AAOS’s Change Initiative: The Amendola Interview

Voting on the American Academy of Orthopaedic Surgeon’s (AAOS) proposal to streamline its bylaws begins in about a month—May 2025. Change, as we’ve noted in prior articles about AAOS, is difficult. And AAOS’s board is embarking on a long overdue updating of its bylaws. While AAOS has received strong support, it has also been on the receiving end of vigorous criticism. 

In the pages of Orthopedics This Week, for example, we’ve given space to one of AAOS’s more strident critics. Kevin Plancher, M.D. 

Shortly after returning from the annual AAOS meeting this past March, OTW received a lengthy and formal letter from the AAOS taking issue with the articles we published which featured Dr. Plancher’s criticisms of AAOS.

Sometimes people agree with what we publish and sometimes they don’t.  But this letter from AAOS was different. The staff went to great lengths to take issue with and to correct, in detail, many of Dr. Plancher’s statements. We decided to publish AAOS’s letter, verbatim—no editing—as commentary to each of these articles. Here are links so you can read the commentary yourself.

• scroll to the bottom to read AAOS’s commentary  
• scroll to the bottom to read AAOS’s commentary  

And…cards on the table…we fully and without reservation support AAOS’s efforts—a truly significant undertaking—to streamline this essential institution for a future where the practice of orthopedics is likely to change in profound ways. 

We urge AAOS Fellows to support AAOS’s Board recommendations to update its bylaws and create a more responsive education, advocacy, and resource institution.

In our view, educational societies (AAOS, NASS, ACSM, etc.) must adapt and, yes, change if necessary, to remain relevant in a world that is digitizing and adopting such consequential technologies as artificial intelligence (AI) and advanced, CRISPR generated biologics, for example.

What is AAOS’s future? 

On March 24, the week after AAOS ended, we had the opportunity to interview incoming AAOS President Anunziatto (Ned) Amendola, M.D., FAAOS about AAOS and these proposed changes to its bylaws and governance.

Dr. Amendola is the 93rd president of the AAOS and he arrives at a time of profound change—not only technological change, but also orthopedic procedural and reimbursement change.

In his acceptance speech, Dr. Amendola talked about “change” and his responsibility to help AAOS evolve and deliver ever more value to its members.

So, I began OTW’s interview by asking Dr. Amendola to expand on the theme of change.

Dr. Amendola responded by explaining his leadership style, process, the rise of the sub-specialty societies, of which he is an active member, and the need for younger voices and leadership.   

Ned Amendola: “Thank you Robin and thank you for your support. As you probably know, I’m an immigrant to this country and as an immigrant, I learned to listen a lot to what people have to say, to what their opinions may be.

I feel that leaders need to take all the information in before moving forward. So, the decision to change and the decision to move forward for the AAOS was not just my decision. It came from a lot of input from a lot of sources.

I feel very strongly about our profession of orthopedic surgery and for the AAOS that we’re at a point where we do need to look at our organization as it is moving forward, for a number of reasons.” 

The Importance of Subspecialty Societies

“I’m a sports medicine specialist. I take care of the Duke University sports teams. I’ve been a member of the Sports Medicine Society, the Arthroscopy Association, and the Foot and Ankle Society.

These subspecialty organizations have become very strong. Subspecialty training is really what most orthopedic surgeons now engage in. General orthopedic practice is not as common as it used to be. 

Historically, AAOS has tried to provide everything for every orthopedic surgeon. The challenge today is different.  

Strong specialty societies help surgeons to stay at the top of their game, which is good for them and also good for patients. The rise of specialty societies is one component of the changes occurring today.

Another is technology. The ways we communicate and the ways we acquire new information come over the Internet, social media, other publications and many other sources. 

Thirdly, industry is evolving and taking a more active role in the education and promotion of orthopedic surgery, even directly to patients.

For all those reasons, the AAOS is not where it used to be, when it was the prominent source of orthopedic education and of orthopedic networking. So, despite the fact that we’re a very strong and healthy organization, now is the time really to look at where we are in terms of relevance to the profession of orthopedic surgery.

If we stay the same as an organization and leadership structure, same governance, same bylaws, without ushering in a wave of change where we encourage younger members, new thinking, then we’re going to stagnate and ultimately fail to be relevant over time.”

Robin Young: “I think everyone can agree with those goals. Among AAOS’s key functional goals is to provide education. You mentioned subspecialties as being effective at also providing education. How does AAOS evolve in terms of delivering educational value?”

Ned Amendola: First, it’s not a competition. We need to partner and collaborate as much as we can with specialty societies. That includes listening and seeing what they need for their organization to move forward and how we can contribute to that.” 

Robin Young: What do you think AAOS brings to the subspecialties that they cannot do themselves?

Ned Amendola: We bring the profession of orthopedic surgery in its entirety. The whole profession. Our Annual Meeting, as you know, is a huge global networking event where attendees can connect with the widest array of members and colleagues and even other subspecialties which you wouldn’t see otherwise.

At the AAOS, you see trainees, graduates, fellows, the entire panoply of orthopedic surgeons. Young trainees can come and interact with mentors in every specialty.

In addition, industry appreciates having a general gathering of orthopedic surgeons because everybody’s there. At the Annual Meeting, they can see and engage with every subspecialty at one time, which is much more beneficial for them.

