It also further safeguards animal welfare, a long-term priority for AO VET within the AO, as its positioning of the AO as a core member of AAALAC International shows.

Going where the need is greatest

In March 2018, AO CMF held a seminar in Bhutan in association with the 3rd International Craniofacial and Dental Summit 2018. This was the first time that AO CMF had held an event in this country, where although health care is free, resources are limited.

AOCMF Faculty and participants at the AOCMF Introductory Seminar in Bhutan
AO CMF faculty and participants at the AO CMF Introductory Seminar in Bhutan

The seminar focused on giving local surgeons the latest information on treatment approaches in their field and helping enhance their skills to improve patient care. Surgeons from across the country came to attend the event, where they learned both the theoretical basis of the operative treatment of CMF fractures, and their complications, and were able to take part in practical exercises.

New AO Mobility Toolkit could become the standard in large, multicenter research trials

Originally conceived as a “mobility toolkit” enabling physicians and researchers to collect and use objective outcome data on patient performance-based measures (PBMs), the AO Mobility Toolkit project was launched in 2015 and is today an ever-evolving and ever-expanding software suite.

It encompasses three motion sensor applications and two website functions for use by rehabilitation physicians, physical therapists, orthopedic surgeons, neurologists, geriatricians and prosthetists, and could be very useful to total joint replacement surgeons tracking patient mobility before and after surgery.

“There are many electronic systems available to monitor patients' mobility, but the AO Mobility Toolkit is the first one being utilized in large, multicenter research trials, and it could potentially become the standard for use in multicenter clinical research,” said Project Leader Dr Stephen Sims, past chair of AO Trauma North America, AO Foundation Trustees Alumnus, past AO Trauma International Board member, and editor for the AO Trauma Pelvis and Acetabulum Education Taskforce.

“There are many electronic systems available to monitor patients' mobility, but the AO Mobility Toolkit is the first one being utilized in large, multicenter research trials, and it could potentially become the standard for use in multicenter clinical research,” said Project Leader Dr Stephen Sims.

Sims’ collaborators on the project were recently retired Dr Richard Peindl, chair of Bioengineering at Atrium Health (formerly Carolinas Medical Center); AO Foundation Past President Dr James Kellam; and Dr Rachel Seymour, director of research of the Musculoskeletal Institute at Atrium Health.

The project has its roots in Peindl’s interest in assessing fall risks of head injury patients and elderly patients. A funding shortfall had stalled development of a mobility cloud for storing information related to that work, and that’s where Sims, the AO Mobility Toolkit project team—and the AO Strategy Fund—stepped in.

Today, the AO Mobility Toolkit is being used in two research centers and soon will be used at an additional seven sites, Sims said, including centers that are part of the US Department of Defense-funded Major Extremity Trauma Research Consortium (METRC). It's also listed in other research projects that could expand it to another five or 10 sites.

“This project would not have taken place without support from the AO Strategy Fund. There has also been significant financial support from Atrium Health, as well as Atrium Health Clinical Research,” Sims said. “The AO Mobility Toolkit project has shown that you can—in a very simple, non-intrusive way—get a much more refined objective measurement of patient PBMs and that this can be a very valuable research tool.” said Project Leader Dr Stephen Sims.

More on patient outcomes at AO in 2018

Healing signals from the bone: towards the world's first continuous healing sensor

Soft-Tissue Management initiative update

AO Technical Commission Experts Symposia respond to clinical needs