Orthopaedics Annual Report 2014-2015 The Outsized Impact of Orthopaedics

Hospital for Special Surgery Department of Orthopaedic Surgery Todd J. Albert, MD, Surgeon-in-Chief, 212.606.1004

The Outsized Impact of Orthopaedics Department of Orthopaedic Surgery 2014–2015 Annual Report

Message from the Surgeon-in-Chief

Dr. Leon Root (1929–2015)

All at Hospital for Special Surgery were deeply saddened by the loss of Dr. Leon Root in September. Dr. Root’s extraordinary leadership and vision in advancing patient care, providing for the community at large, championing medical education, and overseeing groundbreaking research will be felt well into the future. Dr. Root spent almost five decades of his medical career at HSS. He joined the staff in 1967, and in 1970 he became the Hospital’s first chief of pediatric orthopaedic surgery, essentially creating the Service. He served in

Like all surgeons, I think about my patients every day. And, of course, like all physicians, I try to keep up with the advances that could allow me and my colleagues here to do even more for patients tomorrow than we could today.

But as I move well into my second year here at HSS, I’ve come to reflect on what it is about my job that feels a bit unique. I think I’d summarize the answer this way: As part of HSS, I feel a special responsibility to the field of orthopaedics.

Meanwhile, leadership and advancement have never been more critical to the field.

These are challenging times for medicine, involving rapid change and growing pressures to deliver more value. Far from being isolated from these changes and pressures, orthopaedics is likely to end up at the heart of the whirlwind. On one hand, there is a likely tsunami of growth heading our way in the burden of degenerative joint disease and reduced bone quality because of an aging population.

On the other, medicine is being pushed to focus on the major chronic diseases.

That’s appropriate, but it carries a risk

that those outside of orthopaedics will underestimate the field’s huge impact on population quality of life and productivity, and won’t fully recognize the potential benefits of advances in musculoskeletal care, including sufficient access to specialists to avoid long waits for treatment or less than top-quality care.

About Hospital for Special Surgery

This year we took a major step forward in delivering higher-value musculoskeletal care by creating the role of Chief Value Medical Officer. Catherine MacLean, MD, PhD, joined HSS in July 2015 to help us better coordinate many activities that support the delivery of high-value musculoskeletal care. A major focus for Dr. MacLean will be on helping HSS do an even better job at producing highvalue care by more accurately measuring patient health improvement while ensuring we are responsible stewards of our healthcare dollars.

All of us in this field have to step up, and share the burden of leadership, advocacy, and producing advances. We’re acutely aware of it here at HSS, and it drives us to do better in every way possible. Let me share a few of the areas of focus here that I think are having real impact on the field: Design by Addison www.addison.com

Todd J. Albert, MD, FACS Surgeon-in-Chief and Medical Director, Korein-Wilson Professor of Orthopaedic Surgery

That sense of needing to do more for the field, a sense I know I share with all my colleagues here, is one that stems from being with an institution that’s entirely dedicated to musculoskeletal disease and nothing else. Everything that happens here revolves around the field; everyone here is a specialist in it. The sheer volume of patients and surgeries here, and the breadth of orthopaedic services, ensure that it commands our attention 24/7, and provide us with a big picture of patient challenges and outcomes. That institutional focus and perspective compel us to do our share and more in strengthening the field and pushing it forward.

this role for 27 years. Dr. Root thought of himself as an orthopaedic family doctor, caring for his patients from childhood through adulthood. Among his many accomplishments, Dr. Root established New York City’s first clinic for children with osteogenesis imperfecta at HSS, founded New York State’s first Pediatric Orthopaedic Outreach Program, which was named the Leon Root, MD, Pediatric Outreach Program (POP) in his honor, and expanded the Hospital’s Cerebral Palsy Clinic. Dr. Root also served as medical director of the Rehabilitation

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology, and rehabilitation. HSS is ranked #1 in the country for orthopaedics and #3 for rheumatology (in association with NewYork-Presbyterian Hospital)

by U.S.News and World Report Best Hospitals 2015–16 rankings. It is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. Located in New York City, HSS also serves patients in the regional area with outpatient centers in Connecticut, New Jersey, Long Island, and Queens, and serves Florida patients with an outpatient rehabilitation office in West Palm Beach.

Patients choose to come to Hospital for Special Surgery from across the U.S. and from around the world. HSS has one of the lowest infection rates in the country. HSS is a member of

Department at HSS for more than four decades, overseeing its transition into the nationally recognized service it has become today. Former patients and colleagues will remember him best for his outstanding contributions to the field of pediatric orthopaedics, for his deep concern for those under his care and for their families, for his extraordinary ability to mentor and teach, and for his vision and efforts to create a better quality of life for those with musculoskeletal conditions, especially children.

Officers

the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medicine, and as such, all Hospital for Special Surgery medical staff are faculty of Weill Cornell Medical College.

The Hospital’s Research Division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. To learn more, please visit www.hss.edu.

Chair Kendrick R. Wilson III Vice Chair Michael Esposito Thomas Lister Deirdre Stanley President and Chief Executive Officer Louis A. Shapiro Surgeon-in-Chief and Medical Director Todd J. Albert, MD Executive Vice President Lisa A. Goldstein

Attributions

The Department of Orthopaedic Surgery 2014–2015 Annual Report is produced by the Communications Department at Hospital for Special Surgery.

©2015 Hospital for Special Surgery. All rights reserved.

Executive Vice President and Treasurer Stacey L. Malakoff Executive Vice President, Chief Legal Officer and Secretary Irene Koch, Esq. Chairman, Emeriti Richard L. Menschel Dean R. O’Hare Aldo Papone

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Refining the diagnostic and treatment pathways Before I came here, I was acutely aware of HSS’s reputation for handling complex cases. But now that I’m here, I find myself equally excited by our ability to leverage our large patient volume and specialization in constantly making incremental improvements in handling the more routine cases, cumulatively leading to better outcomes and satisfaction for our overall patient population.

Improving the circle of orthopaedic care Many of the most impactful refinements happen outside of surgery. Our anesthesiologists, pain management specialists, physiatrists, nurses, therapists, and other care providers are tireless in finding ways to reduce pain, discomfort, and unnecessary delay associated with bringing patients through the entire cycle of care, and in making rehab more efficient and effective, and recovery fuller. Fast-tracking, when done appropriately, can be a huge boon to patients.

Demonstrating the value of interventions Rigorously tracking our patients’ shortand long-term outcomes has enabled us to shed light on the relative value of different approaches, treatments, and care pathways for all types of cases. Doing so helps guide our future progress, and leaves patients and payers better able to recognize and appreciate the most appropriate courses of action.

Whatever improvements and contributions we make, we always keep two things in mind. First, we have to find ways to do even better. And second, collaboration within the field will ultimately be the best way to progress. As surgeons and other medical professionals, as well as institutionally, we can all be somewhat competitive, and that can be highly motivating. But in the end, we best thrive and do the most for patients by sharing with and learning from each other.

Education To ensure the future strength of our field, we’ve been aggressive in establishing efforts here to broaden and improve the training, mentoring and continuing education of physicians, nurses and other specialists in the field through a range of programs. Our residency program continues to be top-ranked nationally, and our fellowship program is highly competitive, allowing us to further train the brightest thought leaders of tomorrow. We’re also constantly expanding our patient education efforts through our sports medicine programs and community outreach, to help reduce injury rates and encourage fitness.

As a field, it’s together that we’ll continue to increase the positive impact of orthopaedics on the health, well-being, and productivity of the population. I look forward to continuing and expanding all forms of these collaborations. And I know the results will be beneficial — ​most importantly for patients, but also for the field and all of healthcare’s many stakeholders.

Todd J. Albert, MD, FACS Surgeon-in-Chief and Medical Director, Korein-Wilson Professor of Orthopaedic Surgery

Contents 02 The Impact of Musculoskeletal Problems on the Workplace

12 Introduction to Our Service Areas

26 Orthopaedic Trauma Service

14 Adult Reconstruction and Joint Replacement Division

28 Pediatric Orthopaedic Service

03 The Benefits of Focus 04 A Culture of Specialized Care

18 Foot and Ankle Service

05 Patient Results

20 Hand and Upper Extremity Service

06 Delivering the Care Patients Want

22 Hip Preservation Service

07 Healthcare Research Institute

23 Limb Lengthening and Complex Reconstruction Service

08 Research & Innovation 09 Education 10 Expert Care for Complex Cases

24 Metabolic Bone Disease/ Musculoskeletal Oncology Service

30 Spine Service 32 Sports Medicine and Shoulder Service 35 Department of Biomechanics 36 Endowed Chairs, Professorships, and Fellows 37 Department of Orthopaedic Surgery 38 Recognition and Influence 39 Dr. Root Tribute

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The Impact of Musculoskeletal Problems on the Workplace

Musculoskeletal problems are the single largest and fastest-growing driver of many employers’ healthcare spend. Working with a healthcare provider that can effectively manage these problems leads to better outcomes and lower total healthcare costs.

16 5.6 12 8 %

Musculoskeletal conditions are the largest spend for most employers and, on average, account for 16% of employers’ overall healthcare spending.1

%

Musculoskeletal conditions are the fastest-growing healthcare spend for most employers at 5.6% per year.1

%

Employers report that, on average, 12% of their employees miss work each year due to musculoskeletal conditions.2

Days

Employees with musculoskeletal conditions miss, on average, 8 days of work each year due to those conditions.2

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1. Source: Huse DM, Marder WD: “What are the leading drivers of employer healthcare spending growth?,” Truven Health Analytics, April 2013 2. Source: National Health Interview Survey, Adult Sample, 2012

The Benefits of Focus

HSS is entirely dedicated to musculoskeletal diagnosis and care.

