A career editorial by Richard Rothman reflecting on 48 years of academic orthopedic practice. He distills his experience into five structured lessons covering team-building, subspecialization, operative simplicity, patient selection, and surgeon self-preservation. His sharpest commentary targets the history of arthroplasty innovation — what worked, what failed, and how to evaluate what comes next.
The pressure to adopt the latest implant or approach is constant in arthroplasty practice, but the history of innovation in this field includes serious failures — metal-on-metal hips and modular necks caused real patient harm before being abandoned.
Rothman's framework operationalizes skepticism: when THA mechanical failure is already below 1% at 10 years, the burden of proof for any new technology must be high. Apply his two-question test before changing your practice: does this solve a real problem, and is there 5-year Level I evidence?
For patient selection, his rules translate directly to clinic: reschedule the poorly controlled diabetic, push the morbidly obese patient toward weight loss first, and when you're uncertain whether surgery is indicated. Wait. Time almost always clarifies the picture.
The one clear advance he endorses. Highly cross-linked polyethylene. Is worth knowing cold, both as a board fact and as a reference point for what genuine incremental innovation looks like.
A career editorial by Richard Rothman reflecting on 48 years of academic orthopedic practice. He distills his experience into five structured lessons covering team-building, subspecialization, operative simplicity, patient selection, and surgeon self-preservation. His sharpest commentary targets the history of arthroplasty innovation — what worked, what failed, and how to evaluate what comes next.
The pressure to adopt the latest implant or approach is constant in arthroplasty practice, but the history of innovation in this field includes serious failures — metal-on-metal hips and modular necks caused real patient harm before being abandoned.
Rothman's framework operationalizes skepticism: when THA mechanical failure is already below 1% at 10 years, the burden of proof for any new technology must be high. Apply his two-question test before changing your practice: does this solve a real problem, and is there 5-year Level I evidence?
For patient selection, his rules translate directly to clinic: reschedule the poorly controlled diabetic, push the morbidly obese patient toward weight loss first, and when you're uncertain whether surgery is indicated. Wait. Time almost always clarifies the picture.
The one clear advance he endorses. Highly cross-linked polyethylene. Is worth knowing cold, both as a board fact and as a reference point for what genuine incremental innovation looks like.