Challenges and opportunities in developing quality initiatives in orthopaedics.

With a renewed focus on quality in US health care, the field of orthopaedic surgery faces both challenges and opportunities to lead the way in providing high-quality musculoskeletal care for patients. Orthopaedics has historically been an eminence-based and tradition-based specialty, and the future will require more evidence in the form of higher-level clinical studies. The orthopaedic oncology literature in 1 leading journal is analyzed between 2005 and 2011 to highlight the published levels of evidence. Models of quality initiatives from leading medical specialty organizations such as the American College of Cardiology are provided. A brief history of past quality efforts from the American Academy of Orthopaedic Surgeons as well as a more detailed review of the current initiatives including clinical practice guidelines, technology overviews, and appropriate use criteria are listed.