Thirdly, we provide an avenue for subspecialty societies to partner with AAOS on many levels. One key area of AAOS comparative advantage is advocacy.

The AAOS is unique in that it advocates for all of orthopedics. Our Office of Government Relations and our Advocacy Council is one of AAOS’s key strengths.” 

Robin Young: AAOS’s legislative advocacy is, I agree, a significant comparative advantage. Given everything happening in DC, including but not limited to reimbursement policy, it’s never been more important, I think, for AAOS to advocate on behalf of orthopedic surgeons than now. 

Reimbursement policy today seems to be going in the wrong direction.”

Ned Amendola: “I completely agree. I think, with the changes in the government and the unpredictability, it’s essential that we have a voice, a strong voice, in Washington for reimbursement, certainly, but also orthopedic research support.

At Duke University, where I work, we’re one of many institutions that have been significantly affected by actions taken in Washington. The entire whole healthcare system, schools of medicine and orthopedic departments have been suddenly put on crash diets right now. At Duke, we’ve had a lot of NIH [National Institutes of Health] grant funding affected. Duke Orthopaedics is generally #1 or #2 in terms of NIH funding each year. Our overhead funding has been cut by almost 3/4. From 60% to 15%, approximately. These government grants really supported the whole healthcare and research infrastructure. 

The third important strategic area of focus for AAOS is military and the Department of Defense [DOD]. The DOD funds quite a bit of orthopedic research. The active soldier is like an athlete. When injured, they’re really interested in returning to the field. The DOD has a lot of initiatives supporting orthopedic research in areas of advanced care and getting these people back to work.

Financially, AAOS is healthy and we’re able to support some of the research areas. Recently, the AAOS put forth funding to support an area in collaboration with the Department of Defense focus which is Orthobiologics to help treat joint injury. This is a large project in which researchers are looking at the effects of Orthobiologic injections.”

Bringing AAOS’s By-Laws Into the 21st Century

Robin Young: “We began our discussion talking about change. In your opinion, how important is it for AAOS to be nimble and responsive, particularly as advanced technologies begin to play a bigger and bigger role at the hospital and clinic? 

How, in your opinion do these change forces bubbling up affect the legacy structures of AAOS—bylaws, for example?”

Ned Amendola: “Our bylaws are outdated. So, we’ve made a proposal to go from 70 pages or so down to about 30 pages.

Changing bylaws takes a really long time. It took several years to get a final set of proposed bylaws. And then to move forward all the various groups with a stake in AAOS governance have a vote and, finally, we engage the full membership. It’s complex, takes time and patience, but that’s the way it is.

Under the legacy bylaws, a small group of members can propose a resolution or bylaws change. That starts a long and complex process. It really clogs up the system. So, instead of thinking strategically, thinking in terms of new technologies, AI or digital health, we’re chasing issues that matter to a small group at the expense, really, of these very important longer term strategic issues.

The purpose of these proposed changes is to streamline AAOS and put a lot of the current bylaws into an operational document. Going forward, changes can be made through the Board of Directors or through committees, rather than having to go through the whole bylaws process.

It’s important to emphasize that these changes do NOT take away members’ ability to change the bylaws. With the new bylaws, Fellows can still recommend bylaws changes. The recommendations can be made by the Board of Directors or 10% of the Fellowship. In order for the proposed recommendation to be adopted, 10% of the Fellowship must vote, and if that change then has the support of at least 2/3 of the voting Fellows, the change is adopted.

A streamlined process creates a much stronger AAOS.

Again, if a group of Fellows wants to change the bylaws or, for example, wants to make a change to the Nominating Committee, they can still recommend a proposed bylaws amendment for consideration through the process.” 

Robin Young: “When this discussion about updating bylaws first started, how long did it take to move through the process to, as we are now, get to a membership vote?”

Ned Amendola: “Three full years. It required a two-year period for the Board of Directors review to discuss and make recommendations. AAOS’s Board of Directors took responsibility for reviewing the bylaws before I became president. The process included an extensive, collaborative, and transparent review by the Board that included input from many AAOS Fellows as well as legal advisors

All of these legal advisors reached the same conclusion. It was unanimous. They all agreed that the current structure could be significantly improved.

The Board considered all the perspectives, internal and external, listened to all the recommendations—accepting some from the external advisors, but also rejecting others. 

Today, five of the Nominating Committee members are voted on by the membership. The membership can nominate and vote for whomever they want. If you’re popular and you get nominated, you could get nominated for the committee repeatedly. In the proposed bylaws amendments, we changed this so that you can be on the Nominating Committee only once—which allows more members to be involved.

Throughout the two-year process of reviewing AAOS’s structures and bylaws, there was a lot of Board discussion and governance discussion. The Board looked at everything and made the recommended proposed changes that were essential for AAOS to be able to function effectively for the near future.

Importantly, we didn’t want to take away anything from the membership. They can propose changes to move forward. It is important to note that the changes have been developed, reviewed and approved by the AAOS Board of Directors, Board of Councilors, Board of Specialty Societies and the AAOS Bylaws Committee.”

Robin Young: “Thank you Dr. Amendola. The amount of time, effort and the manner in which the Board engaged with multiple points of view from both inside and outside the AAOS is impressive. Thank you for taking the time to speak with Orthopedics This Week.”

Ned Amendola: “Thank you Robin, it was a pleasure.”