Editorial Comment: Selected Proceedings of the 2019 International Society of Limb Salvage Annual Meeting

What a difference a century makes. Diseases and information travel around the world at ever faster speeds since the pandemic of 1918, and disrupts traditional medical research, practice, and education in increasing proportion with the pace of dissemination. The eventual outcome is directly influenced by leaders who make global organizational decisions, but ultimately more so by the individual practitioner who is the consumer for new knowledge and research, and decides whether or not to attend an in-person or virtual medical meeting.

Coronavirus disease 2019 (COVID-19) has affected all medical disciplines, and it will inevitably transform the International Society of Limb Salvage (ISOLS), an organization highly dependent on internet communication, international relationships, and travel. New forms of communication will expand to the profession’s benefit, while personal interaction and international travel will contract to the profession’s detriment. Consequently, the meeting captured in this Symposium will likely be the last classic edition before the specialty is transformed.

Panayiotis Papagelopoulos, MD hosted the 20th General Meeting of the ISOLS in September 2019. Dr. Pagagelopoulous did a great job advancing the goals of the ISOLS, which “serves as a forum for intellectual exchange among physicians, engineers, scientists and other persons interested in limb salvage, promotes advances in the field of limb salvage and ongoing education of persons engaged in the field of limb salvage” [4].

This statement of purpose is clear, but it fails to mention the first word of its title, “International.” From the outset, this group has brought leading thinkers and doers together, highlighted by moving the meeting to Vienna, Austria in 1983, and then migrating the presidency and meeting host on a rotating basis to different continents every 2 years.

While ISOLS has always been “orthocentric,” the meeting has broadened from merely one about surgical technique and implant design to all of musculoskeletal oncology, including imaging, systemic treatment, and basic science. Selected papers from the September 2019 meeting presentations are included in this volume of Clinical Orthopaedics and Related Research®, the official journal of ISOLS.

What will our meetings look like moving forward? While there is no substitute for interpersonal interactions, a new approach has been forced upon us, and the consequences are far-reaching. The COVID-19 pandemic has halted just about all planned medical congresses, so many of my colleagues have become more accustomed to meeting virtually. One way that ISOLS can create value for members is to develop webinars on popular and controversial topics. Their eighth such webinar, jointly sponsored with the Societdad Latino Americana des Tumores Musculo Esqueleticos, highlights the potential for this approach to enhance education [5].

While adding web-based education reflects forward-thinking on the part of the organizational leadership, it is just a start. Innovative approaches, such as the entire meeting being a virtual poster session, as planned for the Musculoskeletal Tumor Society in September 2020, may or may not succeed, but should certainly be explored. However, there is no clear path for interaction between presenters and participants in this venue. The dialogue needed to probe the presented data and translate it into practical applications will be absent, compromising the value of the conference. The Connective Tissue Oncology Society and The Orthopaedic Research Society plan to hold similar meetings in 2020 and 2021, respectively. Results from these experiments with important clinical and basic science platforms are anxiously awaited.

It is now just over a century since the Great Influenza pandemic of 1918, as chronicled by famed historian John M. Barry [1]. Some of the fascinating work to emerge from that tragedy, which killed more people than World War I, was an approach to immunotherapy. United States Navy Lieutenants Lee W. McGuire and William R. Redden used infusions of patient serum from those recovering from pneumonia to shorten the disease duration, reducing mortality from 38% to 4% [6]. The Navy honored Lts. McGuire and Redden with the Navy Cross, the second-highest award for valor in combat [2], for their bravery in implementing a potentially dangerous new therapy. As we battle cancer, immunotherapy and targeted antibody therapies are sparking great interest [3, 7]. However, these emerging therapies can only go as far as their funding allows.

Investment in research and care of low-incidence primary bone tumors is likely to be de-emphasized societally, while it is inevitable that high-frequency infectious diseases will dominate the attention of investigators and funding agencies. There are so many unanswered questions. Even the future of highly successful organizations, such as ISOLS, is uncertain. Will COVID-19 result in the cancellation of the ISOLS Los Angeles 2021 meeting? The pandemic will have the last word, but how we respond to transform education and professional communication will be influential as it was in the great influenza [1].