That single focus pays off with healthcare value that can reduce an employer’s spend and provide better care to employees.

Higher Surgical Volume Leads to Higher Quality

HSS has 106 surgeons performing nearly 30,000 surgeries each year. Research has proven again and again that the providers

who get the best results from procedures tend to be the ones who perform those procedures the most often.

The Number of Orthopaedic Procedures HSS Performs Annually HSS Total Volume

29,607

HSS Medicare Volume

7,185

Total Orthopaedic Surgical Volume

19,327

Volume of Other Procedures, Including Reconstruction and Spine Surgery

2,752

Volume of Other Procedures, Including Reconstruction and Spine Surgery

4,433

2,28

Total Joint Replacements

Total Ort Surgical

10,280

Total Joint Replacements

875

Total Joi Replacem

HSS internal data, 2014

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A Culture of Specialized Care

HSS clinicians are leaders in defining and driving evidence-based best practices in the field. That leadership leads to better results for patients across episodes of care.

The Key: An Accurate Diagnosis

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%

Among patients who come to HSS looking for a second opinion, 38% received a recommendation for a different course of treatment.

It all starts with an accurate diagnosis. Many patients come to us with questions about what to do next.

Surgery benefits many patients

with orthopaedic conditions, but it’s not right for all patients. We’re experts in guiding patients in the appropriate choice of treatment.

Source: HSS internal data pilot, 2014–2015

Safety is a critical measure of success at hospitals. When the diagnosis calls for surgery, HSS has found ways to anticipate, measure, and minimize potential problems, both common and

complex, day in and day out. That’s why patients can be assured they have the best chance of a successful outcome at HSS.

HSS ranks in the 99.4 percentile in New York State and the 99.9 percentile nationally in Major Orthopaedic Surgery based on avoided complications.

Source: CareChex® — ​a division of Comparion®, FFY2012–FFY2014 MedPAR data

30-day unplanned readmission for Hip/Knee surgery:

At HSS, we’re continually working toward reducing the chance patients will need to

Hospital for Special Surgery

come back for an unexpected problem after surgery.

3.8%

National Rate

Source: Medicare “Hospital Compare,” Risk-Adjusted, 2010–2013

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5.2%

Patient Results

Many of our patients are in pain when they first come to HSS and often are unable to function the way they need to. On average, these patients do much better after surgery at HSS, according to the information they report to the Hospital.

Patients report improvement two years after Total Hip Replacement

Relief from pain:

Return to function:

Quality of life:

99.4

98.8

97.8

Source: HSS Arthroplasty Registry, 2007–2012

Patients report improvement two years after ACL Reconstruction

Relief from pain:

Return to function1:

Return to function2:

92.0

96.3

95.2

1. Lysholm Scale 2. IKDC Scale Source: HSS ACL Registry, 2009–2013

Lower Total Cost of Care

HSS’s focus on quality and safety reduces costs and lowers the risk of setbacks and patient frustration.

The Right Diagnosis The Right Treatment Fewer Complications Lower Rate of Readmissions Fewer Revisions

TOTAL COST

Improved Employee Productivity

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Delivering the Care Patients Want

92

%

As is the case in other industries, “likelihood to recommend” is a leading indicator of success. Ninety-two percent of patients

would recommend HSS, compared to 86 percent among other leading national orthopaedic hospitals.

Source: http://www.hcahpsonline.org. Centers for Medicare & Medicaid Services, Baltimore, MD, 2013

Privileged to Serve High-Performance Athletes Some of the most demanding athletic organizations turn to HSS to improve performance, and to prevent and repair injury. Here are some of the teams and organizations we work with:

U.S. Olympic Committee USA Basketball USA Swimming USA Volleyball USRowing FIFA New York Giants New York Mets New York Knicks

The World Chooses HSS

120,000+ The number of patients served at HSS last year. Patients want the value we deliver.

104 The number of countries represented by our patient population. We work hard to offer care worth traveling for.

50 Patients come to HSS from all 50 states in the U.S.

Source: HSS

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New York Liberty Brooklyn Nets New York Red Bulls New York Road Runners Los Leones del Escogido St. Lucie Mets Brooklyn Cyclones Westchester Knicks IMG Academy

St. John’s University Athletics Iona College Athletics Saint Peter’s University Athletics CUNY Athletic Conference USA Football Ballet NY Public School Athletic League Asphalt Green

Healthcare Research Institute

Faculty Stephen Lyman, PhD Director of the Healthcare Research Institute & Associate Scientist Carol Mancuso, MD Associate Scientist Alvin Mushlin, MD, ScM Associate Scientist Jayme Burket, PhD Instructor Scott DeNegre, PhD Instructor

Staff Joseph Nguyen, MPH Director of Biostatistics Huong Do, MA Director of the Clinical Data Core Vinicius Antao, MD, PhD Director of Patient Registries

The Healthcare Research Institute was established in 2014 under the direction of Stephen Lyman, PhD, to serve as the academic home for clinical and population health research at HSS. It facilitates consolidation, organization, and optimization of the vast amount of clinical material generated at HSS with an end goal of improving patient outcomes and lowering healthcare costs.

The Institute has three core services: biostatistics, clinical data, and patient registries. The Registries Core directly oversees eight HSS Institutional Patient Registries (IPRs) with over 140,000 enrollees and also provides varying levels of support for more than 40 other HSS registries. During 2014, the Biostatistics Core consulted on over 300 research projects.

Seven research labs comprise another component of the Institute. “Our labs focus on the type of methodology and research questions needed to create study designs that help HSS become expert in certain thematic areas,” says Dr. Lyman. “The concept behind the labs is to allow for crossdisciplinary fertilization so, for example, we might have anesthesiologists talking to radiologists who talk to surgeons who talk to epidemiologists, and new ideas grow out of that.”

During the past year, one research spotlight focused on Patient Reported Outcome (PRO) surveys. “The best validated surveys are the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS), which are 40 and 42 questions, respectively,” says Dr. Lyman. “That’s too long, especially for older patients, and this leads to incomplete data collection. Working collaboratively with HSS physicians and biostatisticians, we got the HOOS down to six questions (HOOS, JR.), and the KOOS down to seven questions (KOOS, JR.) that are highly predictive of both pain and function in knee and hip patients.

These new, validated short forms have received tremendous interest from the orthopaedic community as word has gotten out.” The HOOS, JR. and KOOS, JR. can be administered in a variety of ways depending on patient preference, including through smartphones.

The Institute is strongly committed to education outreach, including resident training for both clinical and health policy-related research.

Institute members have also published over 90 papers during the past year and have given multiple presentations at national and international orthopaedic conferences.

“Looking ahead, we’re primarily interested in driving forward the quality of research in the musculoskeletal world,” says Dr. Lyman. “I feel that orthopaedics still lags behind cardiology, oncology, and some of the other specialties, but we’ve really been making great strides in closing that gap.”

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Research & Innovation

HSS physicians and scientists have consistently driven advances in musculoskeletal technologies through research and innovation. HSS also partners with researchers and inventors to help bring inventor ideas to market by helping bridge the gap between research and commercialization. Dr. Lionel Ivashkiv, Chief Scientific Officer at HSS, and Dr. Robert Hotchkiss, the Hospital’s first Chief Innovation Officer, both help facilitate the robust research and innovation programs at HSS.

Research

Other research is being conducted on facilitating the attachment of bone to implants to improve stability, developing biomarkers for early identification of patients who might react negatively to the polyethylene debris generated by some implants, and on what drives the necrotic and inflammatory tissue reactions caused by debris released from metal-onmetal implants.

The mission of research at HSS is to translate breakthrough findings into new ways of treating and preventing serious orthopaedic and rheumatic conditions. HSS uses a team-based approach to research, and the way in which basic science and clinical research are linked is what sets HSS apart from many other institutions.

“The majority of our research is centered on how to repair and regenerate tissues,” says Dr. Ivashkiv. “For example, Dr. Mary Goldring’s research team studies cartilage, the mechanisms that damage cartilage, and how you can preserve cartilage and prevent it from degenerating in osteoarthritis.

Dr. Scott Rodeo, a sports medicine surgeon, is investigating the best methods for tendon repair, and Dr. Suzanne Maher’s team has successfully used a tissue engineering approach to develop a meniscus replacement.”

Current spine research includes identifying the pathways that maintain disc health in order to create therapies that either reverse or prevent degeneration, and developing a gene therapy– based approach to see if there are substances or stem cells that can be injected into the area of a prolapsed disc to help the healing process, possibly eliminating the need for surgical fusion.

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HSS is also extremely proud that two of its research faculty members are consecutive Presidents of the prestigious Orthopaedic Research Society (ORS). Dr. Mary Goldring served as ORS President for 2014– 2015, and Dr. Mathias Bostrom is President for 2015–2016.

The Center works with entrepreneurs to turn original ideas into real healthcare solutions. “We’ve built the HSS Innovation Center to provide support through the four stages of technology development — ​idea generation, evaluation, acceleration, and commercialization — ​all with the goal of helping patients,” says Dr. Hotchkiss.

The HSS Innovation Fund was established to financially support the advancement of early-stage technologies that have commercial potential, and to accelerate projects to prepare them for external investment. HSS has seeded the fund with $1 million and is committed to raising additional funds through philanthropy.

Innovation HSS has a long history of pioneering innovations that impact patient care. In just the past 30 years, HSS has been associated in some way with well over 1,000 patents.

