For 128 years, physicians at the Schulthess Klinik have remained
dedicated to the clinics core mission: to keep patients moving.
Focusing only on the locomotor system, surgical and nonsurgical
specialists at the clinic function in a culture of interdisciplinary
Wilhelm Schulthess founded the clinic in 1883 as a private orthopaedic
institute for children in Zurich. At that time, the focus was on conservative
treatment specifically for
In these early years, the therapeutic possibilities were merely
conservative and surgical measures were mostly considered as being too
dangerous for a principally not life-threatening disease, Norbert
Gschwend, MD, former chief of the Schulthess Klinik, told Orthopaedics
Today Europe. General anesthesia and blood or liquid infusions
were rather risky undertakings.
Surgeons perform approximately 15,000 surgical procedures
annually at the Schulthess Klinik, which translates to about 40 surgeries a
Image: Schulthess Klinik
In researching scoliosis, Schulthess developed various devices for
diagnosing and treating the spinal deformity. A specialty of the
old Schulthess Klinik was the functional treatment of
scoliosis, Dieter Grob, MD, a former consultant in the clinics
spine department, told Orthopaedics Today Europe. One device was a
loom-like machine that allowed patients to create corrective pressure on the
deformity with their own muscle activity.
The results were not overwhelming, but the concept is still
nowadays recognized in conservative treatment of scoliosis, Grob said.
From private institute to nonprofit
After Schulthess death in 1917, his son-in-law and daughter
succeeded him at the clinic. Eugene Hallauer and Claire Hallauer Schulthess
continued offering conservative treatment, although they also began treating
In 1935, the couple converted the private institute into a nonprofit
organization. Claire Hallauer Schulthess established a school to educate
handicapped women and nurses. Perhaps their greatest achievement, Gschwend
said, was to establish a vocational school for physically disabled children
many afflicted with severe congenital deformities or paralysis related
When Gschwend assumed control of the clinic in 1962, orthopaedics was
changing rapidly to embrace surgical treatments. He endorsed the trend of
operative intervention, especially for
arthritis and scoliosis.
One of the most significant accomplishments for patients with
inflammatory diseases is the focus on rheuma- orthopaedics, the
specialization in surgical techniques and strategies for patients with multiple
joint and tendon damage due to inflammatory diseases such as rheumatoid
Ines Anne Kramers-de Quervain, MD, chief of rheumatology and
rehabilitation, told Orthopaedics Today Europe.
Through his work at the University-Hospital Balgrist, Zurich, and stints
at several leading orthopaedic centers in London, Rochester, Minn., USA, New
York, USA, and Iowa City, Iowa, USA, Gschwend learned one very important
lesson: The future of orthopaedics, in Switzerland especially, belonged
to a well-functioning teamwork of super-specialized orthopaedic surgeons
working together with rheumatologists, Gschwend said.
As a result, he subdivided the medical staff at the clinic according to
individual body regions. He expanded the staff to include a spine surgeon,
Heiner Scheier, and a rheumatologist, Hubert Baumgartner.
Unlike other European hospitals where the steep hierarchy
with one person at the top dominated the introduction of specialties
such as hip and knee, spine, upper extremities and foot, with a relatively
extensive autonomy, allowed faster development and evolution with excellent
quality, Grob said.
Although the departments are subdivided, they all operate in a culture
of interdisciplinary cooperation. Depending on the patient, members of the
orthopaedic surgery department consult closely with rheumatology, neurology,
physical medicine, and other departments.
This team-based approach to patient care continues to this day.
Schulthess, founder of the clinic, developed several devices for diagnosing and
Thanks to a subspecialization of the surgeons, each intervention
is performed on a high level of expertise and with a high case load for each
surgeon, Kramers-de Quervain said.
Tradition of design innovations
In the early days of Gschwends tenure, more patients began to
visit the clinic with
a disease so destructive that joint replacement was the only treatment option.
Realizing that the available artificial joints were inadequate, Schulthess
physicians were driven to develop their own designs like the GSB
(Gschwend-Scheier-Bahler) knee and elbow implants.
Clinic physicians continue this tradition of implant design innovations,
developing prostheses such as the Promos shoulder prosthesis, the Innex knee
prosthesis (Zimmer) and the Mobility artificial ankle joint (DePuy).
Strict quality control and personal follow-up of all patients is
critical. Schulthess Klink [physicians] have a longstanding tradition to
follow their results with an established outcome control system,
Kramers-de Quervain said.
The control systems used, the Quomuex (shoulder and upper extremity) and
Tango, are internationally recognized registers that help determine the
efficacy of different treatment modalities, Grob said. Much of the development
work on both registers was completed at the clinic. Patients also participate
in the quality control process by offering their opinions on the effectiveness
of certain treatments, he said.
Staff always seeking improvements
Clinic staff strive constantly to improve treatment methods. For
example, surgeons are now able to monitor spinal cord function during the
procedure, which, depending on the location, permits the monitoring of at-risk
New highly potent medications have improved polyarthritis treatment,
Kramers-de Quervain said. Thanks to those medications and a more
aggressive medical treatment strategy, severe joint damage can be prevented in
many cases, which reduces the need for orthopaedic interventions, she
said. On the other hand, there still are progressive destructive forms of
arthritis needing surgery. Due to the immunosuppressive nature of the
medication, these people are at a higher risk for infections, which gives a
particular challenge to the orthopaedic intervention. The close collaboration
between the rheumatologists and the surgeons [is] even more important.
The future seems bright for the Schulthess Klinik, said Rafael Velasco,
MD, chief of pediatrics. The clinic has grown steadily over the years. In 1995,
the clinic expanded with a new 120-bed facility; growth has been so significant
that another new building is planned. New departments have been added, such as
pediatrics and sports medicine, which have required additional staff. When
Velasco first took over the pediatrics department, he was the only physician;
the department now includes three pediatric surgeons.
And just recently, the clinic became home to a Fédération
Internationale de Football Association (FIFA) Medical Centre and is a FIFA
Medical Assessment and Research Centre. Additionally, the clinic has been
designated as a Swiss Olympic Medical Centre. by Colleen Owens
- Norbert Gschwend, MD, can be reached at
- Dieter Grob, MD, can be reached at
- Ines Anne Kramers-de Quervain, MD, can be reached at Lengghalde 2,
8008 Zürich; +41 44 385 74 33; e-mail:
- Rafael Velasco, MD, can be reached at Lengghalde 2, 8008
Zürich; +41 44 385 7420; e-mail: Rafael.firstname.lastname@example.org.