Orthopaedic surgery as a specialty was not practised in New Zealand until the First World War. Early in 1918 arrangements in Christchurch were made to receive the first orthopaedic casualties returning from Europe. Concurrent to the establishment of orthopaedics at Christchurch were the establishment of military hospitals at Rotorua, Trentham and Auckland. Military units were set up and included a very important splint and surgical footwear department. Six men Wylie, White, Mill, Ulrich, Wallis and Gower were considered New Zealand's first orthopaedic surgeons. In June 1919 the number of service patients under treatment in the various military hospitals was over 4,800 and by 1922 the number had fallen to less than 1,000. After this initial development of military orthopaedics in New Zealand came the dawn of civilian orthopaedic surgery with the names of Macky, McCaw, Morris and MacDonald as some of the first names associated with orthopaedic surgery in New Zealand.
During the next decade and especially during the Second World War orthopaedic surgery was practised by a small number of the pioneers working especially in the main centres with a large proportion of the orthopaedic work completed in the smaller centres by the General surgeons. During the war years a large contingent of New Zealanders trained in orthopaedic surgery either in London at the Royal National Orthopaedic Hospital or at Oswestry in Shropshire. After the war these young men returned to New Zealand and swelled the the ranks of the orthopaedic fraternity. The New Zealand Orthopaedic Association was formed in 1950. The association has been in existence ever since and has grown in structure and stature. One of the issues of concern then was the number of orthopaedic surgeons in smaller areas and these remain today. To provide a quality cover three surgeons is the bare minimum.
One of the most important initiatives that the Association has been responsible for is working with the Royal Australasian College of Surgeons (RACS) to develop the orthopaedic training scheme. Training undertaken over five years for 10 trainees a year, giving a cohort of 50 trainee orthopaedic surgeons, has developed an excellent reputation where positions are keenly sought.
There is considerable debate about the number of trainees as when times are booming there are not enough Kiwi trained orthopaedic surgeons to fill all vacancies and overseas trained orthopaedic surgeons immigrate to New Zealand. On the other hand when times are tighter our young Fellows tell us they struggle to get a consultancy appointment. This debate is likely to rage back and forth as more surgeons work for longer as they are fit and healthy and their experience is high. Nevertheless demand for orthopaedic surgery is increasing and will continue to do so as the population ages.
The establishment of the New Zealand joint registry under the auspice of Professor Alastair Rothwell has proved to be of enormous benefit to the development of the art and science of orthopaedic research and has developed an excellent international reputation.
The establishment of both the Wishbone Trust and the NZOA Trust, and more recently the Research Foundation to fund research has facilitated the advancement of knowledge and understanding of problems and issues and by the application of research, advancement in treatment modalities are able to be made.
In Colin Hooker’s words “The science of our specialty, then, is the means by which we assess our results, analyse our mistakes, advance our knowledge and further the application of the science of materials and engineering in the treatment of injuries and disease” (Hooker, 1996, 139).
Research is an essential aspect of the profession and while scientific observation and practise is very important so too is the “art of orthopaedic surgery”. The two art and science need to be married together as Henry Thomas over 120 years ago claimed “The crying evil of our art in these times is the fact that much of our surgery is too mechanical, our medical practice too chemical and there is a hankering to interfere which thwarts the inherent tendency to recovery possessed by all persons not actually dying”. He added however “that there are actions which nature cannot do so well as the artist in charge” (Hooker, 1996, 140).
International networks of orthopaedic surgeons were a founding philosophy of the association and this has been kept. The Carousel of Presidents of over ten orthopaedic associations throughout the world and growing is an important aspect for every President. Substantial travel must be undertaken to attend the annual scientific meetings of these associations by the President or President elect to develop and promulgate internationally consistent guidelines. This has been one of the strengths of the international orthopaedic community. Associated with this has been the development of travelling Fellow scholarships such as the ABC Fellow and the Hong Kong Fellow. These are important aspects of the NZOA whereby young leaders can be developed as part of succession planning for the presidential line.
For further information please read Colin Hooker’s fascinating book Orthopaedics in New Zealand (1996). Contact the NZOA if you wish to obtain a copy.