To promote that progressive spirit, the HSS Innovation Center was launched in 2014 to formally provide support to inventors so that they have what they need to bring their ideas to market. The Center encourages the creation of new, viable solutions that improve clinical outcomes, enhance the patient experience, or improve efficiency in care delivery.

Innovation at HSS encompasses both Life Sciences Innovation, which includes novel biomedical products and platforms, and Care Delivery Innovation, which includes digital health solutions and care delivery models. The advancement of technologies and startups is managed through the Hospital’s Technology Development Office.

HSS also has an Accelerator Program, which partners with outside organizations that are the best in their respective fields in order to bring new ideas to market faster and more effectively.

Education

Hospital for Special Surgery is committed to being the source for outstanding initiatives in education, training, research, and information for local, national, and international communities to prevent and treat musculoskeletal conditions.

TOP-RANKED ORTHOPAEDIC SURGERY RESIDENCY

Top Residency Program in the U.S. Doximity is the largest community of physicians in the country; over 60% of U.S. doctors are verified members. The HSS Orthopaedic Surgery Residency Program was recognized as the top orthopaedic surgery residency program in the U.S. on Doximity’s Residency Navigator reputation and research list for the second consecutive year.

Academic Training For more than a century, HSS has trained the minds, hearts, and hands of some of the finest orthopaedic surgeons in the nation. A steadfast commitment to excellence in education dates back to the Hospital’s earliest traditions and continues to influence its present-day mission and vision.

HSS offers the following educational opportunities: • Orthopaedic Residency Program • Fellowships • Stavros Niarchos Foundation — ​ Thomas P. Sculco, MD International Orthopaedic Fellowship • Medical Student Summer Research Fellowship • Academic Visitor Program • Visiting Professor Lecture Series • Bioskills Education Laboratory (BSEL)

The Orthopaedic Surgery Residency Program Under the direction of Dr. Mathias Bostrom, the Residency Program offers a unique opportunity for orthopaedic residents to learn and develop a broad-based skill set that includes musculoskeletal research, a well-rounded surgical education, and a mastery of the fundamentals of orthopaedic surgery. Residents are required to participate in either basic or clinical research and are expected to present a paper in the last year of residency. Following their training, many residents continue their education by taking a fellowship position.

In 2014–2015: • HSS trained 45 residents, 73 fellows, and 604 medical students and trainees.

• Content and curriculum were accessed nearly 49,000 times by participants through a variety of educational offerings.

• HSS ACCME-accredited and nonaccredited professional education programs included 39 live programs, grand rounds, and CMEapproved HSS Journal® articles.

HSS eAcademy® HSS eAcademy® is an electronic platform for distribution of education and academic programs through live streaming, as well as a regularly updated selection of

CME/CEU offerings and activities that can be completed for credit online. HSS eAcademy® modules have reached professionals in 116 countries to date.

Global Partnerships The Department of Global Partnerships promotes the advancement of musculoskeletal medicine worldwide through knowledge transfer, education, and the development of world class healthcare delivery systems.

Programs provide outstanding opportunities for individual healthcare professionals and healthcare institutions from around the world to expand their knowledge through updated treatment techniques and orthopaedic-based practices to contribute toward improved patient care and outcomes.

HSS Journal® HSS Journal® publishes original, peer-reviewed research and review articles along the spectrum of musculoskeletal diseases and conditions as well as their diagnosis and treatment. The goal of the HSS Journal® is to present articles describing cutting-edge research, clinical pathways, treatment, and state-of-the-art techniques that educate the orthopaedic and musculoskeletal communities.

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Expert Care for Complex Cases

HSS has a robust infrastructure that can handle the most complex cases in orthopaedics. This includes patients with highly complex medical comorbidities, such as severe cardiac, pulmonary, or renal disease, patients on experimental or potent medications, or patients who have end-stage disease in one of their organ systems. HSS also believes in sharing its knowledge of complex cases with the greater orthopaedic community though publications and presentations, and by regularly exposing HSS medical trainees to complex cases and techniques, allowing the thought leaders of today to train the thought leaders of tomorrow.

The HSS Complex Case Review Panel: A Cut Above

Geoffrey H. Westrich, MD Co-Chair Michael K. Urban, MD, PhD Co-Chair

What sets HSS apart from other orthopaedic hospitals when it comes to medically complex orthopaedic cases? The Complex Case Review Panel. The Panel, currently co-chaired by Dr. Geoffrey Westrich and Dr. Michael Urban, was set up several years ago when HSS medical staff starting thinking about a better way to take care of orthopaedic patients who presented with comorbidities that made them very complex medically.

Panel members represent the many specialty areas of the Hospital that come in contact with medically complex patients before, during, and after surgery. In addition to orthopaedic surgeons, the Panel includes specialists in anesthesiology, recovery room nursing, physical therapy, internal medicine, cardiology, and pulmonology. Other specialty areas, such as hematology, are included on an ad hoc basis.

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After a medically complex patient is identified, an administrator pulls together all the workups for that patient, such as the medical consultation, the orthopaedic consultation, and all test results.

That information is then circulated to everyone on the Panel. “The system we’ve set up at HSS really helps protect the patient,” says Dr. Geoffrey Westrich, Co-Chair of the Panel. “It optimizes the patient’s care and helps us prepare for complicated cases in the best way possible.”

“We look at it from a risk-benefit perspective,” says Dr. Urban.

“Given a patient’s risks, given their comorbidities and the risk of surgery, is it realistic to move forward, and will we have a good result?” A patient knows from the onset that their case is being discussed by a panel. “For some Panel meetings we’ll bring the patient in,” notes Dr. Urban. It’s important to keep the patient in the loop so they understand the risks involved and can decide if they want to move forward. In some cases, we’ll refer the patient to an ethicist or psychologist to help ensure the

patient understands the risks,” continues Dr. Urban. “Sometimes we conclude surgery is not the best option for the patient, and we propose alternatives.”

The cases reviewed by the Panel might be relatively straightforward from an orthopaedic perspective, but complex from a medical perspective, or both orthopaedic and medical components might be complex. “Sometimes there are extremely complicated cases,” notes Dr. Westrich. “Those patients are so complex medically that we might need to plan using a specialized type of anesthesia while also having different medications on standby. Our recovery room will prepare ahead of time for this medically complex patient, and often that patient will go from HSS directly to the NewYorkPresbyterian Hospital ICU — ​all of that is prearranged. The whole system is designed for a complex case, and we’ve worked very hard to optimize that infrastructure.”

Sharing Knowledge on Complex Cases: Grand Rounds from HSS

HSS plays a leading role in providing easily accessible educational resources on complex orthopaedic cases to the larger orthopaedic community. Grand Rounds from HSS: Management of Complex Cases, edited by Dr. Edward C. Jones, is published three times per year and features detailed case reports about complex orthopaedic cases. Each issue focuses on a specialty area, such as knee, foot and ankle, or

shoulder, and every year one issue is dedicated to rheumatology.

Case reports include informative images and detailed, referenced discussion sections. Issues can be read online or downloaded in PDF format. To access the latest issue of Grand Rounds from HSS: Management of Complex Cases, or to view past issues, visit: www.hss.edu/complexcases.

Lengthening of 20cm in the Femur and Tibia to Equalize Leg Lengths in a Growing Child

A 9-year-old male presented to HSS with a 5.5cm Leg Length Discrepancy (LLD) (Figure 1). There was no history of infection or trauma and growth plates looked normal on x-ray. This appeared to be a congenital LLD and the predicted LLD at maturity was thought to be 7.5cm using standard prediction methods. He underwent a right femur lengthening of 5cm using a monolateral frame on the femur (Figure 2). A minimal incision

Figure 1

Figure 2

Figure 3

quadricepsplasty was done to treat a knee extension contracture. This was uneventful, and it was planned to do another small lengthening as a young teenager. However, during follow-up, the growth plates were noted to be increasingly irregular. At ages 12 and 15 years (Figures 3, 4), the patient was noted to have additional LLD requiring further staged lengthening. In total, he underwent 20cm of right lower extremity

Figure 4

Figure 5

lengthening in 3 stages (Figures 5, 6).

The patient is now an adult and has equal leg lengths, a normal gait, and normal hip, knee, and ankle range of motion. He has no functional limitations.

Figure 6

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Introduction to Our Service Areas

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Adult Reconstruction and Joint Replacement Division

The Adult Reconstruction and Joint Replacement (ARJR) Division is composed of the Hip Service, Knee Service, and Surgical Arthritis Service. Unparalleled experience allows ARJR surgeons to treat more complex conditions with fewer post-operative complications. Use of the latest surgical technology facilitates quicker patient recovery time and improved pain management.

Foot and Ankle Service

The Foot and Ankle Service is the largest program of its kind in the United States, and its surgeons have extensive experience treating a broad range of foot and ankle injuries and conditions. Total ankle joint replacement is a particular focus area, where constant and precise attention is given to implant and surgical technique improvements. Other focus areas for the Service include tendon/cartilage injuries, forefoot/flatfoot reconstruction, and foot/ankle fractures.

Hand and Upper Extremity Service

The Hand and Upper Extremity Service is known internationally as an authority in the treatment of many complex conditions of the hand, wrist, forearm, and elbow; each of its surgeons has a particular area of expertise. The Service is committed to enhancing the quality of life of patients through therapeutic advances, research, and education.

Hip Preservation Service

The Hip Preservation Service focuses on providing joint-preserving treatment options to children and adults. Its surgeons specialize in early identification of the underlying issues that cause various conditions of the hip. This knowledge helps provide patients with more treatment options that help preserve the integrity of the hip joint.

