2020 EFORT Annual Report

EFORT Annual Report 2020

Lean and Agile to reconvene www.efort.org

Annual Report 2020

Table of Contents

CONTACT

MESSAGE FROM THE PRESIDENTS AND SECRETARY GENERAL

EFORT Head Office ZA La Pièce 2 1180 Rolle, Switzerland Phone +41 (0)21 343 4400 Fax +41 (0)21 343 4411 office@efort.org www.efort.org

GOVERNING BOARD AND ORGANISATION Members of the Executive Board and Executive Committee MEMBERSHIP NETWORK Cooperation at national level International: beyond European boundaries

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7 8 9-10 11-13

EFORT’S FRAMEWORK FOR EDUCATIONAL STRUCTURE: THE EOTEP The 1st Virtual EFORT Congress 2020 14-19 EFORT Open Reviews, the EFORT Journal 20-21 EFORTnet and e-Library 22 e-Science 22-25 EUROPEAN ACTIVITIES Implant & Patient Safety - MDR 26 EU assessment of high-risk medical devices faces in-depth review: CORE-MD 27 OUTREACH Orthopaedics Today Europe Website Social media

28 29 30-31

FINANCIAL STATEMENT/FINANCES Auditor‘s report Income and balance sheet statements Cash flow and changes in restricted and general funds statements Changes in restricted and general funds statements Notes to the financial statements

32-33 34 35 36 37-51

ACKNOWLEDGEMENT/DISCLOSURE

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© 2021 European Federation of National Associations of Orthopaedics and Traumatology Most rights reserved. Reproduction is authorised provided the source is acknowledged. e-version only | Published in June 2021

Message from the Presidents and Secretary General

Prof. Dr. Philippe Neyret

Mr. David Limb

Prof. Dr. Klaus-Peter Günther

2020 – Lean & Agile to reconvene Last year we were saying “The path for the future seems to lean on agility”!

The pandemic has forced us to adapt and make our organisation agile. It was always our first priority to preserve everyone’s health and yet to deliver Education & Training in a safe environment.

On 10 March 2020 the EFORT Board still felt optimistic that the 21st EFORT Annual Congress could have taken place as planned. Although at that time the Austrian Federal Chancellery had shared measures for the successive re-opening of activities, it later announced that no events were allowed to take place until at least the end of June of this year.

The global Covid-19 pandemic forced the EFORT Board to take the difficult decision to postpone the face-to-face EFORT Annual Congress in 2020 and to create a new educational offer in the autumn.

At this point, we would like to acknowledge the support & understanding of our participants, commercial partners and service providers in dealing with this disappointing development. Further, we acknowledge the discernment and flexibility that Vienna & the Messe Vienna Exhibition & Congress Center showed in this crisis, which proves the true value of a partnership.

In its commitment to deliver a high quality scientific programme, as well as offer tools for progressive training & education, EFORT launched its first ever Virtual EFORT Congress (VEC). The educational programme included free paper presentations as well as sessions showcasing the latest advances in O&T, Europe-wide and globally. To cement partnerships in the new format between EFORT and industry, together we worked on virtual solutions in the field of online exhibitions and other O&T health-promoting channels, offering sponsored sessions and online networking.

As we looked into options to increase interactivity, the idea of building an EFORT Live TV Studio was realised.

As you will see from what follows, the activity report looks leaner, certainly reflecting the impact the pandemic has had on EFORT up until now. You will also notice, however, that despite all, a fair majority of all activities were maintained.

With finances driving all decisions, key offerings such as the newly launched VEC, the EFORT Open Reviews Journal and the webinar series, including the new venture with industry were primary considerations.

In May the world faced unprecedented scenes of discrimination. With its global view, the Alliance of International Organizations of Orthopaedics and Traumatology, of which EFORT is a member, stood firm for the cause of human rights.

In the field of assessment and transfer of knowledge, EBOT candidates were still able to take their interim exam but unfortunately could not sit the final exam.

Collaborative schemes with our industry partners reflected an unexpected positive impact of this pandemic. It has propelled EFORT towards the tangible implementation of its EOTEP concept, the educational framework of our portfolio to you, developed in conjunction with the National, Specialty and affiliated societies as well as our valued corporate partners.

In life, however, some success stories come to face a new future. Both, EFORT Open Reviews and Orthopaedics Today Europe will be finding new homes for their Annual Report 2020

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Message from the Presidents and Secretary General

respective production. EFORT, the British Editorial Society of Bone & Joint Surgery (BESBJS) and Healio decided to each go their own way. Building on what has been achieved, and re-positioning itsbrand, is EFORT’s strong belief: discussions are well underway to find a new, safe haven for both.

May we thank the British Editorial Society of Bone & Joint Surgery (BESBJS) and Healio for successful collaboration over all these years. We wish them an “invigorating” journey towards new horizons.

The Congress Innovation Group has tackled the balance between three congress days of frenzied action and a steady flow of all-year-round activity. In its pipeline are a range of educational activities, which will complement the main “congress days” to synthetise a richer offer than ever before: The EFORT Educational Partnership Programme (EEPP) proposes a full array of new opportunities to interact with the EFORT O&T community throughout the year.

On the European level, next year will see the achievement of two major initiatives: the CORE-MD project, a report of which can be read in the following pages, and the EFORT White Book.

Finally, the EFORT Board always values interaction with its National members. As such, the creation of the Nominating Committee, as approved during the General Assembly in June 2020, has provided more transparency in processes and a fruitful line of communication for more engagement.

We are grateful for your contribution and at the eve of EFORT’s 30 years anniversary, let us celebrate to reunite with Lisbon 2022.

Prof. Dr. Philippe Neyret EFORT President 2019/2020

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Prof. Dr. Klaus-Peter Günther EFORT President 2020/2021

Mr. David Limb Secretary General

Governing Board and Organisation

2020 MEMBERS OF THE EXECUTIVE BOARD Prof. Dr. Klaus-Peter Günther Prof. Dr. Philippe Neyret Prof. Dr. Li Felländer-Tsai Prof. Dr. Enrique Gómez Barrena Mr. David Limb Prof. Dr. Theofilos Karachalios Prof. Dr. Katre Maasalu Prof. Dr. Stefan Nehrer Prof. Dr. Pietro Ruggieri Dr. Yavuz Saglam

President Germany Immediate Past President France First Vice President Sweden Second Vice President Spain Secretary General United Kingdom Treasurer Greece Member at Large Estonia Member at Large Austria Member at Large Italy Young Member at Large Turkey

2020 MEMBERS OF THE EXECUTIVE COMMITTEE Co-opted Members: Dr. Nanni Allington Belgium Dr. Jasmin Diallo Switzerland Prof. Dr. Jean-Alain Epinette France Prof. Dr. Pierre Hoffmeyer Switzerland Ass. Prof. Dr. Per Kjaersgaard-Andersen Denmark Dr. George Macheras Greece Prof. Dr. Aare Märtson Estonia Prof. Dr. Rob Nelissen The Netherlands Prof. Dr. Søren Overgaard Denmark Prof. Dr. Ulrich Stöckle Germany Prof. Dr. Hakki Sur Turkey Prof. Dr. Karl-Göran Thorngren Sweden Prof. Dr. Luigi Zagra Italy

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Membership Network

NATIONAL MEMBER SOCIETIES

ASSOCIATE SCIENTIFIC MEMBERS

Albania

AAOST

Albanian Association of Orthopaedic Surgery and Traumatology

Austria

ÖGO

Austrian Society of Orthopaedics and Orthopaedical Surgery

Belarus

BRSMTOS Belarus Republic Scientific Medical Society of Trauma and Orthopaedic Surgeons

Armenia AOTRA The Association of Orthopaedists,

Traumatologists and Rehabilitologists

of Armenia

Belgium

BVOT

Belgium

SORBCOT Belgian Royal Society of Orthopaedic Surgery and Traumatology

Belgian Association of Orthopaedics and Traumatology

Australia

AOA

Australian Orthopaedic Association

Azerbaijan AAOT Azerbaijan Association of

Orthopaedics and Traumatology

Bosnia and Herzegovina UOTBIH

Association of Orthopedists and Traumatologists of Bosnia and Herzegovina

Bulgaria

BOTA

Bulgarian Orthopaedics and Trauma Association

Croatia

COTA/HUOT Croatian Orthopaedic and Traumatology Association

Cameroon CSOST Cameroonian Society of

Orthopaedics and Trauma Surgery

Croatia

CrOS

Croatian Orthopaedic Society of the Croatian Medical Association

Egypt

EOA

Egyptian Orthopaedic Association

Cyprus

CAOST

Cyprus Association of Orthopaedic Surgery and Traumatology

Israel

IOA

Israeli Orthopaedic Association

Czech Republic

CSOT

Czech Society for Orthopaedics and Traumatology

Jordan

JOA

Jordanian Orthopaedic Association

Denmark

DOS

Danish Orthopaedic Society

Lebanon

LOA

Lebanese Orthopaedic Association

Estonia

ETOS

Estonian Orthopaedic Society

Finland Republic of North Macedonia

SOY-FOA

Finnish Orthopaedic Association

Mexico FEMECOT Mexican Federation of Orthopedic

& Traumatology Colleges A.C.

MAOT

France

SOFCOT

Germany

DGOU

German Society of Orthopaedics and Traumatology

Greece

HAOST

Hellenic Association of Orthopaedic Surgery and Traumatology

Hungary

MOT/HOA Hungarian Orthopaedic Association

Iceland

IBF

Ireland

IOA

Bangladesh

BOS

Bangladesh Orthopaedic Society

Oman

OSO

Orthopaedic Society of Oman

Macedonian Association of Orthopaedics and Traumatology

Saudi Arabia

SOA

Saudi Orthopaedic Association

French Society of Orthopaedic Surgery and Traumatology

Iran

POTA

Persian Orthopaedic Trauma Association

EUROPEAN SPECIALITY SOCIETIES

Icelandic Orthopaedic Society

ARTOF

Association for the Rational Treatment of Fractures

Irish Orthopaedic Association

EBJIS

European Bone and Joint Infection Society European Foot and Ankle Society

Italy

SIOT

Italian Society of Orthopaedics and Traumatology

EFAS

Kosovo

KSOTS

Kosovo Society of Orthopaedics and Trauma Surgeons

EHS

European Hip Society

LSOT/LOTD Lithuanian Society of Orthopaedics and Traumatology

EKS

European Knee Society

SLOT

Luxembourgian Society of Orthopaedics and Traumatology

EORS

European Orthopaedic Research Society European Paediatric Orthopaedic Society

Lithuania Luxembourg Malta

AOTSM

Association of Orthopaedic and Trauma Surgeons of Malta

EPOS

Montenegro

AMOT

Association of Orthopaedics and Traumatologists of Montenegro

ESPA

European Society of Pelvis And Acetabulum

ESSKA

European Society of Sports Traumatology, Knee Surgery and Arthroscopy

ESTES

European Society for Trauma and Emergency Surgery

ESTROT

European Society of Tissue Regeneration in Orthopaedics and Trauma

Netherlands

NOV

Dutch Orthopaedic Association

Norway

Nof

Norwegian Orthopaedic Association

Poland

PTOiTR

Polish Orthopaedic and Traumatologic Society

Portugal

SPOT

Portuguese Society of Orthopaedics and Traumatology

Romania

SOROT

Romanian Society of Orthopaedics and Traumatology

Serbia

SOTA

Serbian Orthopaedic Trauma Association

Slovakia

SOTS

Slovak Orthopaedic and Traumatologic Society

Slovenia

EUROSPINE the Spine Society of Europe FESSH

Federation of European Societies for Surgery of the Hand

SOA/ZOSZD Slovenian Orthopaedic Society

ISLASS

International Society of Laser and Percutaneous Procedures in Spinal Surgery

Spain

SECOT

Spanish Orthopaedic and Traumatology Society

SECEC

European Society for Surgery of the Shoulder and Elbow

Sweden

SOF

Swedish Orthopaedic Association

Switzerland

Swiss Society of Orthopaedics and Traumatology (swiss orthopaedics)

Turkey

TSOT/TOTBID Turkish Society of Orthopaedics and Traumatology

Ukraine

UAOST

Ukrainian Association of Orthopaedic Surgeons and Traumatologists

United Kingdom

BOA

British Orthopaedic Association

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Membership Network

COOPERATION AT NATIONAL LEVEL EFORT FORA have continued to collaborate with our stakeholders. This series of sessions, launched in 2002, aims to organise specific EFORT symposia during the annual congresses of our member National Societies.

The EFORT Board would like to acknowledge and thank the member societies for their invitations to attend various high level education meetings and congresses, promoting best practice.

In recent years, the EFORT Fora have reached a very high scientific level and have provided an excellent exchange between National Societies and EFORT. Accordingly, the interest in such Fora has grown significantly.

2020 EFORT Fora sessions • SECOT | Virtual Congress 2020 - Spain | 30 September 2020 EFORT Forum: Complex Proximal Tibial Fractures: ‘The times they are a Changing’ • SOROT | Cluj, Romania | 08 October 2020 EFORT Forum: ‘Middle Age Knee OA Treatment-Arthroscopy UKA/HTO-Orthobiology’ • HAOST | Athens, Greece 16 October 2020 EFORT Forum: ‘Massive Rotator Cuff Tears: Current Treatment Options’ • TOTBID | Antalya, Turkey | 08 November 2020 EFORT Forum: ‘Geriatric Hip Fractures’

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Membership Network

Will education need to be adapted because of Covid-19?

During the year 2020, it was perhaps even important for EFORT to be connected to the national member societies. EFORT conducted two series of calls with national delegates in April and October.

With no surprise the main concern of all those having participated was the global Covid-19 pandemic and the implications felt on finances, annual meetings and education.

All elective surgery have been put on hold and only emergency operations could be performed with the consequence of a significant backlog of operations in summer and fall.

A majority of societies cancelled or postponed their annual meetings. One of the more worrying impact, especially on annual events, was the withdrawal of industry partners from pre-booked conference services such as exhibition and satellite symposia activities, to name only a few. There is an ongoing concern not only about current support but also about future commitment.

Some of the national societies also confirmed that their governments had offered financial support programmes to help overcome this unprecedented crisis.

With 80% of the surgeries being on hold and many restrictions in place, it is difficult to continue with appropriate educational offerings for residents, a lot of them having been assigned to support the medical teams managing Covid-19 patients. What will be the effect of the pandemic on medical training in the future and will education need to be adapted?

This is certainly one of the challenges that national, European and international healthcare organisations will face in the future.

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Membership Network

INTERNATIONAL: BEYOND EUROPEAN BOUNDARIES AIOT, The Alliance of International Organizations of Orthopaedics and Traumatology The Alliance of International Organizations of Orthopaedics and Traumatology (AIOT) is the joint platform of five leading international organisations of orthopaedics and traumatology.

It was established to increase collaboration and facilitate communication among member organisations in 2018.

The AIOT member organisations (in alphabetical order) are: • APOA (Asia Pacific Orthopaedic Association) • EFORT (European Federation of National Associations of Orthopaedics ad Traumatology) • PAOA (Pan Arab Orthopaedic Association) • SICOT (Société Internationale de Chirurgie Orthopédique et de Traumatologie) • SLAOT (Sociedad Latinoamericana de Ortopedia y Traumatologia) Over the course of the last year, The Alliance published two statements, respectively on ”Covid-19 Best Practices” and a Statement on “Human Rights – We Stand in Solidarity Against Discrimination and Violence”.

AIOT Joint Statement – COVID-19 Best Practices – 27 April 2020 – The outbreak of a novel coronavirus, referred to as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) or coronavirus disease-19 (COVID-19) has rapidly become a global public health threat, endangering the health and well-being of all people, but especially vulnerable populations. The pandemic has also precipitated social disruption, exceptional health-care utilisation, and economic instability worldwide. Limiting further spread of COVID-19 has become the singular focus, with unprecedented international collaboration and rapid dissemination of emerging scientific evidence.

The Alliance of International Organizations of Orthopaedics and Traumatology (AIOT) agreed on a number of over-arching best practices to guide our international members. AIOT recommends global research collaborations to maximise efficiency and existing networks during COVID-19 to determine impacts of the pandemic on orthopaedic and trauma care worldwide.

KEY RECOMMENDATIONS General considerations nn Ensure patient and staff safety. nn Keep up-to-date regarding evolving clinical guidelines, as well as your institution capacity issues relative to the regional pandemic severity. nn Judicious use of Personal Protective Equipment (PPE) and prepare contingency plans for supply shortages. nn Establish rotating teams that can work in isolation of each other.

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Membership Network

nn Postpone elective surgeries. Only schedule urgent or emergent surgical cases. nn Develop a plan for phased return of elective and non urgent procedures. nn Promote tele-health modalities to increase access for diagnostic and rehabilitation purposes. nn Use technology to help trainees engage in remote knowledge and skill acquisition training. nn Senior Consultants should be available to actively support trainees.

Outpatient care and elective procedures nn Screen patients and personnel attending outpatient and in-patient facilities for COVID-19. nn When possible, help reduce emergency departments workload by extending operating hours of outpatient clinics and increase their resolution capacity. nn Schedule clinics in line with social/physical distancing principles. nn Prior to determining definitive management of semi urgent or other controversial cases seek for senior surgeons’ advise. nn Minimise imaging requirements. Avoid images that are unlikely to change patients’ nn management. nn Prevent unnecessary follow-up appointments. nn The local epidemiological situation and availability of resources should be considered before planning to resume elective surgeries. Develop protocols and be cautious. Stay prepared for a rapid scale-down in case pandemic severity worsens.

Urgent/emergent procedures and risk mitigation strategies nn Implement a surgical review committee to assist in surgical cases prioritisation. Develop clear policies for airway management in known/suspected COVID-19 patients. nn Develop a dedicated COVID-19 operating room: 1) Away from high traffic areas; 2) Physical or taped-off anteroom; 3) Negative pressure where available (or turn off positive pressure and air conditioning). nn Develop independent flow pathways for traffic in and out of designated COVID-19 OR. nn If possible, plan surgeries as day-cases aiming for an early discharge and single-staged surgeries. nn Perform interventions only if documented treatment effects are superior to non-operative management.

Discuss benefits and harms with patients.

Consolidation of 83 published recommendations.

The strength and quality of each recommendation was assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.

This determines the quality of evidence to be either good, fair or poor; and the strength of evidence to range from strong recommendation for, to strong recommendation against.

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Membership Network

AIOT Joint Statement on Human Rights – We Stand in Solidarity Against Discrimination and Violence – 12 June 2020 – During these unprecedented times, leaders of APOA, EFORT, PAOA, SICOT and SLAOT want to take a stand to support the victims of discrimination all over the world. We recognise the pain, frustration and despair arising from injustices that people face every day. We reject all forms of discrimination including those based on characteristics such as race, culture, gender, religion and disability.

AIOT unconditionally believes in human rights and is against any form of discrimination.

We support individuals and organisations who seek a path toward moral and political equality through peaceful nonviolent resistance and open discussion. This is a call to action for each and every one of us across the world to do more, to speak up and be part of lasting solutions. It is time to seek change diligently against systemic discrimination deeply rooted in our world.

Contributors (in alphabetical order): Jamal Ashraf (Secretary General, APOA), Onder Aydingoz (Past President, EFORT), Mohit Bhandari (Research Academy Chairman, SICOT), Horacio Caviglia (President, SLAOT), Ali Hassan Chamseddine (Past Vice President, PAOA), David Choon (Immediate Past President, APOA), Mohamed Darwish (President, PAOA), Mahmut Nedim Doral (President, APOA), John Dormans (President, SICOT), Francisco Forriol (Vice President, SLAOT), Klaus-Peter Günther (First Vice President, EFORT), Philippe Hernigou (Treasurer, SICOT), Vikas Khanduja (Education Academy Chairman, SICOT), David Limb (Secretary General, EFORT), Edward T Mah (Past President, APOA), Philippe Neyret (President, EFORT), Shanmuganathan Rajasekaran (Immediate Past President, SICOT) and James Waddell (Secretary General, SICOT).

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EFORT’s Framework for Educational Structure: the EOTEP

"Diversity in Europe is not only a matter of language, but also cultural and educational […].

We therefore advocate for harmonisation that respects diversity."

—Prof. Philippe Neyret, VEC 2020 Congress President VIRTUAL EFORT CONGRESS 2020 EFORT 2020 Congress re-worked: Virtual EFORT Congress (VEC) was held from 28 to 30 October 2020.

No doubt the path to the “new normal” has accelerated ways to deliver education differently. Embracing the journey to inventive solutions has convinced EFORT to create its first Virtual EFORT Congress or VEC, which was held from 28 to 30 October 2020.

Learn, network and science were the building blocks of the program placed under the main theme of “Harmonisation and Diversity.”

EFORT Best National Papers 2020

Sweden Is the Risk of Revision after Arthroplasty Surgery Associated with Specific Gene Loci?

A Genome-Wide Association Study of Single Nucleotide Polymorphisms in 1,130 ArthroplastyTreated Twins Authors & Institutions: Anders Brüggemann (1), Niclas Eriksson (2), Nancy L Pedersen (3), Karl Michaëlsson (1), Nils P Hailer (1) 1. Department of Surgical Sciences, Orthopaedics, Uppsala University 2. Uppsala Clinical Research Center Uppsala University 3. Department of Medical Epidemiology and Biostatistics, Karolinska Institute , Stockholm Switzerland Augmented Reality Guided Osteotomy – Proof of Concept

Periacetabular

Authors & Institutions: Pascal Kiarostami, Cyrill Dennler, Simon Roner, Reto Sutter, Philipp Fürnstahl, Mazda Farshad, Stefan Rahm, Patrick Zingg Balgrist University Hospital, Zürich

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On 10 March 2020, the EFORT Board still felt optimistic that the 21st EFORT Annual Congress could take place as planned in Vienna. The EFORT Board always considered the safety and health of all participants, sponsors, service providers and staff to be their absolute priority. However, on 6 April 2020, the global COVID-19 pandemic forced EFORT to make the difficult decision to postpone what would have been the next face-to-face EFORT Annual Congress to the next year and to create a new educational offer in the autumn: the idea to launch the Virtual EFORT Congress (VEC) was born.

The VEC offered five simultaneous channels, two of which were dedicated to the abstract-based program, another two to scientific sessions and the fifth channel offered sessions with featured content, such as the regular courses (eg. Comprehensive Review Course or CRC), but also specifically designed workshops to support EFORT’s voice within public policy and patient safety initiatives.

The main theme of “Harmonisation and Diversity” was maintained and as Prof. Philippe Neyret, immediate past president and, on this occasion, VEC 2020 Congress President, liked to say, “Diversity in Europe is not only a matter of language, but also cultural and educational […]. We therefore advocate for harmonisation that respects diversity.”

Several sessions were presented on this topic, such as Women in Orthopaedic and Traumatology Surgery, Harmonising the Management of Mass Injuries in Children, Global Diversity in Bearing in Primary THA, to name a few.

To engage more with national member societies in regard to the development of parts of the scientific content and to create a research culture within the O&T community, EFORT implemented the Best National Paper initiative, which focused on the presentation of the best abstracts from each national member society. A total of 22 e-posters of the best national papers were made available during the VEC, the best scored of which were also presented orally during the highlighted session, just before the closure of the VEC. During this session, attendees were invited to vote live to choose the winner of the Best National Paper Award.

More than 70% of the accepted abstracts, which were planned for presentation during the face-to-face congress in Vienna 2020, were presented during the VEC in October. This represented more than 1,200 abstracts, including 400 free paper oral pre-recorded presentations and 800 poster presentations with audio narrations.

EFORT’s Framework for Educational Structure: the EOTEP

Portrait of congress participants in 2020 - Main Regions of Work

Europe

82.6% Northern America

Asia

1.8%

4.6%

Middle East

4.6%

Africa Latin America

5%

0.2%

Oceania

1.2%

Gilles Walch was the EFORT Honorary Lecturer during the VEC. His contribution towards the 2020 scientific program was to give the Erwin Morscher Honorary Lecture entitled, “Reproduce the Diversity in Treatment of Anterior Shoulder Instability.”

Reformatted CRC The CRC will was also featured in the VEC program and has been reformatted to fit the new virtual environment.

Discussion times were extended and took place at the end of each of the eight modules.

Virtual exhibition In parallel, a virtual exhibition was developed, whereby companies had several options to interact directly with the audience and showcase their latest solutions. Through this initiative, EFORT invited industry to work together to keep brands and products at the forefront and extend their global outreach.

Bioskills Under the new brand “Bioskills@EFORT” EFORT broadcasted extremely realistic procedures digitally to provide continuing medical education and professional development to its members throughout Europe. Two sessions respectively on Pilon Fractures and Proximal Tibia Fracture were performed as live surgery on anatomical specimens in a clinical environment.

These session aimed at transferring theoretical issues to students and young surgeons concerning surgical planning and diagnostic classification.

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EFORT’s Framework for Educational Structure: the EOTEP

Through technology it was possible to bring practical skills to those surgeons who do not have ready access to hands-on training from a more experienced practitioner. According to Dr. Peter Biberthaler, course director and member of the Trauma Education Group within the EFORT Education Committee, it allows practical skills to be taught online where the demonstration of specific techniques can really help someone in a more remote area who may encounter a difficult case to better provide treatment in that case. He continues “We can transfer the best medical knowledge to the most remote places, and this will bring a lot of new creative people to the whole experience, and they will likely have fantastic ideas to develop even newer and better practices. I believe this is a good thing for a dramatic development of medical science.”

Continued medical education through industry partnerships: The example of the Surgical Skills Workshop Heraeus and EFORT brought together top experts to demonstrate surgical skills for infection management in an efficient and memorable virtual platform More now than perhaps prior to the global pandemic, it is essential to bring together the orthopaedic and traumatology community to build best practices, to demonstrate the latest technologies and surgical techniques, and to share updated research and new understandings in the practice of orthopaedics and traumatology. To address the requirement to remain physically distant alongside the necessity to remain close and to unite medical professionals through knowledge, EFORT organised an extremely engaging Virtual Surgical Skills Workshop as part of its first-ever Virtual EFORT Congress. The workshop was one of numerous opportunities for continuing education and professional development that EFORT provides consistently for its members.

In collaboration with Hereaus, an EFORT industry partner, headquartered in Germany that provides solutions for joint arthroplasty and revision arthroplasty and components for modern cementing techniques, EFORT engaged experts for an evening of presentations and group discussion to hone top skills for handling joint infection, spacers and cementing in an evidence-based and practical demonstration of these techniques. The evening was interactive and accessible digitally from across the globe – a format made necessary by current pandemic restrictions but also extremely beneficial for students of all levels and surgeons of any experience. The userfriendliness of the platform and concisely structured approach of the virtual event contributed immensely to the transmission of pointers for practice and understanding of the materials presented. In fact, ongoing replays of the presentations are accessible online. [Insert Link to information] Practical demonstration: The next element of the key learnings was a pre-recorded video demonstration by Hereaus. This was shot in a format similar to a product information file guide for regulatory compliance on how to best use concrete for patient safety.

The practical experience of seeing the cement used and applying some of the techniques discussed previously, especially with regard to custom solutions and mixing of antibiotics, reinforced the information from a conceptual case study to a demonstration that made it feel like the viewer has actually used the product in a clinical setting.

Beyond the theoretical, this practical experience is invaluable in fixing the research-based concepts to memory for the moments that count in the operating room.

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EFORT’s Framework for Educational Structure: the EOTEP

Live streaming and access times during the Virtual EFORT Congress 2020

Live streaming

12,516 Live streaming unique viewers 175,660 session views 588 days 12 hours 57 min of live streaming views 1 hour 03 min 23 sec average viewing time

2.1%

49.6% 7.4%

Access time

22.8%

10.9%

2.5%

Harmonising best practices: “Harmonisation and Diversity” was the overarching theme of the Virtual EFORT Congress for 2020, and the workshops that reinforced surgical skills embodied that theme by harmonising approaches to surgical situations to a much more diverse audience than previous onsite EFORT Congresses allowed these experts to reach in the past.

TV Studio As the perfect round up, the EFORT Live TV Studio has been a first and a truly enriching experience to highlight and promote the digitally developed programme. Throughout the VEC moderator Julie Mac Donald was our host, and together with our guests presented & discussed: Every morning, the overview of the daily programme with highlights not to be missed • O&Talks“ with interviews on expert topics introducing featured programme spots • New learning formats in collaboration with industry such as the Bioskills@EFORT sessions • Wrap-up & Awards sessions This first VEC was granted 14 European CME credits (ECMEC) by the European Accreditation Council for Continuing Medical Education. Online features made it possible for attendees to record the time they spent watching the scientific content while they attend the “live” educational sessions.

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EFORT’s Framework for Educational Structure: the EOTEP

Virtual EFORT Congress 2020 press coverage in Orthopaedics Today Europe —08 April 2020 EFORT issues official statement on COVID-19 concerning 2020 Congress in Vienna This official statement was issued by the EFORT Head Office in Rolle, Switzerland on 6 April 2020

—29 October 2020 Approach family life ‘as a team’ to improve work, life balance For orthopaedic physicians, commitment, structure, parental leave and partner relationships are key factors for improving work/life balance, according to a speaker at the Virtual EFORT Congress.

—21 April 2020 COVID-19 has been a game changer Within a few weeks, the pandemic due to the novel coronavirus became the largest game changer experienced in modern times.

—29 October 2020 Patients with tibial plateau fractures show higher VTE rates than other trauma patients The 4% venous thromboembolism or VTE rate researchers found for 571 patients with tibial plateau fractures supports their theory that the non-weight-bearing sometimes needed after fracture treatment may predispose patients to develop a VTE.

—06 October 2020 Walch to share insights into shoulder conditions Gilles Walch, MD, a great specialist in surgery and arthroscopy of the shoulder and pioneer of numerous concepts for treatment of the most common shoulder conditions, is among the most well-known orthopaedic surgeons in France.

—28 October 2020 Reduced knee pain seen with novel medial incision for nailing tibial shaft fractures Data presented showed return-to-sport time and anterior knee pain were improved when surgeons used a novel transverse medial parapatellar incision for intramedullary nailing of tibial shaft fractures.

—28 October 28 2020 Gage’s sign, metaphyseal cysts may predict Legg-Calvé-Perthes disease Head-at-risk signs, such as Gage’s sign and metaphyseal cysts, are risk factors that may predict poor prognoses in pediatric patients with LeggCalvé-Perthes disease, according to presented results.

—29 October 2020 IKDC score after ACL reconstruction may predict safe return to sport Patients who follow a structured rehabilitation program and a comprehensive return-to-sport assessment after ACL reconstruction can have a low graft rupture rate, according to presented results.

—29 October 2020 Marathon running has no negative impact on the hip joints, muscles Marathoners have minimal abductor muscle atrophy and CAM impingement after marathons, however marathon running has no negative impact on the pelvis and hip joints and muscles, according to presented results.

—29 October 2020 Distal femoral replacement for knee trauma yielded positive clinical, functional outcomes Results presented at the Virtual EFORT Congress showed patients with distal femoral fractures experienced low mortality and reoperation rates, high implant survivorship and acceptable functional outcomes after distal femoral replacement.

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Annual Report 2020

—29 October 2020 Over time, little comorbidity variation seen in patients with total hip, knee replacement In patients who undergo total hip replacement or total knee replacement, there has been little change in comorbidity profiles over time, according to presented results.

—30 October 2020 Higher white blood cell count seen in patients with septic arthritis vs gout Patients who have septic arthritis show significantly higher white blood cell count compared with patients who have gout, according to presented results.

—30 October 2020 Key reason for midterm to long-term medial, lateral UKA revision: OA progression Despite issues with mobile-bearing lateral unicompartmental knee arthroplasty implants, researchers found similar midterm to long-term survivorship of both lateral and medial unicompartmental knee arthroplasty performed from 2007 to 2017.

—31 October 2020 Porous tantalum acetabular implants show ‘excellent survivorship’ for complex revision THA Porous tantalum cementless acetabular components show stable fixation, positive outcomes and “excellent survivorship” at 10- to 15-year follow-up for revision hip arthroplasty, according to data presented at the Virtual EFORT Congress.

—01 November 2020 Patients with multiple osteochondromas report lower physical, mental quality of life According to recently presented results, unemployment, low physical activity and female sex are associated with lower quality of life for patients with multiple osteochondromas compared with the general population.

EFORT’s Framework for Educational Structure: the EOTEP

—02 November 2020 IL-6, neutrophil-to-lymphocyte ratio may predict patient outcomes of TKA for OA Interleukin-6 and neutrophil-to-lymphocyte ratio may be used as preoperative risk stratifying tools among patients undergoing total knee arthroplasty for osteoarthritis, according to results presented at the Virtual EFORT Congress.

—03 November 2020 Young patients find lack of rehabilitation programs for their needs after hip fracture Young and middle-aged adults with hip fractures face continual challenges through 3.5 years after their injury, according to results of a study to highlight patients’ recovery experiences.

—03 November 2020 Patellofemoral OA did not affect preoperative outcome measures in medial, lateral OA Preoperative knee-specific and generic patient-reported outcome measures were not affected by the presence of patellofemoral osteoarthritis among patients with medial or lateral OA, according to results from the Virtual EFORT Congress.

—04 November 2020 EFORT recognises awardees of its first Virtual EFORT Congress A congress is as good as its scientific program. Therefore, each EFORT Annual Congress, even a virtual one, relies on the high-quality content from orthopaedic and traumatology physicians and researchers from Europe and worldwide.

—10 November 2020 Stroke risk predicted by assessment score in patients with hip fractures Results presented at the Virtual EFORT Congress showed an association between the CHA2DS2-VASc score with risk of stroke, thromboembolism and death among patients with or without atrial fibrillation undergoing treatment for hip fracture.

—14 November 2020 Hip fracture sustained as inpatient vs outpatient event led to higher mortality risk Patients who sustained a hip fracture in hospital had a higher mortality risk than patients who sustained a hip fracture outside the hospital, according to results presented at the Virtual EFORT Congress.

—15 November 2020 Immobilisation for 1 week after a humeral fracture considered effective conservative care One week of immobilisation was as effective as 3 weeks of immobilisation for patients with proximal humeral fractures in results of a prospective study that included mostly Neer two-part fractures treated with the technique.

—17 November 2020 Ceramic-on-polyethylene showed higher revision rate vs metal-onpolyethylene THA implants Patients who underwent total hip arthroplasty with ceramic-onpolyethylene implants had a higher risk of revision compared with those who had metal-on-polyethylene implants, according to results presented at the Virtual EFORT Congress.

—17 November 2020 Vitamin E-diffused polyethylene liners have a high resistance to linear wear after THA Despite no notable differences in hip function or pain in patients who underwent total hip arthroplasty, vitamin E-diffused polyethylene liners had “significantly less liner wear” than cross-linked polyethylene liners at 7-year follow-up.

—12 November 2020 Function is better with fixed-bearing vs mobile-bearing UKA Oxford Knee Score improvements after fixed-bearing unicompartmental knee arthroplasty were associated with more meaningful patient outcomes vs. those for mobile-bearing unicompartmental knee arthroplasty, study results showed.

—13 November 2020 Single preoperative dose of tranexamic acid may decrease blood loss after TJA A preoperative 1-gram dose of tranexamic acid decreased blood loss in patients undergoing total hip and knee arthroplasties, according to results of the Gold Award-winning paper in orthopaedics at the Virtual EFORT Congress.

Annual Report 2020

19

EFORT’s Framework for Educational Structure: the EOTEP

EFORT OPEN REVIEWS, THE EFORT JOURNAL Editor in Chief nnPierre Hoffmeyer

Since its inception EFORT has published 15 volumes of Instructional Lecture volumes at its congresses lately under the editorship of George Bentley with various publishers including the British Editorial Society of Bone and Joint Surgery and SPRINGER.

Scientific Editor nnGeorge Bentley

However, the need for a regular scientific EFORT publication became apparent and in 2010, the first issue of volume 1 of the new European Orthopaedics and Traumatology (EOTR) appeared during the EFORT Madrid Congress. The publication was the Official Journal of the European Federation of National Associations of Orthopaedics and Traumatology and published by SPRINGER a major publishing company.

Professor Emeritus nnWolfhart Puhl Associate Editors (AEs): nnBasic Science: Enrique Gómez Barrena and Bernd Grimm nnFoot & Ankle: Marino Delmi

The EOTR was conceived as a general orthopaedics and traumatology journal with a mix of original articles, reviews and sounding boards. It was a paper based publication distributed widely to all members of the societies participating in EFORT which represents +40000 potential readers throughout Europe and more than 7000 institutions worldwide. EOTR published 329 articles in six volumes between 2010 and 2015. Although the Journal thrived, it did not achieve inclusion in major databases or indexation in PubMed. It therefore became clear that a new and novel approach was needed if EFORT’s publications were to be recognised internationally.

nnHand & Wrist: Philippe Kopylov nnHip: Luigi Zagra nnKnee: Hermes Miozzari nnOncology: Stephen Cannon nnPaediatrics: Julio de Pablos

The next step therefore was to focus efforts in the direction of Open Access publishing. Because surgeons remain attached to the printed word it was decided that the new publication would have one paper issue which would be distributed to the participants of the annual EFORT congress as part of the Congress package fee. Also the new publication would be more focused and publish only review type articles. The reviews would contain up to date information on topics of interest to juniors and seniors alike. Some reviews would be very general and others extremely focused thereby touching upon a wide range of potential readers. It was believed that an educational tool of this nature was missing on the European orthopaedic and traumatology scene.

Furthermore, it was decided to resolutely and identifiably brand the publication and therefore the name “EFORT Open Reviews” (EOR) was chosen.

nn Shoulder & Elbow: Przemysław Lubiatowski The new EOR nnSpine: Enric Cáceres-Palou nnSports & Arthroscopy: Daniel Fritschy nnTrauma: Ulrich Stöckle

20

Annual Report 2020

The new EOR was entrusted to Bone & Joint Publishing (BJP) managed by the British Editorial Society of Bone and Joint Surgery (BESBJS) based in London.

The EOR team consists of an editorial group led by the Editor in Chief (EiC) and the Scientific Editor, the latter being responsible for the Instructional Lectures and the Oncology section. The Associate Editors are each responsible for their specific section.

EFORT’s Framework for Educational Structure: the EOTEP

The first article was on the web in January 2016 and already in May 2017 we were indexed in PubMed. EOR is now indexed in Scopus and is included in Google Scholar and the directory of Open Access journals, and it is indexed in PubMed with full-text provided in PubMed Central and therefore included in the PubMed database (PMC). A Clarivate Analytics impact factor was awarded in June 2020 and stands at 2.295. This impact factor ranks EOR 30th in a list of 82 Orthopaedics and Traumatology Journals worldwide with impact factors. The prospects of improving impact factor and journal ranking are deemed excellent both by the EOR team and by independent observers.

Article Processing fees (APC’s) have been instated since November of 2020. It was decided to charge 1500 Euros per article.

EFORT Open Reviews: Key statistics 2017

2018

2019

2020

Overall submissions

77

107

95

157

Invited submissions

54%

43%

31%

6%

Non-invited submissions

46%

57%

69%

94%

65

82

78

83

Accepted

2

6

23

25

Rejection rate

3%

7%

23%

23%

Published papers

59

73

79

99

Usage* (full-text downloads)

181,584

137,548*

339,261

528,761

Table of Content registrants

N/A

2,547

3,337

3,518

Rejected

* Full-text downloads (EOR website www.efortopenreviews.org and PubMed) The actual situation At the end of the year 2019 the Council of Management of the British Editorial Society decided to conclude their involvement with EOR when the agreement expired at the end of December 2020.

To conclude the experience of collaborating with Bone and Joint Publishing is extremely satisfactory. The team is notable for its efficacy and efficiency. The Publisher has developed a particular competence in all things orthopaedic and traumatology and this is of great help to the EiC, to the AEs, the members of the editorial board and the reviewers.

In anticipation of this state of affairs, in the spring of 2020 EFORT has designated a task force to search for a new publisher and to negotiate for a one-year extension of the current agreement with BESBJS.

Annual Report 2020

21

EFORT’s Framework for Educational Structure: the EOTEP

e-SCIENCE EFORT e-Science offers scientific content from past EFORT Annual Congresses and eLearning material After the success of the EFORT pilot webinars, the Board granted approval to move forward with a regular live broadcast. 2020 provided the O&T Community with 7 webinars which are available for replay on https://www.efort.org/education-and-courses/elearning.

EFORTnet is the platform where personal accounts can be created to access the full range of EFORT’s educational projects & products. A t the same time is used as an intranet for the Board and committees serving the organisation.

The e-Library includes all available formats of delivered Education focusing on replaying past congress presentations, webinars (live and replay), all submitted abstracts accepted as poster or free papers in sessions during the EFORT Annual Congresses (a mapping is available through the interactive EORN map) and presentations made during selected EOTEP training courses.

EFORTNET and the e-Library EFORTnet at a glance (as of 31 December 2020): nn21,321 users nn85.3% of users from Europe nn102 countries represented nn26,146 documents available in the e-Library nn88,378 visits (+10.81% compared to 2019) nn508,074 pages views in 2020 (+9.83% compared to 2019) nn3.2 page views per visit | Average length of visit 2 min 31 sec

22

Annual Report 2020

nnOrthopaedic & Trauma Surgeons In Time Of Covid-19 | Monday 06 April 2020 Learning objectives: -Practical suggestions for the orthopaedic community in this challenging time of the coronavirus pandemic -Understand the role of orthopaedic & trauma surgeons in the present setting -Share experiences around Europe at different level: do and dont‘s -How to improve care and safety of orthopaedic & trauma patients in a pandemic situation -How to organise the department, the team, the emergency, the surgery, the consultation office nnFast-Track In Joint Replacement | Monday 27 April 2020 Learning objectives: -The definition of fast-track programme in arthroplasty -The requirements for establishing a fast-track unit by multidisciplinary collaboration with a well-defined organisational set-up -Which measures make a protocol fast-track and differentiate it from a standard procedure -The effect of fast-track programmes in post-operative length of stay, convalescence, functional recovery, morbidity and mortality nnCo-Existing With Covid-19 – Elective Orthopaedic Surgery: When & How? | Monday 11 May 2020 Learning objectives: -How to safely organise the activity: outpatients, departments, OR, patients’ journey, the staff.

-How do we prioritise patients when reinstating surgery in a stepwise manner: the easy or the more complex patient, the easy or the complex cases, the ones that are complex patients and cases, but cannot wait anymore?

-The value of screening tests: optimising timing pre and post-operatively -Current PPE and safety protocols for the staff

EFORT’s Framework for Educational Structure: the EOTEP

e-SCIENCE nnNon-Infected Painful Total Hip Arthroplasty | Monday 08 June 2020 Learning objectives: -Objectivise clinical situation: pain intensity, functional limitations, level of activity.

-Other areas are cause of local pain: lumbar spine, abdominal hernias, genitourinary pathology.

-Suspect: loosening without radiolucent lines or migration, too thick / rigid stems, subluxation in extreme positions.

-Discard: poly wear, pseudotumors, particle disease, trunnionosis, ceramic fracture, ALVAL, allergies to metals.

-Reconsider: lower limb discrepancy, inadequate offset, insufficient abductors, tightened adductors, localised trochanteritis and impingement in flex-internal rotation nnNon-Infected Painful Total Knee Arthroplasty | Monday 06 July 2020 Learning objectives: -Clarify the clinical situation: diagnosis of the painful knee arthroplasty, general management of some problems.

-Consider the location: intra or extraarticular source of pain, local or referred pain, extensor mechanism or other regions may also cause knee pain.

-Component positioning, over- and under sizing, eventual conflicts such as malposition, malrotation or impingement should be investigated.

-Soft tissues may be the origin of pain, management may vary with diagnosis: instability, stiffness, tendinosis, iliotibial tract,...

-Material and fixation problems are frequent pain causes: consider loosening, debonding, osteolysis, metal allergy, metallosis, material failure.

e-Science: re-visit the platform!

Readers are encouraged to revisit content of educational events, including the VEC 2020 that is available and accessible online.

For those who did not participate, it is clear, that just the experience of the VEC 2020 for example shows successfully that EFORT pulled off a more interactive way to earn continuing medical education credits while connecting to a more broad base of professionals across Europe, even while socially distanced.

We look forward to seeing how this current necessity will continue to be an added bonus to what the field of orthopaedics and traumatology can rely upon to continue to better harmonise our practices in the future.

nnBone Metastases: Principles Of A Modern Treatment | Monday 28 September 2020 Learning objectives: -Focus on modern treatment of bone metastases.

-Understanding of the new concept of oligometastases and its consequences on clinical approach and treatment.

-Updating on new surgical techniques and the concept of a multidisciplinary approach. nnRotator Cuff Repair: When And How? | Monday 30 November 2020 Learning objectives: -Focus on most relevant treatment options of rotator cuff tears.

-Understanding of the new concept of rotator cuff tendon healing.

-Updating on new surgical techniques and the concept of a multidisciplinary approach.

A joint collaboration between EFORT and the European Society for Surgery of the Shoulder and Elbow (SECEC).

Annual Report 2020

23

EFORT’s Framework for Educational Structure: the EOTEP

EFORT WEBINARS 2020 2500

EFORT Webinars 2020 - Registered vs Live attendees

2000

2020 total 2,998 registered 3,034 live attendees

1288

1500

1000

324

500

365 246

772 391

491

402

216

352

240

288

319

338

0

REPLAYS / Post‐event views 2020 EFORT Webinars 2020 - Replays / post-events views 4500 4000

3900

2020 total 7,248 replay views

3500

3000

2500

2000

1500

1000

500

0

24

Annual Report 2020

949 381

594

662

450

312

EFORT’s Framework for Educational Structure: the EOTEP

Industry Collaborative Webinars (ICW) “In response to the extraordinary situation we faced in 2020, we have been working on a richer offer than ever before. The main “congress days” have been complemented by a series of educational activities, starting with a webinar series of more than 10 broadcast programmes. Other items to be jointly organised and promoted under the format of new collaborative schemes are in the pipeline…”

—Prof. Stefan Nehrer, Chair of the EFORT Education Committee.

In the course of the development, EFORT recently launched its new joint venture format with commercial companies, starting with a partnership with Orthofix. Both were pleased to announce their new collaboration over a series of webinars to be broadcast via the eScience platform of EFORT and which will be integrated and placed next to their latest eLearning offering.

“Medical education has always been the flagship of Orthofix’s efforts. As Orthofix Extremities keeps abreast of the latest in technologies, we also acknowledge the pivotal role played by medical education in informing surgeons about the latest medical knowledge” —Attilio Adami, Vice President Global R&D, Marketing and Medical Science.

Under the denomination of Industry Collaborative Webinars (ICW) both parties join forces to put forward a complementary and multidimensional alternative within training & education offerings aimed at orthopaedic & traumatology surgeons.

EFORT strives to consolidate its status as leader for unbiased science with regards to the Continuous Medical Education and Continuous Professional Development of health care professionals in the fields of orthopaedics and traumatology. EFORT believes that partnership with the business community and other third party commercial providers can have a beneficial impact on European and ultimately global health promotion with respect to reducing the burden of illness and complications arising from orthopaedic and trauma related disease and injury.

It also recognises the significant resources that the private sector and others can bring to EFORT to support achievements of the EFORT mission and thus contribute towards the welfare of the European orthopaedic and traumatology community.

Annual Report 2020

25

European Activities

IMPLANT AND PATIENT SAFETY - MDR On 28 October 2020, during the Virtual EFORT Congress (VEC), EFORT continued an extremely important dialogue around the new Medical Device Regulation (MDR): From the previous Congress in Lisbon (2019) and an intervening workshop in January of 2020 for a deep-dive into an ongoing topic of great importance, the impact of the Medical Device Regulation (MDR).

At EFORT‘s 2019 Annual Congress in Lisbon and at the January 2020 Implant and Patient Safety Workshop, expert orthopaedic and traumatology practitioners, representatives of medical industry manufacturers and regulatory representatives had spirited talks on the issues at hand.

Now, with the date of application of the MDR pushed because of the COVID-19 pandemic to May 2021, notified bodies, advisory boards and expert panels become further organised. Manufacturers ensure that their implementation plans properly account for the necessary clinical evaluations of their devices. Time is running and pressure is increasing to ensure that all parties have the guidance and input necessary to continue to properly ensure the best outcomes for patients.

How these outcomes are best defined, however, is not always agreed upon. The continuation of this conversation took place at the VEC, which is accessible as a digital re-broadcast.

The October 2020 discussion was separated into two major themes: 1) The New Implant – Future Consequences of MDR 2) How to Handle New Problems with Old Implants Recommendations from the EFORT Implant and Patient Safety Initiative The session concluded with an overview of all of the initiatives that EFORT has and will undertake to provide its input for the implant and patient safety initiative. This included the previously highlighted discussion in Lisbon as well as the Implant and safety workshop in Brussels in January 2020. Bringing together stakeholders including surgeons, scientists, representatives of policy, regulators, implant manufacturers and patient organisations is paramount to this effort with the final goal of the process being to find consensus amongst stakeholders, delegates and national societies for the path forward on recommendations, to support understanding of MDR and to support notified bodies with the information they need for uniform practices.

During the first workshop in January 2020, all of the key elements for the recommendation were defined and the first draft was produced in February with all of the participants. The second draft came out in October with feedback from participants, national delegates and societies. The key content of the recommendations includes: • expectations for new implant and implant-related instrumentation • how to define a new implant • how to evaluate pre-clinical and clinical information before it is introduced • information on when new implants can begin to be used routinely.

26

Annual Report 2020

European Activities

“[…] We aim to see wider adoption of optimal methodologies for clinical investigations by both researchers and manufacturers, fewer approvals with limited evidence, and greater transparency of standards.”

—Prof. Rob Nelissen, Chair NORE Committee EU ASSESSMENT OF HIGH-RISK MEDICAL DEVICES FACES IN-DEPTH REVIEW The CORE-MD consortium

The methods for evaluating high-risk medical devices are set to be reviewed in the EU-funded CORE-MD project, Coordinating Research and Evidence for Medical Devices.

nn European Society of Cardiology

CORE-MD is the first formalised group of stakeholders in Europe working together to identify ways to enable the scientific, fair, and systematic evaluation of medical devices. Led by the European Society of Cardiology (ESC) and the European Federation of National Associations of Orthopaedics and Traumatology (EFORT), the consortium includes 22 partners involved in the development, evaluation, approval, clinical use, and monitoring of medical devices.

nn Biomedical Alliance in Europe

nn European Federation of the National Associations of Orthopaedics and Traumatology (EFORT) nn European Academy of Paediatrics nn European Patients Forum nn Academisch Ziekenhuis Leiden (Leiden University Medical Centre) nn The Chancellor, Masters and Scholars of the University of Oxford

The project comes as new EU medical device regulations come into force on 26 May 2021 (originally May 2020 but postponed due to the pandemic), increasing the requirements for clinical evidence on high-risk medical devices1.

However, there are no specific EU recommendations on the design and conduct of trials for high-risk devices. In addition, medical device developers have expressed concerns that the new rules may inhibit innovation and delay market access.

nn Region Uppsala nn Royal College of Surgeons in Ireland nn Insel Gruppe Ag (University Hospital Bern) nn Katholieke Universiteit Leuven nn UMIT- Private Universität für Gesundheitswissenschaften, Medizinischeinformatik und Technik GmbH

More than 50% of high-risk implantable medical devices in Europe are used in cardiology and orthopaedics – such as heart valves and hip replacements – and CORE-MD will focus primarily on these areas. The three-year project begins with a systematic review of methodologies used in clinical trials to evaluate high-risk medical devices, including statistical methods and the utility of patient-reported outcomes for regulatory decisions.

(University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria) nn Göteborgs Universitet (Gothenburg University) nn Politecnico di Milano nn Health Products Regulatory Authority (Dublin)

CORE-MD will propose how to generate evidence using innovative methodologies like randomised registry trials and how to assess artificial intelligence algorithms that are designated as medical devices. The project will also examine how to evaluate medical devices used in children. Advice will be provided on ways to extract maximum value from real-world evidence including medical device registries and clinical practice.

nn Laegemiddelstyrelsen (Danish Medicines Agency, Copenhagen) nn Urzad Rejestracji Produktow Leczniczych, Wyrobow Medycznych I Produktow Biobojczych (Office for Registration of Medicinal Products, Medical

Recommendations from the CORE–MD consortium will be submitted to the Working Group on Clinical Investigation and Evaluation of the European Commission, so that they can be considered as the basis for developing EU guidance documents or common specifications.

Devices and Biocidal Products, Warsaw) nn Rijksinstituut Voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, Bilthoven, The Netherlands)

Professor Rob Nelissen of EFORT said: “Ultimately, the overall impact of CORE-MD will be to improve the benefit/ risk ratio of new implantable medical devices and other high-risk devices for patients. We aim to see wider adoption of optimal methodologies for clinical investigations by both researchers and manufacturers, fewer approvals with limited evidence, and greater transparency of standards.”

nn Istituto Superiore di Sanita (Italian National Institute of Health, Rome) nn HTA Austria - Austrian Institute for Health Technology Assessment GmbH (Vienna) nn Fundacion Publica Andaluza Progreso y Salud

The CORE-MD consortium includes four European medical professional associations, one European umbrella organisation for patient groups, eight academic institutions, one public body (Region Uppsala), three national regulatory authorities of EU member states, two national public health institutes, two health technology assessment bodies and one trade association for European notified bodies: 1 The Regulation on Medical Devices (EU 2017/745) was published in 2017 and will enter into application from 26 May 2021. http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uriserv:OJ.L_.2017.117.01.0001.01.ENG&toc=OJ:L:2017:117:TOC

(Progress and Health Foundation, Sevilla) nn European Association of Notified Bodies for Medical Devices Funding This project has received funding from the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement No 965246.

Annual Report 2020

27

Outreach

ORTHOPAEDICS TODAY EUROPE

Orthopaedics Today Europe, the official newspaper of EFORT, delivers news on the latest advances in the practice of orthopaedic medicine throughout Europe. It also provides practical, useful and timely coverage of scientific congresses and new surgical techniques.

Orthopaedics Today Europe at a glance (as of 31 December 2020): nn29,058 contacts | 10,365 readers per month | 8 issues in 2020 nn470,751 emails sent in 2020 | 41.1% open rate (5.7% click through) nn386,642 pages views in 2020 | 5,587,292 pages views since creation | 79.2% new visits nnTop ten countries: UK

IT

SP

DE

CH

FR

GR

TR

PT

JP

nn1.22 pages viewed per visit | Users spend 03 min 19 sec per visit (-8 min 59 sec compared to 2019)

28

Annual Report 2020

Outreach

WEBSITE Lenght of visits (in minutes)

90

EFORT Websphere at a glance (as of 31 December 2020): nn853,402 visits in 2020 nnTop five visited pages: • Main homepage www.efort.org (27.2%) • Vienna 2020 homepage https://congress.efort.org (18.1%) • VEC 2020 homepage https://vec.efort.org (17.2%) • Othopaedic Event Calendar https://www.efort.org/orthopaedic-event-calendar (12.1%) • EFORT e-Learning https://www.efort.org/education-and-courses/elearning (6.2%)

Length of visits (in minutes)

80 70 60 50 40 30 20 10 0 1

2

2016

2017

3

Series1

4

2018

Series2

Series3

5

2019

Series4

2020

n less than 3 min. n 3-10 min. n 10-30 min. n over 30 min.

Unique visitors - geographical repartition (in %) Geographical repartition in Europe (in %) North America

Europe

8.9%

55.8%

Geo repartition in Europe 2020

30%

Western Europe

Western Europe

Southern Europe (incl. Iberian Peninsula

27%

Southern Europe

Asia 15.8%

Northern Europe incl. UK - BALTIC

31%

Northern Europe

Eastern Europe

12%

Eastern Europe

0

5

10

15

20

25

30

Visits by age (in %)

MENA

Demographics Visits by age

9.1%

33.9%

Latin America

Africa

Oceania

5.7%

3.1%

1.5%

20.5% 14%

13.9% 10%

Unique visitors (in volume) 300000

240,437

243,462

309,401

}

290,331

7.7%

1 18-24

2 25-34

3 35-44

4 45-54

5 55-64

6 65+

Demographics Visits by Gender

235,627

250000

Visits by gender (in %)

186,244 200000

123,157

150000

Male Female

100000

55.9%

44.1% 50000

0

1 Geneva 2016

2 Vienna 2017

3 Barcelona 2018

4 Lisbon 2019

5 Vienna 2020

VEC 2020

6

Annual Report 2020

29

3

Outreach

SOCIAL MEDIA EFORT has ensured the continuity of its social media presence and the constant growth of its Twitter, Facebook, Instagram, LinkedIn and Youtube channels up to a regular posting.

EFORT’s social media news strategy reflects the development of EFORT products and programmes (EFORT Open Reviews, EFORT Congress, Webinars, Fellowships....). Posting still respects a fair balance between purely scientific content and messages on educational activities of a more promotional and marketing nature.

Referral Tra�ic 2019-2020 Social media channels overview

Clicks by Referrer

TYPE

Fans

1.1K

159.8K

4

0

3

mail.google.com/mail/u/0…

0

2

www.google.com

1

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

4.5K followers 4.5K

Fans

Neutral

Positive

Jul '19

Jan '20

Jan '19

4500

DATE

3500

+40D 10H

Posts

Referral Tra�ic

Clicks byEFORT Referrer

9.9K engagements 148

shares received by content associated with EFORT channel (for the selected timeframe).

3

4

0

3

mail.google.com/mail/u/0…

0

2

www.google.com

1

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

EFORT

841

Positive

Positive

Neutral

Negative

DATE

6k

MESSAGE

0 Jan '20

Jan '21

Jul '20

tweets

Posts Table DATE

3.3K

SHARES

Jul '20

Jan '21

2.1K

engagements

engagements

� Pelvic motion the key to understanding spine–hip interaction https://bit.ly/31o0cjh #Pelvic motion Missed Virtual #EFORT2020 Congress & interested in watching replays? �Access scientific sessions, -477 from 1.3Kacting +2.5 811 -686 from 2.8K 31 0 as a hinge between the #spine and hipsfrom is essential to maintain proper balance during @EFORTnet ePosters, Abstracts & Bioskills@EFORT EveningLab for 45€ �https://vec.efort.org/registration

Oct 20, 13:28

Nov 23, 12:38 bipedalism. Pelvic rotation is recruited as a compensation mechanism when spinal malalignment… #orthopedics #traumasurgery #orthopedicsurgeons #implants #infection #roboticsurgery #facture

Full room @EFORTnet event on #implant & #patientsafety initiative this morning in #Brussels � EFORT is delighted to announce that the Virtual EFORT #Congress 2020 is now live! Plan your ow 1 28 0 organised today Tuesday 21 January 2020 at the Saxony Liaison O�ice Brussels. Lively discussion a�er @EFORTnet #VEC2020: log-in to study the detailed Scientific Programme, Abstracts, ePosters to create your Oct 23, 11:42 views given from #surgeons #patient manufacturers and regulatory perspectives at today's

EFORT

0

Inbound Messages byMar Sentiment Messages Jan '20 Inbound '20 by Sen… Negative Neutral

Positive Positive

Neutral Negative

Inbound Messages by'20Sentiment Inbound Messages

by Sen… May '20 Jul

Negative

Neutral Neutral

Positive

Positive Negative

Tweets Jan '19

Mar '19

Inbound Messages

by Sentiment Jan '21 Sep '20 Nov '20

Negative

Neutral

30

Positive

Negative

4

May '19

Jul '19

Sep 3 '19

Nov '19

Jan '20

20 2 10

1

0

20

1

Jan '20

Mar '20

May '20

0

Jan '20

Jul '20

Sep '20

Mar '20

May '20

0 Nov '20 Jan '20

Jul '20 Jan '21Mar '20

Sep '20

May '20

Nov '20

Jul '20

Jan '

10

Posts Table DATE

82 from 278 � EFORT #Webinar: #Orthopaedic & #Trauma Surgeons in Time of #COVID19 on Monday 06 April at 19:00 CET. �

Apr 02, 15:20

EFORT Posts

COMMENTS

EFORT

2

MESSAGE

EFORT

REACTIONS

Are you practicing Orthopaedics & Trauma surgery outside Europe?

Clicks by Country & �Exploring, solutions has convinced us to create the 1st Virtual # ? �embracing Then this and o�ero�ering is right inventive for @EFORTnet 5 EFORT Congress from 28 to 30Nov October Maymessage '19 Jul- #VEC2020 '19 Sep #VEC20200 '19#EFORT2020 '19 2020. Info77& registration� Jan '20 https://www.efort.org you: watch now this from Prof.

Neyret #Congress President!

Jun 26, 16:27 c #VEC2020 #EFORT2020 #orthopedics #trauma #surgery #surgeons #elearning https://twitter.com/ #elearning #surgeons #education #surgery #trauma #Orthopedics

30

196

3k Jan '20

Jan '21

2

comments from the author of the post

Jan '

� Dual #mobility total #hip #arthroplasty: should everyone get one? http://bit.ly/2QWknQH Hip � All the best to Dr. Selvaratnam & Dr. George who started their EFORT #Robotics Travelling 41 1 #instability following total hip arthroplasty @EFORTnet (THA) remains a major challenge and is one of the main #Fellowship with 1week at the hospital @diakovere �� . � hosts Prof. Windhagen & Dr. Ettinger.

Febmobility 26, 17:37(DM) implants have been introduced to try to overcome t… causes of revision #surgery. Dual #surgeons #orthopaedics #trauma #surgery #orthopedicsurgery #roboticsurgery #doctorslife https

Jan 14, 17:17

4

3

others and private messages). Does not include

Nov '20

� ! We are pleased to #BestPractices to guide our international members. AIOT recommends global #research collaborat 86 1 announce that all the Scientific@EFORTnet Sessions details of the 1st Virtual EFORT Congress are now available to maximize e�iciency & existing networks during #COVID19 to determine impacts of pandemic on Apr 29, 12:58 online. � https://vec.efort.org/scientific-programme EFORT aims to propose an extended and… #orthopaedic & #trauma care worldwide. �key recommendations https://www.efort.org/aiot-joint-

engagements

EFORT

4

Tweets

Jan '20

Sep '20

#Replacement will provide an update on the@EFORTnet latest techniques and treatments for 06 joint replacement specialists Monday April from 19:00-20:30 CET.and � #Free registration: 41 http://bit.ly/2ANy4Jz 0#orthopedics Mar 31, that 12:32awaits you and register now! http://bit.ly/2ST�n3 �… consultants. �Get an overview of the programme #education #surgery #patientcare #patientsafety #covid_19 #CoronavirusPandemic https://twitter.

Jan 21, 13:22

Inbound Messages by Sen…

Neutral

Jul '19

Total#Webinar: #Hip and Total #Knee & #Trauma #Surgeons in Time of #COVID19 will take place next 0On Thursday 1 11 June 2020, the #EFORT2020 Full-Day of advanced concepts � in EFORT #Orthopaedic

Feb 18, 15:19

6

Mar '19

Inbound message by sentiment 0 1 38 from 186

messages received by EFORT (comments, posts by

Annual Report 2020

ow.ly

mail.google.com/mail/u/0…

• Inbound messages by sentiment: sum of inbound

30

8

online.boneandjoint.org.u…

+3.6K from 6.3K posts

• Engagement: sum of reactions, comments and

Jan '19 Oct 06, 14:55

REFERER

online.boneandjoint.org.u…

Jul '20

� Virtual EFORT Congress (VEC) has its #CME Accreditation granted! We areThis pleased to #OpenReviews announce that article the 1stsuggests Virtual intramedullary #nailing with #poller #screws has lower EFORT @EFORTnet 127 with nailing alone1 �https://bit.ly/2 #EFORT2020 Congress was granted of 14 European CME credits (ECMEC) byrates the European Accreditation Council for of #nonunion and coronal malalignment when compared Jul 28, 16:31 Continuing Medical Education (EACCME). During the 3 days of the Congress, the #trauma time you#bone will spend in each of the… uZm #fracture https://twitter.com/EFORTnet/status/1288150209214795776/photo/

Sep 15, 15:48

TYPE

Jan '19 7k

� You have less than a month to send us your #EFORT2021 #Abstract : submission closes on 11 #acetabular orientation, & consequently functional cup #Pelvic rotation can a�ect functional @EFORTnet January 2021, 23:591k CET. � Submit your abstracts now and prepare yourself to have your work positioning if a total #hip #arthroplasty (#THA) is needed. �189 https://bit.ly/31o0cjh3#OpenReviews Oct 20, 13:27 integrated into the 2021 Scientific Programme for the EFORT #Congress.

Be an active part of the… #spine https://twitter.com/EFORTnet/status/13185444344479 #surgery #orthopaedics #orthopedics

Jul '20

EFORT

Posts Engagement

Jan '20

May '20

4k

EFORT

2500 Jan '20

Jan '21

Jul '19

Mar '20

� EFORT #Webinar: #Orthopaedic & #Trauma Surgeons in Time #COVID19 on Monday 06 April&at 19:00 CET. � Areofyou practicing #Orthopaedics #Trauma #surgery outside Europe? � Then this o�er is right for you: watch n @EFORTnet 5,625 14 #EFORT2020 1 Scientific #Programme & Faculty, see what to expect: • Lessons learned in one of Prof. the most critical areas Claudio this message from Neyret - #VEC2020 #Congress President! https://youtu.be/dNCA1LAkyhs Oct 06, 13:05 Castelli, Bergamo, #Italy • Reorganized O&T in a tertiary #hospital Enrique Gómez Barrena, Madrid, #Spain#trauma • How t… #elearning #surgeons #education #Orthopedics 5k#surgery

Dec 17, 17:51

Sep 23, 13:31

time spent watching since account creation

Jan '19

Jan '20

Tweets Table

EFORT

3000

Jul '20

+1.6K from 5.1K

Followers

2k

Apr 02, 15:20

2k

followers from 5.1K 1.6K

Followers

MESSAGE EFORT

4000

6.6K followers 6.6K

Negative

3k

4k

0 Jan '20

2.7K followers 2.7K

+2K from 722

1

Jan '20 0

Jul '19

1

followers 2K from 722

2

Posts Table

+29.9K from 130.9K

1Y 78D 11H

Positive

3

5000

6k

views

Time views

Neutral 4

+654 from 3.9K

Followers

Inbound Messages by Sentiment

Negative

Followers

1

Followers

1

followers from 3.9K 654

+710 from 4.1K.

Jan '19

0

0

ow.ly

Inbound Messages by Sen…

from 4.1K 710fans

+292 from 804

Videos views

3

online.boneandjoint.org.u…

mail.google.com/mail/u/0…

Followers

subscribers

online.boneandjoint.org.u…

Followers

4.8K fans 4.8K

Subscribers

Clicks by Country

REFERER

0

efortnet Scientific #Programme & Faculty, seeJan what areas Claudio '20to expect: • Lessons learned Mar '20in one of the most critical May '20 16, 16:38 Castelli, Bergamo, #Italy • Reorganized O&T in a tertiary #hospital Enrique Gómez Barrena, Madrid, #SpainApr • How t… � You have less than a month to send us your #EFORT2021 #Abstract : submission closes on 11

Posts

REACTIONS MESSAGE

Jul '20

COMMENTS

SHARES

� Management of #multiligament #knee injuries https://bit.ly/2xrnIjE Multiligament knee injuries (M 5,625injuries. They Sep 14 108 '20 Nov '20 '21 are defined as injuries to at least two of the four majorJan ligaments in the knee: anterio posterior cruciate ligament, lateral collateral ligament (and posterolateral corner) and medial colla

Injuries sustained in motorcycle collisions can be organized into distinct patterns to improve recog

TYPE

REFERER

online.boneandjoint.org.u…

3

4

online.boneandjoint.org.u…

0

3

mail.google.com/mail/u/0…

0

2

www.google.com

1

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

online.boneandjoint.org.u…

0

1

mail.google.com/mail/u/0…

0

1

Outreach

Positive

DATE

Inbound Messages by Sentiment

Negative

Tweets Table

1

1

Inbound Messages by Sen… Neutral

0

ow.ly

Neutral

Positive

Negative

4

MESSAGE @EFORTnet Oct 06, 13:05

RETWEETS

REPLIES

LIKES

Are you practicing #Orthopaedics & #Trauma #surgery outside Europe? � Then this o�er is right for you: watch now 3 this message from Prof. Neyret - #VEC2020 #Congress President! https://youtu.be/dNCA1LAkyhs #EFORT2020 #elearning #surgeons #education #surgery #trauma #Orthopedics

11

1

30

2 can a�ect functional #acetabular orientation, & consequently functional cup #Pelvic rotation positioning if a total #hip #arthroplasty (#THA) is needed. � https://bit.ly/31o0cjh #OpenReviews #surgery #orthopaedics #orthopedics #spine https://twitter.com/EFORTnet/status/131854443444799…

5

0

15

@EFORTnet Oct 20, 13:27

1

This EFORT #OpenReviews article suggests intramedullary #nailing with #poller #screws has lower rates of #nonunion and coronal malalignment when compared with nailing alone �https://bit.ly/2Veg uZm #trauma #bone #fracture https://twitter.com/EFORTnet/status/1288150209214795776/photo/1

@EFORTnet Jul 28, 16:31

0

Jan '20

Mar '20

May '20

Jul '20

#BestPractices to guide our international members. AIOT recommends global #research collaboration to maximize e�iciency & existing networks during #COVID19 to determine impacts of pandemic on #orthopaedic & #trauma care worldwide. �key recommendations https://www.efort.org/aiot-joint-s…

@EFORTnet Apr 29, 12:58

Posts Table

2020 channels: Topembracing 5 postsandbyo�ering Reactions �Exploring, inventive solutions has convinced us to create the 1st Virtual DATE Social media MESSAGE @EFORTnet Jun 26, 16:27

EFORT

Apr 02, 15:20

@EFORTnet Mar 31, 12:32

EFORT

Dec 17, 17:51

@EFORTnet Feb 26, 17:37

EFORT

Sep 23, 13:31

@EFORTnet Nov 23, 12:38 EFORT

Sep 15, 15:48

EFORT Congress #VEC20200 from 28 to 30 October 2020. Info & registration� https://www.efort.org/ve � EFORT #Webinar: #Orthopaedic & #Trauma Surgeons in Time of #COVID19 on Monday 06 https://twitter.com/E… April at 19:00 CET. � c #VEC2020 #EFORT2020 #orthopedics #trauma #surgery #surgeons #elearning Scientific #Programme & Faculty, see what to expect: • Lessons learned in one of the most critical areas Claudio Castelli, Bergamo, #Italy • Reorganized O&T in a& tertiary #hospital Enrique Gómez Barrena,will Madrid, #Spain • How t… � EFORT #Webinar: #Orthopaedic #Trauma #Surgeons in Time of #COVID19 take place next Monday 06 April from 19:00-20:30 CET. � #Free registration: http://bit.ly/2ANy4Jz #orthopedics � You have#surgery less than#patientcare a month to send us your #EFORT2021 #Abstract : submissionhttps://twitter.co… closes on 11 #education #patientsafety #covid_19 #CoronavirusPandemic January 2021, 23:59 CET. ��Submit your abstracts now and prepare yourself to have your work integrated into 2021 Scientific&Programme for the EFORT #Congress.

Be an active part of the… � All the best tothe Dr. Selvaratnam Dr. George who started their EFORT #Robotics Travelling

Positive

EFORT @EFORTnet Feb 18, 15:19 Oct 06, 13:05

EFORT @EFORTnet Jan 14, 17:17 Oct 20, 13:27

Negative

Neutral

Positive

Negative

0

12

Nov '20

5

REACTIONS

Jan '21

0

108

0

189

11

3

1

2

1

127

11

1

1

14

1

86

10

1

3

11

1

77

On Thursday 11 June 2020,4the #EFORT2020 Full-Day of advanced concepts in Total #Hip and Total #Knee Are you practicing & #Trauma outside Europe? � Then this o�erreplacement is right for you: watch now #Replacement will#Orthopaedics provide an update on the #surgery latest techniques and treatments for joint specialists and this message�Get from Prof.

Neyret -of #VEC2020 #Congress President! https://youtu.be/dNCA1LAkyhs #EFORT2020 consultants. an overview the programme that awaits you and register now! http://bit.ly/2ST�n3 �… #elearning #surgeons #education #surgery #trauma #Orthopedics 3 total #hip #arthroplasty: should everyone get one? http://bit.ly/2QWknQH Hip � Dual #mobility #Pelvic rotation can a�ect #acetabular & consequently functional cup #instability following totalfunctional hip arthroplasty (THA)orientation, remains a major challenge and is one of the main � https://bit.ly/31o0cjh positioning if a total #hip #arthroplasty (#THA) needed.have causes of revision #surgery.

Dual mobility (DM)isimplants been introduced to#OpenReviews try to overcome t… #surgery #orthopaedics #orthopedics #spine https://twitter.com/EFORTnet/status/131854443444799…

SHARES 11

14

10

RETWEETS

12

COMMENTS 0

4

5,625

#Fellowship with 1week at the hospital @diakovere �� . � hosts Prof. Windhagen & Dr. Ettinger. � Virtual EFORT Congress (VEC) has its #CME Accreditation granted! We are pleased to announce that the 1st Virtual #surgeons #orthopaedics #trauma #surgery #orthopedicsurgery #roboticsurgery #doctorslife https:/… #EFORT2020 Congress was granted of 14 European CME credits (ECMEC) by the European Accreditation Council for Continuing Medical Education (EACCME). During the 3 days of the Congress, the time you will spend in each of the…

Missed Virtual #EFORT2020 Congress & interested in watching replays? �Access scientific sessions, ePosters, Abstracts & Bioskills@EFORT EveningLab for 45€ �https://vec.efort.org/registration � ! We are pleased to #orthopedics #traumasurgery #implants #infection #roboticsurgery announce that all the Scientific#orthopedicsurgeons Sessions details of the 1st Virtual EFORT Congress are now#factures available…

online. � https://vec.efort.org/scientific-programme EFORT aims to propose an extended and… � EFORT is delighted to announce that the Virtual EFORT #Congress 2020 is now live! Plan your own @EFORTnet #VEC2020: log-in to study the detailed Scientific Programme, Abstracts, Are you practicing Orthopaedics & Trauma surgery outside Europe?ePosters to create your Oct 23, 11:42 EFORT Table # & ? � Then this o�er is right for Tweets Oct 06, 14:55 Messages by you: watch now this message from Prof. Neyretby - #VEC2020 #Congress President! #EFORT2020 Inbound Sen… Inbound Messages Sentiment DATE MESSAGE #elearning #surgeons #education #surgery #trauma #Orthopedics Neutral

5 Sep '20

10

5

REPLIES

3 LIKES

41 11

0 1

30

8

41

5

1 0

10 15

5

0 0

12

5

0 0

4

0

2

� Pelvic motion the key to understanding spine–hip interaction https://bit.ly/31o0cjh #Pelvic motion This EFORT #OpenReviews article suggests intramedullary #nailing withproper #poller #screwsduring has lower acting as a hinge between the #spine and hips is essential to maintain balance rates of #nonunion and coronal malalignment when compared with nailing bipedalism.

Pelvic rotation is recruited as a compensation mechanism whenalone spinal�https://bit.ly/2Veg malalignment…

1 uZm #trauma #bone #fracture https://twitter.com/EFORTnet/status/1288150209214795776/photo/1

EFORT @EFORTnet Oct 20, 13:28 Jul 28, 16:31

Full room @EFORTnet event on #implant & #patientsafety initiative this morning in #Brussels #BestPractices toTuesday guide our AIOT Liaison recommends global #research collaboration organised today 21international January 2020members. at the Saxony O�ice Brussels.

Lively discussion a�er 0 to maximize e�iciency & existing networks during #COVID19 to determine impacts ofatpandemic views given from #surgeons #patient manufacturers and regulatory perspectives today's on Jan '20 care worldwide.

Mar�key '20 recommendations May '20 Jul '20 #orthopaedic & #trauma https://www.efort.org/aiot-joint-s…

EFORT @EFORTnet Jan 21, 13:22 Apr 29, 12:58

Inbound Messages by Sen… Inbound Messages by Sentiment �Exploring, embracing and o�ering inventive solutions has convinced us to create the 1st Virtual Posts Table Negative EFORT Congress Positive #VEC20200Neutral from 28 toNegative 30 October 2020. Info & registration� https://www.efort.org/ve

31

28 Sep '20

Positive Neutral @EFORTnet Jun 26, 16:27

DATE

MESSAGE

@EFORTnet efortnet Mar 31, 12:32 Apr 16, 16:38

@EFORTnet efortnet Feb 26, 17:37 Nov 24, 12:27

@EFORTnet efortnet Nov 23, 12:38 Jul 28, 16:30

30 c #VEC2020 #EFORT2020 #orthopedics #trauma #surgery #surgeons #elearning https://twitter.com/E…

LIKES

11 5

��All the best to Dr. Selvaratnam & Dr. George who started their EFORT #Robotics Travelling Injuries sustained in motorcycle collisions can be organized into distinct patterns to improve recognition and treatment. #Fellowship with 1week at the hospital @diakovere �� . � hosts Prof. Windhagen & Dr. Ettinger.

Lowside, highside, topside, and collision are the four main categories of motorcycle crash types. Within those four crash #surgeons #orthopaedics #trauma #surgery #orthopedicsurgery #roboticsurgery #doctorslife https:/… types, mechanisms of injury include head-leading collisions, direct vertical impact, motorcycle #radius, motorcycle…

10

1

1 72

11 2

Missed Virtual #EFORT2020 Congress & interested in watching replays? �Access scientific sessions, � Systematic review on the outcomes of #poller #screw augmentation in intramedullary #nailing of long #bone #fracture ePosters, Abstracts & Bioskills@EFORT EveningLab for 45€ �https://vec.efort.org/registration https://bit.ly/2VeguZm Various technical tips have been described on the placement of poller screws during #orthopedics #traumasurgery #orthopedicsurgeons #implants #infection #roboticsurgery #factures … intramedullary (IM) nailing; however studies reporting outcomes are limited. Overall there is no consistent conclusion…

1

1 71

10 4

Positive efortnet

Negative

Nov 17, 16:36

efortnet Jun 07, 16:57

efortnet Oct 08, 12:44

Nov '20

Jan '21

1 67

10 3

� Register now for the free EFORT #Webinar on Rotator Cu� Repair: When And How? taking place Monday 30 November Neutral Positive Negative 2020, 19:00 to 20:00 CET. The learning objectives of this #EOTEP webinar are: • Focus on most relevant treatment options of 4 #rotatorcu� tears. • Understanding of the new concept of rotator cu� #tendon healing. • Updating on new surgical…

62

0

Tomorrow, on Monday 08 June 2020 at 19:00 CET! � EFORT #Webinar: Non-Infected #Painful Total Hip #Arthroplasty It is 3 still time to register! � Resources, info & #free registration: www.efort.org/elearning Get ready and check from e-Science (or the EFORT e-learning page) the following #video #resources, recorded from former EFORT Congresses, such as: � No…

60

3

� Discoid #meniscus: current concepts https://bit.ly/30p4RBc Discoid meniscus is the most frequent congenital 2 #malformation of the menisci, and primarily a�ects the lateral meniscus; it is highly prevalent in the Asian population. The anatomic, vascular, and ultrastructural features of the discoid meniscus make it susceptible to complex tears. Discoid…

58

0

57

0

Inbound Messages by Sen… Neutral

11

0 151

3

2

COMMENTS

10

Jan '20 MarVirtual '20 May '20 Julyour '20 own Sep '20 ��EFORT is delighted to announce that the EFORT #Congress 2020 is now live! Plan � Freddie H. Fu, MD, DSc(Hon, DPs(Hon) from the UPMC Sports Medicine Centre in Pittsburgh, Pennsylvania, USA, is one of #VEC2020: log-in to study the detailed Scientific Programme, Abstracts, ePosters to create your the most prominent figures in sports medicine, physical therapy and mechanical engineering for sports. He has a little something to tell you about the Virtual EFORT Congress (28-30 October 2020)! Have a look! � https://vec.efort.org for…

Oct 23, 11:42 Oct 22, 19:41

12

Jan '21

� EFORT #Webinar: #Orthopaedic & #Trauma #Surgeons in Time of #COVID19 will take place next � Management of #multiligament #knee injuries https://bit.ly/2xrnIjE Multiligament knee injuries (MLKI) are devastating Monday 06 April from 19:00-20:30 CET. � #Free registration: http://bit.ly/2ANy4Jz #orthopedics injuries. They are defined as injuries to at least two of the four major ligaments in the knee: anterior cruciate #ligament, #education #surgery #patientcare #patientsafety #covid_19 #CoronavirusPandemic https://twitter.co…

20 posterior cruciate ligament, lateral collateral ligament (and posterolateral corner) and medial collateral ligament (and…

0

@EFORTnet efortnet

Nov '20

7

Inbound Messages by Sentiment

1

� Full Day On Total Hip And Total Knee Replacement (TKR-THR) during the Virtual EFORT Congress 2020. A panel of recognised European experts with an in-depth experience in total hip and knee replacement will share their knowledge on of key issues with a focus on day-to-day practice in both primary and revision surgery. The…

efortnet Sep 14, 19:41

0

Posts Table DATE

Jan '20

Mar '20

May '20

Jul '20

Sep '20

� Pelvic motion the key to understanding spine–hip interaction https://bit.ly/31o0cjh #Pelvic motion acting as a hinge between the #spine and hips is essential to maintain proper balance during bipedalism Pelvic rotation is recruited as a

efortnet

MESSAGE efortnet Apr 16, 16:38

efortnet

Nov '20

Jan '21

56

LIKES � Management of #multiligament #knee injuries https://bit.ly/2xrnIjE Multiligament knee injuries (MLKI) are devastating injuries. They are defined as injuries to at least two of the four major ligaments in the knee: anterior cruciate #ligament, posterior cruciate ligament, lateral collateral ligament (and posterolateral corner) and medial collateral ligament (and…

Injuries sustained in motorcycle collisions can be organized into distinct patterns to improve recognition and treatment.

Lowside, highside, topside, and collision are the four main categories of motorcycle crash types. Within those four crash

0

COMMENTS

151

5

72

2

Annual Report 2020

31

Financial statements

AUDITOR‘S REPORT

Report of the statutory auditor to the General Assembly of EFORT Rolle Report of the statutory auditor on the financial statements As statutory auditor, we have audited the financial statements of EFORT, which comprise the income statement, balance sheet statement, cash flow statement, changes in restricted funds and general funds statement and notes (notes 1 to 7.7), for the year ended 31 December 2020. As permitted by Swiss GAAP FER 21 the information in the performance report is not required to be subject to audit.

Executive Board’s responsibility The Executive Board is responsible for the preparation of the financial statements in accordance with Swiss GAAP FER, Swiss law and with the articles of the federation. This responsibility includes designing, implementing and maintaining an internal control system relevant to the preparation of financial statements that are free from material misstatement, whether due to fraud or error. The Executive Board is further responsible for selecting and applying appropriate accounting policies and making accounting estimates that are reasonable in the circumstances.

Auditor’s responsibility Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with Swiss law and Swiss Auditing Standards. Those standards require that we plan and perform the audit to obtain reasonable assurance whether the financial statements are free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial statements. The procedures selected depend on the auditor’s judgment, including the assessment of the risks of material misstatement of the financial statements, whether due to fraud or error. In making those risk assessments, the auditor considers the internal control system relevant to the entity’s preparation of the financial statements in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control system. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made, as well as evaluating the overall presentation of the financial statements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

Opinion In our opinion, the financial statements for the year ended 31 December 2020 give a true and fair view of the financial position, the results of operations and the cash flows in accordance with Swiss GAAP FER and comply with Swiss law and with the articles of the federation.

Emphasis of Matter We draw your attention to note 7.7 to these financial statements, which states that the association experienced liquidity issues during the year ended 31 December 2020 and the balance sheet for the year then ended showed negative Funds. This, along with other matters as described in note 7.7, indicates the existence of a material uncertainty which may cast significant doubt about the ability of the federation to continue as a going concern. If it is not possible for the federation to continue as a going concern, the financial statements will need to be prepared on the basis of liquidation values. Our opinion is not qualified in respect of this matter.

32

Annual Report 2020

Financial statements

AUDITOR‘S REPORT

Annual Report 2020

33

Financial statements

INCOME STATEMENT

BALANCE SHEET STATEMENT 2020

2019

CHF

CHF

Membership fees

160,911

198,067

Donations for restricted projects

129,409

144,145

6.1

-

158,700

Annual Congress

5.1

368,079

4,551,731

Post Graduate Training Programme

5.2

-

27,410

01 January to 31 December

notes

Education

Publications Association management Miscellaneous Net revenue

31

143,668

151,426

172,115

13,485

4,998

823,341

5,400,834

2020

2019

notes

CHF

CHF

Cash and cash equivalents

3.1

597,900

1,970,253

Accounts receivable

3.2

106,631

489,289

Other receivables

3.3

110,562

162,883

As of 31 December

Prepaid expenses Total current assets

200,495

140,682

1,015,588

2,763,107

28,119

28,119

Tenant‘s guarantee / deposits

7.1

Leasehold improvements

3.4

-

-

Equipment

3.5

45,607

25,918

Intangible assets

3.6

99,394

121,450

173,120

175,487

1,188,708

2,938,594

109,949

139,277

Total non-current assets

Administration

6.2

575,033

592,499

Executive Committee

6.3

121,830

265,711

Marketing & communication

6.4

337,129

318,182

Publications

6.5

157,368

176,422

Annual Congress

5.1

1,673,724

2,719,813

Post Graduate Training Programme

5.2

94

31,910

Other payables

4.1

54,074

40,816

External affairs

6.6

108,656

114,327

Accruals

4.2

18,497

42,930

Education

6.1

Provision

220,047

226,754

4.3

1,605,235

1,170,881

2,007,802

1,620,658

339,508

752,432

3,313,342

4,971,296

(2,490,001)

429,538

Interest income

67,735

1,135

Interest expense

(540)

(406)

Total operating expenses

Total assets Accounts payable

Deferred revenue Total current liabilities

Operating (loss) / gain

Restricted funds

Foreign exchange loss

(354)

(17,107)

66,841

(16,378)

(2,423,160)

413,160

286,130

-

(2,137,030)

413,160

(69,013)

(47,928)

(2,206,043)

365,232

Financial loss

Total restricted funds General funds

Result before variation of restricted funds Variation of restricted funds Net gain / (loss) 34

1,072,265

707,033 365,232

(1,133,778)

1,072,265

1,188,708

2,938,594

Total liabilities and funds

Release of Italian Withholding Tax provision 3.3

Annual Report 2020 Annual Report 2020

31 May 2021

245,671 245,671

(2,206,043)

Net gain / (loss) Total general funds

Result Before Non-recurring Loss

314,684 314,684

Prof. Dr. Klaus-Peter Günther

Mr. Limb David

EFORT President 2020/2021

EFORT Secretary General

Financial statements

CASH FLOW STATEMENT

As of 31 December

notes

Net gain / (loss) for the year Depreciation

2020

2019

CHF

CHF

(2,206,043)

365,232

41,526

26,946

69,013

47,928

Financial result

(67,195)

(729)

Change in provisions

374,110

127,840

(1,788,589)

567,217

1,841

462,117

Change in restricted funds

Cash flow before change in working capital Changes in operating assets and liabilities: Debtors Deposits Other receivables and prepaid expenses Accounts payable Other payables

-

1,007

(7,492)

253,924

(29,328)

(24,474)

13,258

(437,023)

Accruals

(24,433)

(186,372)

Deferred revenue

434,354

(111,571)

(540)

(405)

(1,400,929)

524,420

(39,159)

(70,544)

67,735

1,134

28,576

(69,410)

(1,372,353)

455,010

1,970,253

1,515,243

597,900

1,970,253

(1,372,353)

455,010

Interests paid Cash flow from operating activities Purchase of equipment

3.5 / 3.6

Interests received Cash flow from investing activities Net change in cash and cash equivalents Balance at 01 January Balance at 31 December Change in cash and cash equivalents

31 May 2021

Prof. Dr. Klaus-Peter Günther

Mr. Limb David

EFORT President 2020/2021

EFORT Secretary General

Annual Report 2020 Annual Report 2020

35

Financial statements

CHANGES IN RESTRICTED FUNDS AND GENERAL FUNDS STATEMENT Opening

Allocation

Revaluation

Utilisation

Transfer

Total Variation

Refund

Closing

65,246

-

(179)

-

-

(179)

-

65,067

24,552

-

2020, CHF Restricted funds Smith & Nephew fellowships Microport fellowships Grünenthal elearning and webinars

(17,733)

-

-

-

-

-

24,552

49

-

-

49

-

(17,684)

Grünenthal data collection

54,422

-

(149)

-

-

(149)

-

54,273

Grünenthal fellowships

27,001

-

-

-

-

-

-

27,001

147

-

-

-

-

-

-

147

23,129

-

(63)

-

-

(63)

-

23,066

5,659

-

(16)

-

-

(16 )

-

5,643

Grünenthal awareness campaign Grünenthal communication activities Medacta educational grant Stryker fellowships

63,248

130,382

(615)

(60,396)

-

69,371

-

132,619

245,671

130,382

(973)

(60,396)

-

69,013

-

314,684

General funds

1,072,265

(2,206,043)

-

-

-

(2,206,043)

-

(1,133,778)

Total general funds

1,072,265 (2,206,043)

-

-

-

(2,206,043)

-

(1,133,778)

Total restricted funds

Closing balance at 31 December 2020

(819,094)

2019, CHF Restricted funds Smith & Nephew fellowships

67,526

Microport fellowships

32,079

-

-

(7,527)

Grünenthal elearning and webinars

11,226

12,946

482

(43,991)

Grünenthal data collection

28,162

32,364

(2,248)

(7,769)

3,913

Grünenthal fellowships

27,001

-

-

-

6,987

-

-

(6,840)

24,762

19,418

(1,363)

-

19,727

712

Grünenthal awareness campaign Grünenthal communication activities Medacta educational grant Stryker fellowship

-

(2,280)

-

-

(2,280)

-

65,246

-

(7,527)

-

24,552

1,604

(28,959)

-

(17,733)

26,260

-

54,422

-

-

-

27,001

-

(6,840)

-

147

(14,171)

(5,517)

(1,633)

-

23,129

(14,780)

-

5,659

-

5,659

-

68,857

(4,470)

(1,139)

-

63,248

-

63,248

197,743

153,312

(9,167)

(96,217)

-

47,928

-

245,671

General funds

707,033

365,232

-

-

-

365,232

-

1,072,265

Total general funds

707,033

365,232

-

-

-

365,232

-

1,072,265

Total restricted funds

Closing balance at 31 December 2019

36

Annual Report 2020

1,317,936

NOTES TO THE FINANCIAL STATEMENTS General information The European Federation of National Associations of Orthopaedics and Traumatology (“EFORT”) is an association located in Rolle, Switzerland.

The aim of the Federation is the promotion of the sciences of orthopaedics and traumatology. To accomplish these objectives, the Federation organises European congresses and training programmes, collaborates with universities and other qualified institutions, stimulates basic and clinical research and undertakes any other activity which might be useful in fulfilling its aims. The funds of the Federation may be used only for the aims outlined above.

In 2020 and in 2019, the Federation employed less than 50 full-time equivalent employees.

1. Summary of significant accounting policies The principal accounting policies applied in the preparation of these financial statements are set out below.

1.1 Accounting principles EFORT prepares its accounts in compliance with the policies described in the following notes.

Accounting policies applied are in compliance with the Swiss GAAP FER (Swiss Accounting and Reporting Recommendations) 21.

As permitted by Swiss GAAP FER 21, the accounts were prepared in compliance with the conceptual framework, the fundamental recommendations and recommendation 21. The accounts also comply with the article 69a of the Swiss Civil Code.

Information required by Swiss GAAP FER 21 on the performance of the Federation, and not disclosed in the financial report, are included in the annual report.

The financial statements have been prepared under the historical cost convention. The income statement is presented using the classification of expenses by function. The statements are based on economic values and present a true and fair view of the Federation’s assets, financial position and results of operations.

1.2 Foreign currency translation a) Functional and presentation currency Items included in the financial statements were measured using the currency of the primary economic environment in which the Federation operates (‘the functional currency’), which is Swiss Francs (“CHF”). The presentation currency is CHF. Annual Report 2020

37

Financial statements

b) Transactions and balances Foreign currency transactions are translated into the functional currency using the exchange rates prevailing at the dates of the transaction. Foreign exchange gains and losses resulting from the settlement of such transactions and from the translation at year-end exchange rates of monetary assets and liabilities denominated in foreign currencies are recognised in the income statement.

Balances in foreign currency are revalued using the exchange rates prevailing at the dates of closing.

2. Principles of valuation 2.1 Cash and cash equivalents Cash and cash equivalents include cash, balances in bank accounts, and short-term time deposits with a residual term of less than three months. They are valued at their nominal value.

2.2 Accounts receivable Accounts receivable are amounts due from parties for services performed in the ordinary course of business. If collection is expected in one year or less (or in the normal operating cycle of the business if longer), they are classified as current assets.

These receivables are valued at their nominal values. Credit default risks are accounted for by specific allowances.

2.3 Property, plant and equipment Property, plant and equipment are valued at purchase cost less any depreciation required by generally accepted accounting principles. Depreciation is charged on a straight-line basis over the useful life of the fixed asset. The assets’ residual values and useful lives are reviewed, and adjusted if appropriate, at the end of each reporting period.

Gains and losses on disposals are determined by comparing the proceeds with the carrying amount and are recognised in the income statement.

The useful lives of assets have been determined as follows: Furniture and Equipment 8 years Computers and hardware 4-5 years Software 4-5 years Leasehold improvements Lease term

38

Annual Report 2020

Financial statements

2.4 Intangible assets Computer software Costs associated with maintaining software programs are recognised as an expense as incurred.

Purchased software are capitalised and amortised on a straight-line basis over a period their estimated useful lives, which does not exceed 4 years.

Internally developed software costs are capitalised only if the following conditions are met: • software are clearly identifiable; • costs are reliably determinable; • the group has sufficient resources to complete their development; • software brings measurable benefits to the group over the course of several years.

The amortisation of internally developed software starts when the asset is ready for use.

2.5 Impairment of assets The value of non-current assets is assessed on the balance sheet date for signs of impairment. If there is evidence of any lasting reduction in value, the realisable value is calculated (impairment test). If the book value exceeds the realisable value, the difference is recognised in profit and loss as unscheduled depreciation.

2.6 Provisions Provisions are recognised if an event in the past gives rise to a justified, likely obligation which is of uncertain timing or amount, but which can be estimated reliably. Provisions are measured on the basis of the estimated amount of money required to satisfy the obligation.

2.7 Trade payables and other liabilities Trade payables are obligations to pay for goods or services that have been acquired in the ordinary course of business from suppliers. Accounts payable are classified as current liabilities if payment is due within one year or less. If not, they are presented as non-current liabilities.

Trade payables and other liabilities are stated at their nominal values.

2.8 Employee benefits Wages, salaries, social contributions, paid annual leave, sick leave and other benefits are paid or accrued undiscounted in the year in which the associated services are rendered by employees of the group. Legal or constructive obligations such as bonus are recognised for the amount expected to be paid in the year the services are provided.

Annual Report 2020

39

Financial statements

EFORT is a member of a collective occupational pension that fully insures the risks with an Insurance Company. This pension scheme is financed by employer and employee contributions.

The economic impact of existing pension schemes on the group is reviewed each year and the related economic benefit or liability recognised. The employer contribution reserves available are recognised as assets. Changes in employer contribution reserves and stated changes in economic impact arising from excess/insufficient cover for pension schemes are recognised in the income statement under personnel expenses.

2.9 Exceptional items Exceptional items are disclosed separately in the financial statements where it is necessary to do so to provide further understanding of the financial performance. They are material items of income or expense that have been shown separately due to the significance of their nature or amount.

2.10 Revenue recognition Revenue is recognised when the services are rendered, if the amounts can be measured reliably and if it is probable that the Federation will receive future economic benefits.

The main revenue streams of the Federation are Membership fees, Annual Congress income, donations and grants for specific projects.

Membership fees are recognised in the accounting period they relate to.

Annual Congress revenue is composed of registration fees and sponsorship income.

Revenue from sponsorship and registration fees are recognised in the period when the services are rendered. Sponsorship invoiced in advance are deferred in the balance sheet.

Grants and Donations received for restricted projects are recognised as an income when expenses are incurred. If they are not used or partially used during the financial year, the unused amounts are recorded in restricted funds. When used in subsequent years, the restricted funds are reduced accordingly. These movements are captured by the variation of restricted funds in the income statement.

2.11 Leasing Leases in which a significant portion of the risks and rewards of ownership are retained by the lessor are classified as operating leases. Payments made under operating leases (net of any incentives received from the lessor) are charged to the income statement on a straight-line basis over the period of the lease.

40

Annual Report 2020

Financial statements

The Federation leases certain property, plant and equipment. Leases of property, plant and equipment where the Federation has substantially all the risks and rewards of ownership are classified as finance leases. Finance leases are capitalised at the lease’s commencement at the lower of the fair value of the leased property and the present value of the minimum lease payments.

Each lease payment is allocated between the liability and finance charges. The corresponding rental obligations, net of finance charges, are included in the Finance Lease Liabilities. The interest element of the finance cost is charged to the income statement over the lease period so as to produce a constant periodic rate of interest on the remaining balance of the liability for each period. The property, plant and equipment acquired under finance leases is depreciated over the shorter of the useful life of the asset and the lease term rebates and excluding taxes and value-added taxes.

3.1 Cash and cash equivalents 2020

2019

CHF

CHF

Petty cash

6,245

5,641

BCV, Switzerland, CHF account

8,224

8,457

UBS, Switzerland, EUR account

57,931

15,990

UBS, Switzerland, CHF account

54,098

-

UBS, Switzerland, CHF account

49,773

1,156,973

404,090

766,843

17,539

16,349

597,900

1,970,253

2020

2019

Raiffeisen, Switzerland, EUR account Santander, Spain, EUR account Total cash and cash equivalents

3.2 Accounts receivable

Receivables from third parties Receivables from related parties

CHF

CHF

476,834

485,483

13,060

6,252

Bad debt provision

(383,263)

(2,446)

Total accounts receivable

106,631

489,289

Annual Report 2020

41

Financial statements

3.3 Other receivables 2020 Withholding tax Italy

2019

CHF

CHF

-

257,827

-

(257,827)

5,705

6,189

Other receivables from third parties

104,857

54,364

Total other receivables

110,562

162,883

Withholding tax Italy provision Receivable from payroll insurance

O.I.C. srl (“OIC”) handled the organisation of the annual congress from 2006 to 2011. OIC deducted withholding taxes on Event income by 27.5% for the fiscal year 2006 (for a total amount of CHF 374 thousands) and only 5% for the following years (for a total amount of CHF 546 thousands).

EFORT filed two separate claims of reimbursements for the tax withheld in 2006 of 22.5% and 5% respectively. As Italian Tax Authorities rejected EFORT’s claims, both parties entered into two litigations: 1. Withholding tax of 22.5% - CHF 290 thousands: in this litigation, EFORT lost in first instance, while gained in second instance. In March 2016, EFORT filed defensive memorials with the “Corte Suprema di Cassazione” (Supreme Court). On 27 March 2019, the Supreme Court confirmed that EFORT was entitled to a full refund and ordered the Italian Tax Authorities to proceed with the payment of the withholding taxes and associated legal costs. The payment occurred in May 2020.

2. Withhodling tax of 5% - CHF 83 thousands: the Court did not accept EFORT’s request of reimbursement in both first and second instance. As a consequence, the judgement became final.

In addition, EFORT had not presented other claims of reimbursement for the tax of 5% withheld from 2007 to 2011. Considering the legal limit of 48 months to claim the reimbursement, EFORT wrote-off CHF 630 thousands in 2013, corresponding to the years 2007 to 2011, for CHF 547 thousands, and to the second litigation on the 5% of withholding tax in 2006, for CHF 83 thousands.

The provision amounting to CHF 257 thousands at 31 December 2019 was reversed in 2020 following on the payment from the Italian Tax Authorities. This generated an exceptional income for CHF 286 thousands which relate to the reimbursement of the tax, reimbursement of the legal fees and the release of the litigation provision.

42

Annual Report 2020

Financial statements

3.4 Leasehold improvements Office 2020

Conference rooms

Total

CHF

CHF

CHF

Purchase value at 01 January 2020 As at 31 December 2020

448,661 448,661

169,607 169,607

618,268 618,268

Accumulated depreciation at 01 January 2020 Depreciation As at 31 December 2020

448,661 448,661

169,607 169,607

618,268 618,268

Net book value at 31 December 2020

-

-

-

Thereof leased assets

-

-

-

Purchase value at 01 January 2019 As at 31 December 2019

448,661 448,661

169,607 169,607

618,268 618,268

Accumulated depreciation at 01 January 2019 Depreciation As at 31 December 2019

448,661 448,661

169,578 29 169,607

618,239 29 618,268

Net book value at 31 December 2019

-

-

-

Thereof leased assets

-

-

-

Furniture / Equipment

Hardware

Total

CHF

CHF

CHF

Purchase value at 01 January 2020 Additions Disposals As at 31 December 2020

16,998 490 17,488

55,461 31,840 87,301

72,459 32,330 104,789

Accumulated depreciation at 01 January 2020 Depreciation Disposals As at 31 December 2020

12,216 2,174 14,390

34,325 10,467 44,792

46,541 12,641 59,182

Net book value at 31 December 2020

3,098

42,509

45,607

Thereof leased assets

3,098

-

3,098

2019

3.5 Equipment

2020

Annual Report 2020

43

Financial statements

Furniture / Equipment

Hardware

Total

CHF

CHF

CHF

Purchase value at 01 January 2019 Additions Disposals As at 31 December 2019

16,998 16,998

78,302 7,348 (30,189) 55,461

95,300 7,348 (30,189) 72,459

Accumulated depreciation at 01 January 2019 Depreciation Disposals As at 31 December 2019

10,093 2,123 12,216

57,796 6,718 (30,189) 34,325

67,889 8,841 (30,189) 46,541

Net book value at 31 December 2019

4,782

21,136

25,918

Thereof leased assets

4,782

-

4,782

Software

Total

2019

3.6 Intangible assets 2020

CHF

CHF

179,048 6,829 185,877

179,048 6,829 185,877

Accumulated depreciation at 01 January 2020 Depreciation Disposals As at 31 December 2020

57,598 28,885 86,483

57,598 28,885 86,483

Net book value at 31 December 2020

99,394

99,394

Software

Total

CHF

CHF

Purchase value at 01 January 2019 Additions Disposals As at 31 December 2019

289,061 63,196 (173,209) 179,048

289,061 63,196 (173,209) 179,048

Accumulated depreciation 01 January 2019 Depreciation Disposals As at 31 December 2019

212,731 18,076 (173,209) 57,598

212,731 18,076 (173,209) 57,598

121,450

121,450

Purchase value at 01 January 2020 Additions Disposals As at 31 December 2020

2019

Net book value at 31 December 2019

44

Annual Report 2020

Financial statements

4.1 Other payables 2020 Social security and payroll taxes VAT payable Total other payables

2019

CHF

CHF

54,073

40,815

1

1

54,074

40,816

2020

2019

CHF

CHF

4.2 Accruals

-

23,000

Other accruals

18,497

19,930

Total accruals

18,497

42,930

2020

2019

Legal fees

4.3 Deferred Revenue

Congress sponsorship deferred revenue Total deferred revenue

CHF

CHF

1,605,235

1,170,881

1,605,235

1,170,881

The deferred revenue at 31 December 2020 corresponds to the sponsoring of Vienna 2020 annual congress which was cancelled. EFORT will complete its obligation in 2021 through the offer of various services and products to the sponsors, resulting in a full recognition of the revenue.

4.4 Provision Tax provision

Employees related

Total

Opening balance at 01 January 2020 Additions Usage

136,709 -

90,045 83,338 (90,045)

90,045 220,047 (90,045)

Closing balance at 31 December 2020

136,709

83,338

220,047

Tax provision

Employees related

Total

Opening balance at 01 January 2019 Additions Usage

136,709 -

71,185 90,045 (71,185)

71,185 226,754 (71,185)

Closing balance at 31 December 2019

136,709

90,045

226,754

2020, CHF

2019, CHF

Annual Report 2020

45

Financial statements

The provisions are for overtime and unused vacation of the staff.

In 2019, an additional provision has been accrued for CHF 136,709 regarding a tax risk for VAT. At 31 December 2020, the risk is still considered as more likely than not and therefore the provision was maintained.

5.1 Annual Congress 2020

2019

Congress

Income

Expenses

Income

Expenses

Vienna 2017 Barcelona 2018 Lisbon 2019 Vienna 2020 and Virtual Congress 2020 Virtual Congress 2021 Lisbon 2022 Congress 2023 Others (Committees) Staff costs

368,079 -

33,218 1,171,527 4,716 538 538 1,933 461,254

4,551,731 -

2,851 2,157,348 81,852 6,144 471,618

368,079

1,673,724

4,551,731

2,719,813

Total in CHF

5.2 Post Graduate Training Programme 2020 Course

46

Annual Report 2020

2019

Income

Expenses

Income

Expenses

FOrTE Summerschool ExMex 2017 Others Staff costs

-

94 -

27,410 -

1,537 556 16,404 13,413

Total in CHF

-

94

27,410

31,910

Financial statements

6.1 Education 2020 EBOT Fora Trauma Group Visiting Fellowships Travelling Fellowships e-Learning project Speciality Societies Committee Education General Staff costs

2019

Income

Expenses

Income

Expenses

-

18,375 427 52,514 989 51,183 8,837 1,000 206,183

146,098 12,602 -

157,342 13,067 10,186 7,653 9,929 38,940 5,262 60,832 449,221

-

339,508

158,700

752,432

Use of restricted funds

60,396

-

73,668

-

Adjusted total in CHF

60,396

339,508

232,368

752,432

Total in CHF

6.2 Administration

Rent and utilities Telephony and postage

2020

2019

CHF

CHF

148,484

151,803

24,234

26,709

Depreciation

2,125

560

Legal fees

2,235

28,714

Audit and accounting fees

145,332

135,560

Staff costs

202,445

185,888

50,178

63,265

575,033

592,499

Other expenses Total administration

Annual Report 2020

47

Financial statements

6.3 Executive Committee 2020

2019

CHF

CHF

-

20,524

Travel expenses

17,899

110,142

Staff costs

86,345

114,214

Other expenses

17,586

20,831

121,830

265,711

2020

2019

Secretary

Total Executive Committee

6.4 Marketing & Communication CHF

CHF

3,372

7,254

Service & support

15,539

12,364

Portal EFORT net and Public website

43,691

30,010

Depreciation

33,453

25,804

174,357

178,778

66,717

63,972

337,129

318,182

2020

2019

CHF

CHF

141,765

149,278

15,584

26,579

19

565

157,368

176,422

CRM database

Staff costs Other expenses Total Marketing & Communication 6.5 Publications

EFORT Open Reviews Staff costs Other expenses Total Publications

48

Annual Report 2020

Financial statements

6.6 External Affairs 2020

2019

Income

Expenses

Income

Expenses

Industry Relationship EUCOMED European Activities Specialty Societies NORE Staff costs

-

359 30,435 1,000 76,862

-

13,449 108 28,982 7,675 854 63,259

Total in CHF

-

108,656

-

114,327

Use of restricted funds

-

-

7,769

-

Adjusted total in CHF

-

108,656

7,769

114,327

7.1 Pledged assets The rent of the Rolle offices is guaranteed by a deposit with the UBS for CHF 28,119 (2019: CHF 28,119).

7.2 Pension Fund The position with the pension fund at the end of the year was a payable of CHF 35,041 (2019: CHF 36,811). The pension fund is fully insured with an insurance company. The capital ratio is therefore 100%.

7.3 Benefits to the Executive Committees and to the Management Indemnities to cover secretarial expenses and paid to the Members of the Executive Committee amounted to CHF 0 (2019: CHF 20,524). From June 2019, the Executive Committee decided to terminate the payment of secretarial fees. For 2019, the amounts are transferred from the main bank account to another bank account considered as a reserve bank account.

These secretarial expenses exclude reimbursements by EFORT of the effective costs incurred by the Members of the Executive Board and other Committees in the normal course of their functions.

As permitted by Swiss GAAP FER 21, benefits paid to management are not disclosed.

7.4 Personnel For the year 2020, total personnel costs amounted to CHF 1,224,264 (2019: CHF 1,502,970).

7.5 Transactions with related parties Receivables and payables to related parties were disclosed in the relevant notes. Transactions with related parties other than salary and indemnities are disclosed below.

The EFORT Foundation was invoiced for CHF 13,052 (2019: CHF 13,320), net of VAT, by EFORT for administration services.

Annual Report 2020

49

Financial statements

7.6 Lease commitments EFORT entered into operational lease and rental agreements. The future payment commitments are: 2020

2019

CHF

CHF

7,140

7,140

Printer Due within one year Due between one to five years Total printer

-

7,140

7,140

14,280

119,820

119,820

Office rent Due within one year Due between one to five years

199,700

319,520

Total office rental

319,520

439,340

Total Lease and Rental Commitments

326,660

453,620

7.7 Subsequent events Due to the pandemic situation caused by the Covid-19, the Board of EFORT decided once more not to hold the annual congress in its original format that was planned to take place in Vienna, Austria. The decision was rendered public on 20 January 2021 through an official statement posted on the usual communication channels such as the website of EFORT, personalised mailings, news bulletins and social media.

Similarly to 2020, a virtual congress will take place from 30 June to 02 July 2021.

The association incurred liquidity constraints, which may cast significant doubt and uncertainty about the ability of EFORT to continue as a goinq concern. However the Board is confident that despite the absence of the annual congress in its original format for two consecutive years the financial situation is sustainable for the following reasons: • EFORT has proposed to its industry partners several products and services that will enable EFORT to recognise in 2021 the majority of the sponsoring income collected for the 2020 annual congress.

• In March 2021, EFORT was granted a hardship subsidy of CHF 600,085 from the Canton of Vaud covering the period 01 January to 31 December 2020. EFORT is eligible for another subsidy of CHF 149,915 for the period 01 January to 31 March 2021. This application is in progress.

• EFORT continues to benefit from reduced working time indemnities from the Canton of Vaud.

50

Annual Report 2020

• EFORT has implemented various measures to reduce its fixed expenses and improve its cash flows.

• EFORT developed several scenarios of cash flow projections to verify its financial sustainability. The more realistic scenarios, although based on conservative assumptions, demonstrate that EFORT is able to maintain positive cash flows for at least the next 12 months.

• Additional financing possibilities are being investigated to provide more flexibility to EFORT. The main measure considered is a cash advance by a financial institution.

The pandemic is still a source of significant uncertainties that can change assumptions and variables used by the Board to assess the financial situation of EFORT. Nevertheless, the Board is confident that adequate measures have been taken. The financial statements have therefore been prepared based on the going concern principle.

NOTES

Annual Report 2020

51

Acknowledgement & Disclosure

ACKNOWLEDGEMENT EFORT would like to thank the following companies for their support towards advancing the mission & vision of EFORT and collaborating within the following educational programmes.

EFORT Annual Congress: nnaap Joints Gmbh (Youshimed); Adler Ortho Spa; Aerobotix Inc; Albomed GmbH; Alsanza Medizintechnic und Pharma GmbH; Amplitude SAS; AO Foundation; Astrolabe Medical; B Braun Aesculap; Bauerfeind AG; Beijing AK Medical Co Ltd; Beijing Fule Science & Technology Dev. Co Ltd; Beijing ZKSK Technology Cop Ltd; Bonalive Biomaterials; Bone & Joint Publishing; BPB Medica; Brainlab; Bricon GmbH; Canwell Medical Co Ltd; Ceramed SA; Ceramisys; Chm sp z.o.o.; Ceramtec GmbH; Community Tissue Services; De Soutter Medical Ltd; DIZG; Dot GmbH; Double Medical; Technology Inc; EBJIS; EFAS; EFORT; EHS; EOS Imaging; EPOS; ESSKA; Exactech International Operation AG; FORTE; G21 Srl; Groupe Lépine; Gruppo Bioimpianti; Hangzhou Rejoin Mastin Medical Device Co Ltd; Hangzhou Xinrun Technology Co Ltd; Heraeus Medical GmbH; HIP International; Imedicom Co Ltd; Implantcast GmbH; Inion; Integra; Intrauma SpA; Johnson & Johnson Medical; Devices Companies; The Journal of Bone and Joint Surgery; KCI, An Acelity Company; Koenigsee Implantate GmbH; LCA Pharmaceutical; Leader Biomedical; LifeNet Health; Lima Corporate S.p.A.; Lyfstone; Lymphatouch Inc; Marquardt Medizintechnik GmbH; Mathys Ltd Bettlach; MDT Int‘l S.A.; Medacta International SA; Medartis AG; Medgal Sp Z.o.o,; Meril Healthcare PVT Ltd; Mindray (Wuhan DragonBio Orthopedic Products Ltd); Newclip Tehnics; NORE; Orascoptic; Orchid Orthopedic Solutions; Orthofix Srl; Osartis GmbH; Permedica Spa; Samumed LLC; Sanatmetal Ltd; Sawbones Europe AB; Shanghai Bojin Electric Instrument & Device Co Ltd; SICOT; Smith & Nephew Orthopaedics AG; SOFCOT; Synimed; Syntec Scientific Corporation; Syntellix AG; TDM Co Ltd; Tecres SPA; Teknimed; THI Total Healthcare Innovation GmbH; VSY Biotechnology B.V; Walkman Biomaterial Co Ltd; Weigao Orthopaedic Device Co Ltd; Wisepress Ltd; Wolters Kluwer; Ziehm Imaging GmbH; Zimmer Biomet; nnSatellite symposia: list of companies having hosted a satellite symposium: B Braun Aesculap; De Puy Synthes; Heraeus Medical GmbH; Smith & Nephew Orthopaedics AG; Zimmer Biomet.

Corporate Partnerships and/or Fellowship Programmes Medacta International

Smith&Nephew

Grünenthal

Stryker

DISCLOSURE

Since 2016 EFORT has adopted the policy of disclosure of conflict(s) of interest for speakers participating in the EFORT Annual Congresses on a mandatory basis.

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Annual Report 2020

23rd EFORT Congress Lisbon, Portugal [Modern Patient Needs - 22-24 June 2022 Challenges And Solutions Abstract submission In O&T] 15 September-15 November 2021 Email communications of abstract acceptance status 31 January 2022 Advanced programme 01 April 2022

#EFORT2022

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