In modern orthopedic practice, some degree of subspecialist expertise is required and training programs must provide for this. Specialist training in university teaching hospitals provides opportunities beyond just exposure to the complex case mix of a tertiary center. Specialist orthopedic hospitals provide care and leadership with national and international expertise. Their role in orthopedic training is substantial. With legislative reductions in permissible working hours orthopedic training continues to adapt to provide surgeons with the opportunities to fully develop skills, with teaching hospitals well placed to facilitate this. This article discusses the role of specialist training and teaching hospitals in contemporary orthopedic surgery.