Limb Lengthening and Complex Reconstruction Service

The Limb Lengthening and Complex Reconstruction Service is recognized as a global center of excellence in the care of children and adults with complex issues regarding limb length equalization and limb deformity. The Service provides opportunities for limb healing and restoration to individuals who may not have had access to treatment alternatives previously.

Metabolic Bone Disease/ Musculoskeletal Oncology Service

The Metabolic Bone Disease/Musculoskeletal Oncology Service is a consortium of basic scientists, clinical diagnosticians, and medical disciplines focused on the prevention and treatment of osteoporosis, Paget’s disease, and related bone disorders. The Service brings together practitioners across multiple specialties to treat metabolic bone disease and collaborate on basic, clinical, and translational research efforts.

Orthopaedic Trauma Service

Globally renowned for its clinical and surgical expertise, the Orthopaedic Trauma Service (OTS) works in collaboration with the NewYork-Presbyterian/Weill Cornell Medical Center to provide orthopaedic emergency care. The Service manages all facets of basic and complex orthopaedic trauma, including upper and lower extremity fractures, pelvic, acetabulum, and articular fractures and polytrauma.

Pediatric Orthopaedic Service

The Pediatric Orthopaedic Service at Hospital for Special Surgery is nationally and internationally recognized as an authority in pediatric orthopaedic surgery and medicine. Its accomplished team of surgeons treats thousands of infants, children, and adolescents each year for a wide range of congenital, developmental, and traumatic conditions affecting children’s bones, joints, and muscles.

Spine Service

The Spine Service has a worldwide reputation for surgical and non-surgical treatment of children and adults with all levels of spine disease and deformity.

Minimally-​invasive surgical techniques are used, resulting in less pain, quicker recovery, and excellent long-term results. Superior outcomes are achieved by actively conducting research and using the latest innovative technologies.

Sports Medicine and Shoulder Service

The Sports Medicine and Shoulder Service is dedicated to treating athletic injuries of the musculoskeletal system, with a special focus on shoulder, elbow, hip, knee, and foot and ankle injuries. Service members are committed to providing the highest level of sports medicine care for athletes of all levels. They also provide medical coverage to various local high school, collegiate, and professional teams and organizations.

Department of Biomechanics

The mission of the Department of Biomechanics is to apply principles of engineering and materials science to solve orthopaedic challenges by performing basic and applied research leading to the development of orthopaedic devices and instrumentation designed to improve patient care. The Department also provides education and training opportunities for students pursuing careers in orthopaedic surgery and biomedical engineering.

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Adult Reconstruction and Joint Replacement Division

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Douglas E. Padgett, MD Chief, Adult Reconstruction and Joint Replacement Division

Physicians in the Adult Reconstruction and Joint Replacement Division at HSS perform more joint replacement procedures than any other hospital in the country. They are continually optimizing joint replacement surgery by using innovative techniques, smaller implants, and less invasive incisions with a focus on quicker recoveries that restore patients to a pain-free, active lifestyle.

Mathias P. Bostrom, MD Chief, Hip Service Steven B. Haas, MD Chief, Knee Service

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Mark P. Figgie, MD Chief, Surgical Arthritis Service

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Michael M. Alexiades, MD [1] Friedrich Boettner, MD [2] Mathias P. Bostrom, MD [3] Robert L. Buly, MD [4] Michael B. Cross, MD [5] Mark P. Figgie, MD [6] Seth A. Jerabek, MD [7] David J. Mayman, MD [8] Douglas E. Padgett, MD [9] Paul M. Pellicci, MD [10] Chitranjan S. Ranawat, MD [11] Eduardo A. Salvati, MD [12] Peter K. Sculco, MD [13] Thomas P. Sculco, MD [14] Edwin P. Su, MD [15] Geoffrey H. Westrich, MD [16] Russell E. Windsor, MD [17] Not pictured: Charles N. Cornell, MD Alejandro Gonzalez Della Valle, MD Allan E. Inglis, Jr., MD Bryan J. Nestor, MD Michael L. Parks, MD Amar S. Ranawat, MD Philip D. Wilson, Jr., MD Emeritus

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Adult Reconstruction and Joint Replacement Division

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Clinical Highlights In 2014, the Adult Reconstruction and Joint Replacement (ARJR) Service’s orthopaedic surgeons had 44,993 patient visits. They performed 9,489 surgeries (8,911 inpatient and 578 ambulatory), approximately 5% more than in 2013.

As part of a strategic growth plan, the Service continues to search for and recruit new talent, welcoming Dr. Peter Sculco in September, 2015. Dr. Sculco completed his residency at Hospital for Special Surgery and his fellowship in Adult Reconstruction at the Mayo Clinic.

During 2015, the Patient Care & Quality Committee has been focused on evaluating pathways for THR, TKR, and UKR as they are built into the Epic electronic medical record. The Committee is also focused on developing real-time dashboards to track LOS, pathway adherence, and to evaluate in real time the impact of initiatives aimed at improvements in patient care and quality.

The Service continues to assess opportunities to improve quality while reducing episode cost by participating in bundled payment programs.

validated independently and endorsed by the American Association of Hip and Knee Surgeons.

Thanks to the generosity of grateful patients and the Estate of Leonard and Caryl Marmor, the Center for Complex Joint Reconstruction was established in late 2014 and, under the leadership of Dr. Thomas Sculco, continues to be developed through 2015 into a comprehensive program of coordinated care for patients with joint replacement revision and a dedicated research effort to study complex joint reconstruction.

Education Updates

Research Initiatives The ARJR Post-Discharge Nurse Call Program, in which a nurse practitioner places phone calls to all patients discharged by the ARJR Service ­approximately one to two weeks post-­ discharge, was expanded in 2014 to all interested members of the Service.

Any non-routine issues are forwarded to the surgeon’s office to be addressed.

The ARJR Service continues to optimize its clinical pathways for total hip, total knee, and partial knee replacement. In 2014, length of stay (LOS) for a unilateral total hip fell to 2.78 days, and LOS for a unilateral total knee fell to 3.70 days.

In 2014, the Service began a pilot program in which pre-surgical screening is scheduled by the Department of Medicine. Early results include seamless scheduling for patients and reduced hospital administration for surgeon offices. Efforts to expand the program are in development.

In April 2014, the Service held its Eighth Annual Research Retreat focusing on research initiatives involving osteolysis, bone restoration, biomechanics/ mechanical testing, metal-on-metal, and inflammatory disease. Clinical projects, collaborative efforts, and potential multicenter projects were reviewed also.

Dedicated discussion time focused on the Total Joint Replacement Registry (TJRR). At the end of 2014, more than 58,500 patients were enrolled.

Research proposals submitted to the Registry in 2014 produced seven abstracts/posters, one publication, and 13 in-process manuscripts.

Major research initiatives started in 2014 include randomized clinical trials with anesthesia regarding pain protocols, multicentered studies with the Mayo Clinic regarding use of tranexamic acid to reduce bleeding in knee replacement surgery, and an initiative with the Rothman Institute regarding infection in total joint replacement.

In collaboration with the Health Research Institute, the Service developed a shortened form for the Patient-Reported Outcomes (PRO) measures HOOS and KOOS. The HOOS, JR. has been

The ARJR Fellowship Program, established more than four decades ago, trains future thought leaders in total joint replacement surgery by optimizing their surgical and technical skills. Under the leadership of Dr. Mathias Bostrom, the Program received 150 highly qualified applicants for the eight fellowship positions offered during the 2016– 2017 year.

New in 2014, small weekly group discussions were established in an effort to expand didactic learning for residents and fellows. This complements the weekly educational program, which incorporates case-based learning, as well as formal lectures covering all aspects of adult reconstructive surgery, biomechanics, and biomaterials.

Finally, Hospital for Special Surgery hosted the 26th Annual Holiday Knee and Hip Course at New York City’s Grand Hyatt, which attracted 193 attendees and included 48 international faculty. This annual educational event continues the legacy of the late Dr. Richard Laskin, who was deeply committed to ongoing continuing education.

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Foot and Ankle Service

Matthew M. Roberts, MD Chief

The feet and ankles are some of the most frequently injured areas of the body, yet their injuries and conditions are often misunderstood and misdiagnosed. The Foot and Ankle Service uses a multi-disciplined approach to skillfully treat the broad range of foot and ankle injuries and conditions that can occur at any stage of life.

Jonathan T. Deland, MD [1] Constantine A. Demetracopoulos, MD [2] Mark C. Drakos, MD [3] Andrew J. Elliott, MD [4] Scott J. Ellis, MD [5] John G. Kennedy, MD [6] David S. Levine, MD [7] Martin J. O’Malley, MD [8] Matthew M. Roberts, MD [9] Harvey Strauss, DPM, FACFAS [10]

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Research Initiatives

Education Updates

The Foot and Ankle Service saw 7,286 new and 15,598 follow-up patient visits, resulting in 440 inpatient and 2,024 ambulatory surgery cases during 2014.

In 2014, the Service received IRB approvals on 12 active research projects, and 19 active protocols received approval by the Foot and Ankle Service Registry Steering Committee.

In October of 2014, the Hand and Foot Center was renamed the Ken Wilson Family Hand and Foot Center, in recognition of the Wilsons’ generosity to HSS. Thanks to their contribution, the Center’s waiting room was renovated and has greatly improved the experience of patients’ families and their friends.

The Foot and Ankle Registry, generously supported by the Susan and Elihu Rose Foundation, continues to be a focal point of the Service’s research. By the end of 2014, the Registry had enrolled over 55,000 patients. The Registry is web-based. It captures demographic data for every new patient and follows patient outcomes at two and five years post-surgery.

The Foot and Ankle Service is actively committed to education. The curriculum for the 16 residents who rotate through the Service each year offers broad clinical and operative training, including two days per week seeing patients in the office and three days per week in the operating room, as well as weekly one-on-one conferences with an attending physician. The three fellows in the 12-month fellowship program develop their clinical, operative, and research skills by spending one year of intensive training with nine attending physicians.

In a joint effort between the Foot and Ankle Service and its anesthesia colleagues, the Service has worked together to optimize postoperative pain protocols. One important finding is that the delivery of peripheral nerve blocks together with pain medication significantly improves patients’ comfort after surgery and results in an increase in same-day discharges.

In 2015, the Service continued to support the growth of an ankle replacement center of excellence and is working to expand foot and ankle trauma treatment by forming close relationships with local and regional providers.

The Service has formalized a Steering Committee for the Foot and Ankle Registry, which focuses on the Registry’s goals and objectives, analytic and publication planning, and ongoing operations, including construction of a novel gait simulator.

Throughout 2015, the Service has been identifying ways to strengthen its infrastructure to support research capabilities. Attending physicians are focusing on utilizing the Registry to its fullest potential, evaluating the data collection platform to more efficiently conduct research and to explore opportunities for integrating with HSS as it plans to implement an electronic health record system. Another goal is to incorporate a patient directed outcomes instrument (PROMIS), which will allow for shorter, more efficient questionnaires.

The Service hosted a Total Ankle Replacement Webinar for professionals through the Hospital for Special Surgery eAcademy, organized and moderated

by Dr. Constantine Demetracopoulos.

Over 434 people participated from more than 32 countries.

The Bioskills Education Laboratory (BSEL) remains an important part of the resident and fellow curriculum.

The BSEL complements the didactic experience for junior residents through anatomy sessions, and allows practice of advanced surgical procedures for fellows.

During 2015, the Service is studying the effectiveness of the resident curriculum by comparing Orthopaedic In-Training Examination (OITE) scores pre- and post-oral exam initiation from the past 10 years. The Service will continue to optimize the fellow application and interview process in order to attract the top candidates.

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Hand and Upper Extremity Service Edward A. Athanasian, MD Chief

The bones, nerves, joints, and muscles of the hand, wrist, forearm, elbow, and shoulder are critical to nearly every activity of daily living. The Hand and Upper Extremity Service has a global reputation for treating children and adults suffering from all bone and soft-tissue conditions of the hand and upper extremities.

Edward A. Athanasian, MD [1] Michelle G. Carlson, MD [2] Duretti T. Fufa, MD [3] Robert N. Hotchkiss, MD [4] Steve K. Lee, MD [5] Andrew J. Weiland, MD [6] Scott W. Wolfe, MD [7] Not Pictured: Aaron Daluiski, MD Lana Kang, MD

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Research Initiatives

Education

In 2014, members of the Hand and Upper Extremity Service performed 133 inpatient surgeries and 2,581 ambulatory surgeries. Patient office visits totaled 23,516, an increase of almost 3%.

In 2014, the Service received IRB approval for 18 research projects; nine are expected to be completed by the end of 2015. The Service also has coordinator-supported registries in seven key areas: basal joint, distal radius, carpal tunnel, neoplasia, pediatrics, brachial plexus, and elbow.

The Service is committed to exploring new ways to enhance training for residents. In 2014, the curriculum was changed to improve the overall experience for residents. Residents’ caseloads were increased, and they received increased exposure to trauma cases.

In addition to HSS, the Hand and Upper Extremity Service directs surgical hand services at two affiliated institutions, NewYork-Presbyterian Hospital and Memorial Sloan-Kettering Cancer Center.

The Service welcomed Dr. Duretti Fufa in 2014. Dr. Fufa specializes in microsurgery, complex reconstruction, and traumatic injuries to the hand and upper extremity with a focus on microsurgery and complex reconstruction.

Dr. Fufa is Chief of Hand Surgery at NewYork-Presbyterian/Weill Cornell Medical Center and leads the Trauma Clinic. In 2014, the Clinic staff had 1,023 patient visits, and 123 hand and reconstructive surgeries were performed. An increase in patient and surgical volume is expected.

The Pediatric and Congenital Hand Clinic is up and running as a combined clinic staffed by the Hand and Pediatric Orthopaedic Surgery Services at HSS. Children with complex upper extremity neuromuscular disorders are being evaluated in the Pediatric Upper Extremity Motion Analysis laboratory. This incredible resource allows more accurate definition of the problems affecting patients who have cerebral palsy and other neuromuscular disorders by aiding decisions on which treatment is most appropriate for improving function.

Residents at the PGY3 and PGY4/5 levels rotate though the Service over 12 weeks. The mentorship-style rotations receive continued praise in evaluations from trainees, and the individual faculty evaluations continue to garner outstanding scores.

A substantial effort has been made to emphasize fellow training in microsurgery and pediatric and congenital hand problems. Hand fellows participate in a weekly pediatric and hand clinic supervised by Dr. Aaron Daluiski.

Microsurgery training of fellows is guided by Dr. Fufa.

Monthly research meetings for fellows, supervised by Hand Service Research Director Dr. Stephen Lee, have facilitated fellows’ research efforts, resulting in journal publications and presentations at regional and national meetings.

“In 2014, the Hand and Upper Extremity Service received IRB approval for 18 research projects; nine are expected to be completed by the end of 2015.”

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Hip Preservation Service

Some hip symptoms can be misdiagnosed, or they might be tolerated by the patient and go unrecognized. The Hip Preservation Service brings together the expertise and experience of various specialists who focus on providing joint-preserving treatment options to young and active adult patients suffering from hip pain in order to restore a high level of function.

Robert L. Buly, MD Chief Robert L. Buly, MD [1] Not pictured: Struan H. Coleman, Dean G. Lorich, MD MD, PhD [2] Peter J. Moley, MD David L. Helfet, MD [3] Bryan T. Kelly, MD [4] Douglas N. Mintz, MD [5] Danyal H. Nawabi, MD [6] Anil S. Ranawat, MD [7] Ernest L. Sink, MD [8] Edwin P. Su, MD [9] David S. Wellman, MD [10]

Clinical Highlights Hip Preservation Service and Center members include specialists in orthopaedic surgery, physiatry, physical therapy, sports medicine, radiology, and biomechanics. This collaborative approach benefits patients by accelerating accurate diagnosis of complex hip pain. Earlier diagnosis often gives patients more treatment options.

In 2015, Dr. Robert Buly was named the new Chief of the Hip Preservation Service. He will continue to define its vision and structure and is looking forward to continued establishment of the Service as the premier hub for hip preservation treatment, education, and research. The Service thanks former Chief Bryan Kelly, MD, for his prior leadership.

Dr. David Wellman has become a member of the Hip Preservation Service.

Dr. Wellman is acutely interested in hip trauma, specifically pelvic ring and acetabular fractures, as well as proximal femur fractures and non-unions.

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An online education experience for hip patients has been implemented, where a nurse practitioner connects with several patients and their family members in a virtual meeting room. This allows multiple patients to simultaneously view the educational material, speak directly with the clinical team, and engage in group discussion.

Research Initiatives The Hip Preservation Registry captures and evaluates the outcomes of surgical and non-surgical treatment for non-​ arthritic hip pain in patients under age 40. Containing over 5,500 patients, it enables clinicians to evaluate the effectiveness of the diagnosis and treatment of hip pain, and to monitor long-term patient outcomes.

Service members are studying the biomolecular cause of early cartilage failure and the development of new approaches for repair, including pioneering techniques that generate new cartilage and promote healing.

During the past year, Hip Preservation researchers published 26 papers in peer-reviewed journals and gave

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12 presentations, eight of which were invited podium presentations, an honor bestowed on only a handful of scientists based on the promise of their work and its great interest to the scientific community.

Education Updates The Hip Preservation Fellowship continues to gain recognition. This non-accredited, secondary training opportunity is the first program dedicated specifically to the technically challenging field of hip preservation. It allows fellowship-trained orthopaedic surgeons to dedicate an additional year to hip preservation techniques and provides the opportunity to spend time at the Schulthess Klinik in Zurich, Switzerland, a pioneer in many hip preservation procedures used today.

In December 2014, HSS hosted a professional education course targeting physical therapists and athletic trainers entitled “Clinical Evaluation of the NonArthritic Hip.”

Limb Lengthening and Complex Reconstruction Service

The Limb Lengthening and Complex Reconstruction Service specializes in limb lengthening and deformity correction for adults and children. It provides technically sophisticated options for limb length equalization and deformity correction, including nonunion and malunion fractures, limb salvage for bone loss and infection, deformities related to knock-knee and bowleg, joint preservation of the knee and ankle, and limb lengthening in patients with congenital conditions and syndromes.

S. Robert Rozbruch, MD Chief Austin T. Fragomen, MD [1] S. Robert Rozbruch, MD [2]

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Clinical Highlights In 2014, the Limb Lengthening and Reconstruction Service saw 579 new patient visits and 3,018 revisits, including Clinic visits. There were 374 inpatient admissions and 284 ambulatory surgery cases.

The Service increased use of and research on an important new limb lengthening technology (PRECICE®), an internally placed motorized nail used for lengthening procedures in the tibia and femur. It is a breakthrough technology because, in many cases, it aids bone elongation without subjecting the patient to some of the restrictions of external fixation devices.

Service members have become experts in use of the integrated fixation method for limb lengthening. This method utilizes both internal and external fixation during an individual’s treatment program, and has the major benefit of decreasing time spent in external fixation and decreasing risk of re-fracture.

Joint preservation of the knee and ankle is approached by Service members

utilizing osteotomy for limb realignment, joint distraction, and stem cells.

A Limb Salvage and Amputation Reconstruction Center (LSARC) was created recently. This multi-disciplinary center focuses on patients who have an at-risk limb, and on the decision between limb salvage and amputation.

The Limb Lengthening and Reconstruc­ tion Service at HSS continues to be the only dedicated limb deformity program as part of an academic department of orthopaedic surgery in the USA. Service members recently published an article in a top-tier, peer-reviewed journal detailing the utility of such a dedicated specialty service.

Research Initiatives The Service developed a registry utilizing REDCap, a web-based, study-specific database system from Weill Cornell Medical College, and it continues to maintain a comprehensive photo database of its patients, which is used for research, publications, presentations, and patient education.

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Ongoing projects include comparing use of the internal limb lengthening nail alone to an integrated fixation approach, using a multicenter corporate-​ sponsored study of clinical experience with the internal lengthening nail, and using that nail for lengthening of the humerus.

The Service is in the process of creating an HSS Limb Deformity Score for limb lengthening and deformity correction.

Education Updates In June 2015, the Service began a formal service rotation for HSS PGY3 orthopaedic residents.

A formalized patient education program providing education on procedure-​ specific issues was developed for the Service website page.

For the year, the Service published 16 peer-reviewed articles, four book chapters, and a major reference work entitled Limb Lengthening and Reconstruction Surgery Case Atlas, featuring over 300 clinical cases.

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Metabolic Bone Disease/ Musculoskeletal Oncology Service Joseph M. Lane, MD Chief Panagiota (Penny) Andreopoulou, MD [1] Richard S. Bockman, MD, PhD [2] Adele L. Boskey, PhD [3] Azeez M. Farooki, MD [4] Joseph M. Lane, MD [5] Linda A. Russell, MD [6] Robert Schneider, MD [7] Alana C. Serota, MD [8]

The Metabolic Bone Disease/Musculoskeletal Oncology Service provides clinical care and treatment for osteoporosis, Paget’s disease and related bone disorders. It’s also responsible for orthopaedic oncology at the Hospital. The Service supports research and education efforts by recruiting appropriate patients into clinical trials and delivering ongoing educational programs to medical professionals and the general public.

Not pictured: Juliet B. Aizer, MD, MPH Steven R. Goldring, MD Marci Anne Goolsby, MD Martin Nydick, MD

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Research Initiatives

In 2014, the Service performed 19 inpatient and 20 ambulatory surgeries at HSS, as well as 197 inpatient and 30 ambulatory surgeries at NewYorkPresbyterian (NYP)/Weill Cornell Medicine. Patient visits totaled 8,584, with an additional 401 nurse practitioner consultations and 2,425 DEXA scans.

The Seymour Cohn Metabolic Bone Registry identifies methods to prevent and repair fragility fractures resulting from osteoporosis and other metabolic bone disorders. Since its 2007 launch, the Registry has recruited 540 participants.

The HSS Osteoporosis and Metabolic Bone Health Center is a state-of-theart testing, diagnostic, and education facility that continues to provide excellent clinical care. It is accredited by the International Society of Clinical Densitometry (ISCD) — ​the only center in New York with this distinction.

The Medical-Orthopaedic Trauma Service (MOTS) is a collaborative effort with NewYork-Presbyterian Hospital. It relies on a multi-​disciplinary team of medical practitioners to provide comprehensive care for osteoporotic patients presenting with fragility fractures.

The Service secured a large research grant to determine bone architectural characteristics in patients with atypical femoral fractures and in individuals who have been on bisphosphonates longterm with no fractures.

A prospective cohort study in collaboration with NYP and the metabolic bone disease team is ongoing to assess whether hip fracture patients with stronger social networks and support systems in place will demonstrate a lower mortality rate as well as better physical outcomes.

NYP-Weill Cornell Medicine/HSS Trauma has been chosen as one of the sites for a national, multicenter research study intended to determine whether spinal vs. general anesthesia, when used as the primary anesthetic

technique for hip fracture surgery, is associated with improved recovery and decreased risk of adverse postoperative outcomes.

Education Updates The Metabolic Bone Disease Service works in collaboration with NewYorkPresbyterian Hospital to offer an interdisciplinary training program and offers regularly scheduled, CME-accredited Metabolic Bone Grand Rounds.

The Metabolic Bone Disease Fellowship provides highly motivated fellows with the clinical knowledge and research skills necessary for a successful career in academic orthopaedics and/or medicine.

Under faculty supervision, HSS PGY-1 residents perform in-patient metabolic bone disease consults on all fragility fracture patients. HSS PGY-2, -3, -4, and -5 attend trauma rounds that emphasize metabolic bone disease, pathophysiology, diagnosis, and treatment.

“The HSS Osteoporosis and Metabolic Bone Health Center is accredited by the International Society of Clinical Densitometry (ISCD) — ​it is the only center in New York with this distinction.”

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Orthopaedic Trauma Service David L. Helfet, MD Chief

The Orthopaedic Trauma Service (OTS) provides orthopaedic emergency care. OTS surgeons treat all fractures, including the upper and lower extremities, pelvis, acetabulum, and other bones and joints, dislocations, and polytrauma caused by sudden catastrophic events, such as automobile accidents. Nonunion and malunion fractures, including cases requiring deformity correction, are also treated by the OTS team.

Duretti Fufa, MD [1] David L. Helfet, MD [2] Joseph M. Lane, MD [3] Dean G. Lorich, MD [4] John P. Lyden, MD [5] David S. Wellman, MD [6] Not Pictured: Louis F. Amorosa, MD David E. Asprinio, MD Gregory S. DiFelice, MD Andrew Grose, MD

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“The significant referral nature of the Orthopaedic Trauma Service at HSS is what makes it unique, and allows fellows to gain a great deal of experience in the management of the more complicated injuries.”

Clinical Highlights In 2014, the Service had 405 inpatient admissions and 469 ambulatory surgeries at HSS, and 1,031 inpatient admissions and 333 ambulatory surgeries at NewYork-Presbyterian (NYP)/ Weill Cornell Medicine. Patient visits to HSS and all affiliated Trauma Centers totaled 4,105.

The Medical-Orthopaedic Trauma Service (MOTS) at NYP ensures that geriatric patients, particularly those with hip fractures, receive quality care through the collaboration of General Medicine and the Orthopaedic Trauma Service (OTS).

At HSS, a Hip Fracture Protocol has been developed under the direction of Dr. Linda Russell to expedite and improve the patient care, workup, surgery needed, and rehabilitation.

This has resulted in better patient care and outcomes.

Research Initiatives The research component of the Service is strong because of its large database,

the volume of complicated or more difficult, unusual cases, and the ability to do basic science research. OTS Attending Physicians, HSS scientists, and an established Research Division and its facilities, all provide an ideal foundation for clinical and laboratory research.

A series of projects is outlined at the beginning of each academic year by a general consensus of Attending staff and fellows. Attending Physicians provide close supervision for each project.

The OTS team has multiple ongoing studies, and a multitude of publications in peer reviewed journals. Funding for these projects has come through the Orthopaedic Trauma Association, AO North America, and from private donors.

Education Updates The educational program for the five residents rotating at any time and the three orthopaedic trauma fellows on the Combined OTS at HSS/NYP includes weekly conferences, Trauma Rounds at HSS and NYP, monthly

Bioskills Education Laboratory (BSEL) exercises, and Journal Club meetings.

Fellows have the opportunity to spend four months at the busiest Level I Trauma Center in New York State, Westchester Medical Center (WMC), with three fellowship-trained orthopaedic traumatologists on staff with whom they take calls.

The significant referral nature of the Service at HSS is what makes it unique.

This allows fellows to gain a great deal of experience in the management of the more complicated injuries, especially those patients with multi-orthopaedic injuries and the more difficult articular and extremity fractures. This provides the OTS a higher volume of such cases and affords the residents and fellows a unique experience, often not achievable in an emergency room setting only.

The addition of Dr. Louis F. Amorosa, fellowship-​trained in both orthopaedic trauma and spine surgery, has helped increase the caseload at WMC and the variety of cases. Consequently, this has dramatically increased the Level I, Acute Trauma experience for fellows.

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Pediatric Orthopaedic Service Roger F. Widmann, MD Chief

The Pediatric Orthopaedic Service brings together the depth and breadth of expertise and compassionate care equal to the top children’s hospitals across the country. Each year, members of the Service perform both conservative and surgical management in the care of thousands of infants, children, and adolescents who have a broad range of congenital, developmental, and traumatic conditions.

John S. Blanco, MD [1] H. Susan Cha, MD [2] Aaron Daluiski, MD [3] Emily R. Dodwell, MD, MPH, FRCSC [4] Shevaun M. Doyle, MD [5] Daniel W. Green, MD, MS, FAAP, FACS [6] Lisa S. Ipp, MD [7] Stephanie L. Perlman, MD [8] Cathleen L. Raggio, MD [9] David M. Scher, MD [10] Ernest L. Sink, MD [11] Roger F. Widmann, MD [12]

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Clinical Highlights The total 2014 surgical volume for pediatric patients was 3,011, inclusive of procedures performed at NewYorkPresbyterian/Weill Cornell Medicine and New York Hospital Queens. Total patient visits for the year were 20,225, excluding patient visits to NewYorkPresbyterian/Weill Cornell Medicine and New York Hospital Queens Clinic.

During 2014, two pediatric nurse practitioners, Grace Solomon and Lucia Fabrizio, completed their six-month training and orientation to pediatric orthopaedics and were welcomed into the Service as providers and physician extenders. Their addition has contributed to noticeable improvements in access to care and physician efficiency.

In 2014, both the MAGEC® Spinal Bracing and Distraction System for spinal deformity correction and the PRECICE® Intramedullary Limb Lengthening System were introduced.

These devices help correct deformities while simultaneously reducing the number of complications and surgical procedures required for the correction.

In 2014, the Hospital for Special Surgery Lerner Children’s Pavilion formalized a partnership with Madison Square Garden’s philanthropic foundation, Garden of Dreams. Working together with the Garden of Dreams organization, Service physicians and staff coordinated many special activities for patients and families.

Working with our Pediatric Council, the Service created a new position dedicated to addressing the psychosocial needs of all of our patients and families.

Research Initiatives The Service research team embarked on a significant growth and restructuring effort that promises to further facilitate the academic activities of Service members by creating a shared pool of research staff. To support this objective, the Service successfully recruited a Senior Research Coordinator and two new research assistants.

Under the leadership of Drs. Daniel Green and Emily Dodwell, 2014 was a very productive year for research.

Members of the Service collectively

participated in over 50 studies, which resulted in 26 presentations, 24 peer-​ reviewed journal publications, five book chapters, and five new grant awards.

To date for 2015, the Service has had 60 abstracts accepted for presentation. Of the abstracts submitted to the prestigious 2015 Pediatric Orthopaedic Society of North America (POSNA) annual meeting, 75% were accepted — ​ an unprecedented acceptance rate.

Education Updates Based on a curriculum that is reviewed and updated annually, the Service is proud to host five weekly didactic sessions, including three weekly clinical conferences, monthly Morbidity and Mortality (M&M) discussions, and a monthly journal club.

By pairing a strong curriculum with daily clinical and operative teaching experiences, the Service strives not only to teach the basics of pediatric orthopaedics, but also to inspire interest in the field.

“In 2014, members of the Pediatric Orthopaedic Service collectively participated in over 50 studies, which resulted in 26 presentations, 24 peerreviewed journal publications, five book chapters, and five new grant awards.”

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Spine Service

Frank Schwab, MD Chief

Many types of spine surgery considered complex at other hospitals are routine for Spine Service surgeons. In spinal surgery, getting it right the first time is crucial, which is why Spine Service members focus on spine conditions only. That focus, along with a continual commitment to research and innovation, consistently generates excellent long-term results.

Todd J. Albert, MD [1] Frank P. Cammisa, Jr., MD [2] Chief Emeritus, Spine Service Matthew E. Cunningham, MD, PhD [3] James C. Farmer, MD [4] Federico P. Girardi, MD [5] Charles B. Goodwin, MD [6] Russel C. Huang, MD [7]

Alexander P. Hughes, MD [8] Han Jo Kim, MD [9] Darren R. Lebl, MD [10] Patrick F. O’Leary, MD [11] Cathleen L. Raggio, MD [12] Bernard A. Rawlins, MD [13] Andrew A. Sama, MD [14] Harvinder S. Sandhu, MD [15]

Frank Schwab, MD [16] Roger F. Widmann, MD [17] Not Pictured: Oheneba Boachie-Adjei, MD Chief Emeritus, Scoliosis Service John S. Blanco, MD Joseph M. Lane, MD

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Clinical Highlights In 2014, the Spine Service performed 2,499 inpatient surgeries and 682 ambu­ latory surgeries, with a total of 17,132 patient visits. New patient visits comprised over 36% of all patient visits.

The joining of the Spine and Scoliosis Services into one Service this past year brings a new level of excellence to patient care. The development of a better business model in terms of efficiency, advancement of the staff, research funding, and overall financial support is also a priority.

In August 2015, Dr. Frank Schwab was named the new Chief of the Spine Service. He comes to HSS from New York University’s Hospital for Joint Diseases, where he served as Chief of Spine Deformity.

Dr. Schwab will continue to build on the fine work of Chief Emeritus Dr. Frank Cammisa and lead the Spine Service to a new level of excellence in patient care.

The Service thanks Dr. Cammisa for his prior leadership.

Dr. Oheneba Boachie-Adjei retired November 1, 2014. Dr. Boachie-Adjei

has served as Chief of the Scoliosis Service since 1994. He has returned to his native Ghana, where he is overseeing orthopaedic care at a hospital that he established. The Spine Service thanks Dr. Boachie-Adjei for his valuable contributions to the Scoliosis Service during his tenure as Chief.

The Spine Service also welcomed a new Director of Research, Virginie Lafage, PhD. Research Initiatives The FDA recently approved the launch of a clinical trial for the M6-C ­artificial cervical disc. This trial compares single-level cervical disc replacement to single-level fusion. HSS is the only participating hospital in the Northeast.

HSS is also participating in studies on cost-effectiveness in spine surgery, the effectiveness of patient navigators, and the parameters that define a “successful” surgery.

During 2014, the Service published a record 98 peer-reviewed journal articles, an increase of more than 25% over 2013. The number of book chapters written almost doubled, from 11 in 2013

to 19 in 2014, and Service members gave 109 presentations during the calendar year.

Education Updates The Spine Fellowship at HSS is one of the largest in the U.S. and is an ACGMEaccredited program. It has a robust curriculum and holds a weekly conference with rotating topics.

Fellowship Director Dr. Andrew Sama was awarded the AO Spine North America grant ($150,000) for the third consecutive time. This two-year award provides financial support of $75,000 per academic term.

Dr. Han Jo Kim joined Dr. Sama as Co-Director of the fellowship this year due to administrative needs and broadened attention to spinal deformity as part of the fellowship.

Interdisciplinary conferences with Neurosurgery are held on a quarterly basis, as well as a multi-disciplinary educational conference including all specialties within the Spine Care Institute.

“During 2014, the Spine Service published a record 98 peer-reviewed journal articles, an increase of more than 25% over 2013. The number of book chapters written almost doubled.”

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Sports Medicine and Shoulder Service

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Answorth A. Allen, MD [1] David W. Altchek, MD [2] Chief Emeritus Struan H. Coleman, MD, PhD [3] Frank A. Cordasco, MD, MS [4] David M. Dines, MD [5] Joshua S. Dines, MD [6] Lawrence V. Gulotta, MD [7] Jo A. Hannafin, MD, PhD [8]

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Anne M. Kelly, MD [9] Bryan T. Kelly, MD [10] Chief John D. MacGillivray, MD [11] Robert G. Marx, MD, MSc, FRCSC [12] Moira M. McCarthy, MD [13] Danyal H. Nawabi, MD [14] Andrew D. Pearle, MD [15] Anil S. Ranawat, MD [16]

Scott A. Rodeo, MD [17] Chief Emeritus Howard A. Rose, MD [18] Beth E. Shubin Stein, MD [19] Sabrina M. Strickland, MD [20] Samuel A. Taylor, MD [21] Russell F. Warren, MD [22] Thomas L. Wickiewicz, MD [23] Riley J. Williams, III, MD [24]

Primary Care Sports Medicine Brian C. Halpern, MD [25] Chief William J. Briner, Jr., MD [26] Kenton H. Fibel, MD [27] James J. Kinderknecht, MD [28] Peter J. Moley, MD [29] Brett G. Toresdahl, MD [30]

Bryan T. Kelly, MD Chief

The Sports Medicine and Shoulder Service is committed to providing a broad continuum of care to the athlete over the course of his or her career. Members of the Service partner with patients through all phases of the consultation, surgical, and rehabilitation process, always mindful of the athlete’s current and future performance needs.

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Not Pictured: Lisa R. Callahan, MD Edward V. Craig, MD, MPH Stephen Fealy, MD Marci Anne Goolsby, MD Osric S. King, MD Michael J. Maynard, MD

Jordan D. Metzl, MD Stephen J. O’Brien, MD, MBA Rock G. Positano, DPM, MSc, MPH Hollis G. Potter, MD Jennifer L. Solomon, MD David A. Wang, MD

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Sports Medicine and Shoulder Service

Clinical Highlights In 2014, the Sports Medicine and Shoul­der Service performed 1,745 inpatient surgeries and 7,579 ambulatory surgeries, with a total of 84,601 patient visits.

In 2014, Drs. David Altchek and Scott Rodeo stepped down as Co-Chiefs of the Service, and Dr. Bryan Kelly was named Chief of the Sports Medicine Service.

With the support of both Chiefs Emeritus, Dr. Kelly restructured the Sports Service in an effort to provide the highest level of clinical care to patients to become the global destination center for high-level athletes and the #1 educational venue for training future sports medicine specialists. For a full listing of sports organizations that choose HSS for care, see page 6 of this publication.

In 2015, the Service began establishing the concept of the Comprehensive Sports Medicine Institute (CSMI), which will fulfill the mission of developing a globally renowned, multi-disciplinary program offering the best evidence-​ based clinical care for athletes throughout the world, including elite, collegiate, high school and recreational athletes.

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Under the leadership of Dr. Jim Kinderknecht and John Cavanaugh, PT, ATC, Service fellows and residents acted as team physicians for 12 football teams from seven local area Public School Athletic League (PSAL) high schools. Plans are underway to expand the visibility of the Clinic to the PSAL to serve more injured athletes.

tissue-engineered implant for articular cartilage replacement, and evaluation of the effect of Vitamin D status on rotator cuff tendon healing.

Research Initiatives

Education Updates

Primary research efforts remain focused on the following areas: knee ligament stability, athletic conditions affecting the shoulder and elbow, shoulder stability, shoulder arthroplasty, hip preservation, meniscus transplantation, rotator cuff tendon healing, and articular cartilage repair.

Attending physicians continue to lead didactic lectures, weekly conferences, and one-on-one education in the Clinic and operating rooms; these are the primary vehicles for the Service’s educational process for residents and fellows.

