Dr. Charles Saltzman, MD—L.S. Peery Presidential Endowed Professor of Orthopaedics at the University of Utah and Editor-in-Chief of Foot & Ankle International and Foot & Ankle Orthopaedics—recently visited Duke Orthopaedic Surgery as the J. Leonard Goldner, MD Visiting Professor. His featured lecture, “Innovation & Orthopaedics: It’s the Journey That Counts,” offered a compelling reflection on the role of persistence, collaboration, and curiosity in advancing patient care.
Saltzman framed innovation not as a single breakthrough, but as a mindset rooted in continual self-questioning. “Innovation is a broad concept,” he said. “We should always be asking ourselves, what can we do better?”
Lessons from History—and Failure
Drawing on historical examples, Saltzman highlighted the work of Dr. Ignacio Ponseti and the development of the Ponseti Method for treating clubfoot. Ponseti’s success, Saltzman noted, was built on years of trial, error, and refinement. “He failed more than he succeeded,” Saltzman said, until his work gained traction through early adopters—beginning with his first “disciple,” John Hirschberg, MD.
The lesson, he emphasized, is that meaningful innovation often starts with a single individual willing to pursue an unconventional idea. “You need to find a lone ‘nut’ doing something great,” Saltzman said. From there, momentum builds—one follower leading to another.
“There Is No Best—But Better Has No Limit”
Saltzman encouraged faculty and trainees to focus their efforts and commit to improving the world in tangible ways. “There is no best,” he said. “However, better has no limit.”
He reflected on his early years as a faculty member at the University of Iowa, where he was encouraged to identify how he could make a meaningful impact. That question—what can I do to make something better?—guided his approach to building teams and pursuing innovation.
“I assembled a team of people I liked and trusted,” he said, “and together we created several medical innovations.”
Advancing Care Through Innovation
Saltzman’s work has focused on improving physical function for patients with limited mobility, particularly through new approaches to treating ankle and midfoot arthritis. Among his most significant contributions are several widely recognized orthopaedic devices and systems, including:
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Trabecular Metal Total Ankle Replacement
Conceived during his tenure at the University of Iowa, this device was designed to restore movement and flexibility to the human ankle. It was licensed to Zimmer in 2002 and introduced to the market in 2013. -
Active and Continuous Compression Bone Screws
holds multiple patents for specialized bone screws that use tension members to apply and maintain compression across bone segments—an essential factor in bone healing. -
Osteochondral Plug Forming Systems
Developed tools and techniques, including cannulated trephines, to prepare and deliver tissue grafts for repairing damaged cartilage and bone within joints. -
Ankle Joint Positioning Devices
These specialized devices assist surgeons in achieving the precision required for ankle joint replacement procedures. -
Bone Plate and Keel Systems
Co-invented stabilization systems for bone fixation, including plates with keel slots and locking assemblies.
Advice for the Next Generation
Throughout his talk, Saltzman emphasized that innovation demands time, discipline, and preparation. “You must be willing to dedicate time to finding a solution,” he said. “It takes time.”
He credited success to a combination of luck, dedication, and timing—but stressed that preparation is essential. His advice to aspiring innovators was clear: devour the medical literature to understand what has already been done, then build the right team—one grounded in trust, shared purpose, and mutual respect.
“Great innovation,” he concluded, “comes from people who are committed to making things better—and who are willing to stay on the journey.”