The 146-year history of Hospital for Special Surgery is
rich with clinical, research and educational accomplishments that have improved
how orthopedic medicine is practiced.
In 1863, Hospital for Special Surgery (HSS) in New York
began as the Hospital for the Ruptured and Crippled in a philanthropic effort
to provide medical care to injured Civil War soldiers and needy city residents.
It has been led by 11 surgeons-in-chief and now has 85 full-time orthopedic
surgeons who performed 24,000 orthopedic procedures in 2008, including more
than 7,366 joint replacements, according to current HSS Surgeon-in-Chief Thomas
P. Sculco, MD.
The list of musculoskeletal medicine pioneers from HSS
reads like a who’s who of orthopedic innovation: Harlan C. Amstutz, MD,
Albert Burstein, PhD, John N. Insall, MD, Chitranjan S. Ranawat, MD, Peter S.
Walker, PhD, and Russell E. Warren, MD, among others.
“The many strong physician contributors at HSS
over the years are typified by how well they integrated excellent patient care
with critical review and analysis of clinical results and applied, basic
science,” said Douglas W. Jackson, MD, Chief Medical Editor of
Hospital for Special Surgery
(HSS) is an independent, free-standing orthopedic hospital that is closely
affiliated with a medical center and the Weill Cornell Medical College for
conducting musculoskeletal research.
Images: Hospital for Special
Leading the way
“We are the oldest orthopedic hospital, certainly
in the United States and probably in the world,” Sculco said.
HSS was founded by the first surgeon-in-chief, James
Knight, MD, whose interest in orthopedics was limited to designing and
constructing braces for children’s congenital deformities.
Eventually HSS’ focus shifted entirely to the
treatment and rehabilitation of the musculoskeletal system for patients locally
and around the world, which remains the mission of the 162-bed hospital. HSS
An early HSS pioneer, Virgil P. Gibney, MD, became the
second surgeon-in-chief in 1887 and held the position 40 years. He instituted
changes in the work performed at the hospital and wrote about hip surgery.
“Virgil Gibney was responsible for establishing the
first orthopedic residency,” in the 1890s, Sculco told Orthopedics
“He put the hospital on the map as a surgical
hospital,” said David B. Levine, MD, Director of HSS Alumni Affairs.
The first HSS Surgeon-in-Chief James Knight, MD, founded
the hospital in 1863 at his home in lower Manhattan. He was a general physician
rather than an orthopedic surgeon.
The late John Marshall, MD, a physician at HSS, is
credited with launching sports medicine as an academic discipline.
Gibney was the first president of the American
Under Philip D. Wilson Sr., MD, who became the fifth
surgeon-in-chief in 1935, the hospital changed its name to The Hospital for
Special Surgery, moved to its current site and affiliated with Weill Cornell
Medical College. In 1996, HSS dropped “The” from the beginning of its
“Wilson, Sr. had the vision to make it a very
specialized institution and improve its research and academic mission,”
Wilson was AAOS president in 1934. His son, Philip D.
Wilson Jr., MD, was the eighth surgeon-in-chief and AAOS president in 1972.
Wilson Jr. bridged the gap between engineering and
biomechanics, according to Sculco.
“He created an environment here in the late 1960s
and early 1970s for the design and development of implants with surgeons
collaborating closely with engineers and basic scientists. To a large extent,
that still goes on today.”
The joint arthroplasty research work performed by
engineers like Walker and Burstein exemplifies that collaboration, yielding the
duo-condylar knee developed in 1971. In 1973 Walker broached the concept of the
cemented cruciate-sacrificing total condylar knee prosthesis that improved on
other available designs.
Burstein and Insall developed the first posterior
stabilized knee prosthesis in 1979 and in 1989 an updated version was marketed.
In the 1970s, “[Wilson, Jr.] reorganized the
orthopedic department into subspecialties and anatomic regions,” Levine
said. “He was way ahead of his time.”
Specialty clinics for treating groups of patients with
similar problems followed.
Sculco said this change at HSS mainly influenced what
happened nationally and started the trend toward subspecialization. More
importantly, Wilson, Jr. created an environment where individual doctors and
researchers could flourish.
The research accomplishments at HSS are as strong as its
clinical areas with work underway in tendon and ligament repair, soft tissue
healing, osteolysis, spine, sports medicine, cartilage repair, osteoarthritis
and other areas. The hospital has a strong commitment to registries and has
several, including a prospective total joint replacement registry with data on
nearly 13,000 patients and one containing more than 20,000 retrieved implants.
Workers at the HSS brace shop are shown working in
the early 1900s. Bracing was a large component of treatments at the hospital.
More recently, orthopedic implants were fabricated on-site at the hospital.
Timothy Wright, PhD, Director of the Department of
Biomechanics started the HSS retrieval program in 1977 with Burstein.
The research and biomechanics programs Walker had in
place when Wright joined HSS in 1976 were unmatched in the world. About then,
they started collaborating with the engineering department at Cornell
University’s main campus, which provided valuable resources for computer
modeling, biomechanical studies and related research, Wright said.
“That collaboration has been really vital and
continues today,” he told Orthopedics Today.
Internal collaboration between surgeons like Ranawat,
Insall and Allan E. Inglis, MD, also spawned many successful concepts.
“If you look at modern total knee replacements some
30 years later, about half the market consists of posterior stabilized knees.
Insall and Burstein developed that concept originally. That was a big stepping
stone because it took an implant that did all the right things — it
resurfaced bone so the pain went away and was well-fixed — and assured
patients of something close to normal function and a larger range of
motion,” Wright said, noting that nothing remotely like it was being done
Another HSS achievement: digitizing radiographs and CT
scans so they could be stored on computers and manipulated. “We were at
the forefront of computer-aided design of implants,” Wright said.
Currently, HSS biomechanics researchers are
investigating areas including tissue engineering and bone adaptation that will
no doubt impact the orthopedic therapies of the future. Wright said researchers
at HSS thrive because they can focus solely on the musculoskeletal system.
“It is a wonderful environment to do translational
research that exists to go not just from bench top to bed, but more
importantly, from bed to bench top and then back to the bed,” he said.
HSS made its name early on by treating children for
scoliosis and other deformities, which was a common reason for the
establishment of many orthopedic hospitals.
On the field
HSS boasts an early sports medicine specialty practice
started by John Marshall, MD, which Warren, surgeon-in-chief emeritus, greatly
expanded. HSS physicians are team physicians or associate team physicians for
six major New York-area professional sports teams.
“I have valued the published results and teachings
of John Marshall. He impacted sports medicine by making it more of an academic
discipline,” Jackson said.
In terms of academics, HSS has 40 residents and a large
multi-national orthopedic fellowship program, with at least one fellow working
with each service and multiple fellows working with the larger ones.
“Our fellowship program has been very successful.
It spawns research and interaction between our faculty, fellows and researchers
which generates research studies,” Sculco said.
For more information:
- Douglas W. Jackson, MD, can be reached at Memorial Orthopedic.
Surgical Group, 2760 Atlantic Ave., Long Beach, CA 90806; 562-424-6666; e-mail:
- David B. Levine, MD, can be reached at HSS, 535 E. 70th St., New
York, NY 10021; 212-606-1555; e-mail:
- Thomas P. Sculco, MD, can be reached at HSS, Belaire Building, 2nd
Floor, 525 East 71st St., New York, NY 10021; 212-606-1475; e-mail:
- Timothy Wright, PhD, can be reached at HSS, Caspary Research
Building, 541 East 71st St., New York, NY 10021, 212-606-1093; e-mail: