Since the foundation of the International Society of Orthopaedic Centers in 2006, the group has continued to grow, with currently 11 members worldwide. During the 2008 annual meeting, the bylaws and mission of the group were approved as well as the acceptance of two additional members. Strict inclusion criteria were established to keep the group both small and effective. The goal of the 2008 meeting and this position statement is to identify current challenges in both research and education for large-volume orthopedic hospitals and to discuss possible approaches and solutions. © Hospital for Special Surgery 2009.