The Service attained a grant to establish a program aimed at preventing injuries among vulnerable young athletes and was awarded an R01 NIH Grant for studying the comparative effectiveness of FAI arthroscopy.

The Service has several ongoing clinical trials, including analysis of biomarkers in the ACL-injured knee, evaluation of cartilage contact patterns in patients undergoing meniscus transplantation, evaluation of bone marrow-derived cells in rotator cuff repair, evaluation of a

The Tissue Engineering Repair and Regeneration Program continues to play a key role in the overall research program.

In addition to the hospital-based education process, Service members continue to educate locally, nationally, and internationally as faculty at numerous meetings and by continuing to publish original research papers and chapters for textbooks. In addition, Service members function as editorial reviewers and book and journal editors.

Department of Biomechanics

The Department of Biomechanics evaluates, designs, and tests orthopaedic implants and surgical treatments using the principles of engineering and materials science to help HSS surgeons solve clinical problems. This includes creating custom implant designs for patients with unique challenges. The Department actively teaches medical and engineering students on the relationship between biomechanics and clinical treatment decisions.

Timothy M. Wright, PhD Director Suzanne A. Maher, PhD Associate Director

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Christina Esposito, PhD [1] Carl W. Imhauser, PhD [2] Joseph D. Lipman, MS [3] Suzanne A. Maher, PhD [4] Timothy M. Wright, PhD [5] Not Pictured: Josh Baxter, PhD Christopher J. Hernandez, PhD Marjolein C.H. van der Meulen, PhD

Technology developed within the Department was successfully licensed into the first life sciences start-up company from HSS, providing a solid example of translating research findings into a new and important approach to joint restoration.

A study describing the biomechanical function of the recently rediscovered anterolateral ligament of the knee was completed and published. This study provides, for the first time, a basic understanding of the stabilizing role of this tissue against provocative, multi­ planar torsional loads, such as those that occur when there are rapid changes in direction during athletic activities.

The Department received the prestigious Otto Aufranc Award from the Hip Society for a study demonstrating that large femoral heads do not increase damage at the head-neck taper of metal-on-polyethylene total hip arthroplasties. This study assures arthroplasty surgeons that a large

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head can be considered as a means of improving joint stability without exacerbating the risk of fretting and corrosion at the taper.

Development of an evidence-based total knee replacement system was initiated in collaboration with Drs. Sculco, Padgett, Mayman, and Westrich. The goal is to develop a high-quality yet low-cost primary total knee device and related instrumentation that can be incorporated into the Hospital’s clinical care pathway for total knee arthroplasty.

The Department pursued an initiative to comprehensively evaluate the ability of a computational model of the knee to predict subject-specific motions and soft tissue loads. This initiative will aid the Department in gaining a mechanistic understanding of the risk of non-contact ACL rupture during sports, as well as the best personalized treatment for patients suffering ACL injury.

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A robotic simulator for studying foot and ankle mechanics was validated, demonstrating its ability to accurately recreate foot and ankle motions. This achievement allows testing of surgical procedures in simulated patient populations and the expected effects of treatment on foot and ankle function during a variety of daily activities.

For 2014, 55 articles on department research and innovation were published in the scientific literature.

Future goals include exploring the unique design capabilities afforded by 3D printing of orthopaedic implant materials to improve the performance of joint replacements for the hip, knee, and digits, and developing computer-​ based teaching modules for residents and fellows that capture the essence of orthopaedic biomechanics principles.

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Endowed Chairs, Professorships, and Fellowships

Endowed chairs, professorships, and fellowships recognize the generosity of our donors and sustain excellence in musculoskeletal care, research, and medical education.

Named Chairs and Professorships

Chitranjan S. Ranawat, MD, Chair in Adult Reconstruction and Joint Replacement Douglas E. Padgett, MD

Korein-Wilson Professorship in Orthopaedic Surgery Todd J. Albert, MD Benjamin M. Rosen Chair in Immunology and Inflammation Research Mary K. Crow, MD Joseph P. Routh Professor of Rheumatic Diseases in Medicine Mary K. Crow, MD Richard L. Menschel Research Chair and Chief Scientific Officer Lionel B. Ivashkiv, MD David H. Koch Chair for Arthritis and Tissue Degeneration Research Lionel B. Ivashkiv, MD Franchellie M. Cadwell Chair Sergio Schwartzman, MD Coleman Chair in Magnetic Resonance Imaging Research Hollis G. Potter, MD

Virginia F. and William R. Salomon Chair in Musculoskeletal Research Carl Blobel, MD, PhD Eduardo A. Salvati, MD, Chair in Hip Arthroplasty Mathias P. Bostrom, MD Thomas P. Sculco, MD, Chair in Orthopaedic Surgery Thomas P. Sculco, MD The Peter Jay Sharp Chair in Lupus Research Alessandra B. Pernis, MD St. Giles Research Chair supporting Theresa T. Lu, MD, PhD Starr Chair in Mineralized Tissue Research Adele L. Boskey, PhD

The Anne and Joel Ehrenkranz Chair in Hand and Upper Extremity Research Robert N. Hotchkiss, MD

Starr Chair in Tissue Engineering Research supporting Chitra Dahia, PhD

The Anne and Joel Ehrenkranz Chair in Perioperative Medicine Linda A. Russell, MD

Russell F. Warren Research Chair supporting Suzanne A. Maher, PhD

Allan E. Inglis, MD, Chair in Surgical Arthritis Mark P. Figgie, MD John N. Insall Chair in Knee Surgery Steven B. Haas, MD Collette Kean Research Chair Jane E. Salmon, MD F.M. Kirby Chair in Orthopaedic Biomechanics Timothy M. Wright, PhD Richard S. Laskin, MD, Chair in Musculoskeletal Education Charles N. Cornell, MD David B. Levine, MD, Chair in Scoliosis Frank Schwab, MD C. Ronald MacKenzie, MD, Chair in Ethics and Medicine C. Ronald MacKenzie, MD

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Leon Root, MD, Chair in Pediatric Orthopaedics Leon Root, MD

Stephen A. Paget, MD, Chair in Rheumatology Stephen A. Paget, MD

Named Fellowships Robert and Helen Appel Fellowship in Biomedical Engineering Natalie Kelly Finn and Barbara Caspersen Fellowship for Spine Research Byung Jo Victor Yoon, MS Charles L. Christian Research Fellowship Franck J. Barrat, PhD Ira W. DeCamp Fellowship in Musculoskeletal Genetics Mary Goldring, PhD Leo Farbman Fellowship for Pediatric Musculoskeletal Research Lorene C. Janowski, DPS, OTR/L, MS, C/NDT Helen Frankenthaler Fellowship in Restorative Mobility Andrew D. Pearle, MD Mary Rodgers and Henry Guettel Fellowship in Biomedical Mechanics Christina Esposito, PhD Ken and Jill Iscol Fellowship in Orthopaedic Research Andrew D. Pearle, MD Irving and Sally Lipstock Fellowship in Orthopaedic Surgery Lazaros Poultsides, MD, PhD Michael D. Lockshin Fellowship of the Barbara Volcker Center for Women and Rheumatic Disease Xiaoping Qing, MD, PhD Ludwig Fellowship for Women’s Sports Medicine Research Elizabeth Selvaggio Stavros Niarchos Foundation — ​ Thomas P. Sculco, MD, International Orthopaedic Fellowship Georgios Triantafyllopoulos, MD Robert and Gillian Steel Fellowship in Musculoskeletal Research Inez Rogatsky, PhD Nancy Dickerson Whitehead Research Fellowship Miguel Otero, PhD Fellowship in Arthroplasty Edward Purdue, PhD Immunology and Inflammation Fellowship Sergei Rudchenko, PhD

Department of Orthopaedic Surgery

Surgeon-in-Chief and Medical Director Todd J. Albert, MD 212.606.1004 Clinical Director Charles N. Cornell, MD 212.606.1414 Vice Chair of Education and Academic Affairs Program Director, Orthopaedic Surgery Residency Program Mathias P. Bostrom, MD 212.606.1674 Chair, Fellowship Committee John S. Blanco, MD 646.797.8366 Faculty Development Director Scott W. Wolfe, MD 212.606.1529

Orthopaedic Surgery Services Adult Reconstruction and Joint Replacement Division Douglas E. Padgett, MD, Chief, Adult Reconstruction and Joint Replacement Division 212.606.1642 Mathias P. Bostrom, MD, Chief, Hip Service 212.606.1674 Steven B. Haas, MD, Chief, Knee Service 212.606.1852 Mark P. Figgie, MD, Chief, Surgical Arthritis Service 212.606.1932 Foot and Ankle Service Matthew M. Roberts, MD, Chief 212.606.1181 Hand and Upper Extremity Service Edward A. Athanasian, MD, Chief 212.606.1962

Hip Preservation Service Robert L. Buly, MD, Chief 212.606.1971 Limb Lengthening and Complex Reconstruction Service S. Robert Rozbruch, MD, Chief 212.606.1415 Metabolic Bone Disease/Musculoskeletal Oncology Service Joseph M. Lane, MD, Chief 212.606.1172 Orthopaedic Trauma Service David L. Helfet, MD, Chief 212.606.1888 Pediatric Orthopaedic Service Roger F. Widmann, MD, Chief 212.606.1325 Spine Service Frank Schwab, MD, Chief 212.774.2834 Sports Medicine and Shoulder Service Bryan T. Kelly, MD, Chief 212.606.1159

Adult Ambulatory Care Center Alejandro Leali, MD, Medical Director 212.606.1433 Department of Biomechanics Timothy M. Wright, PhD, Director 212.606.1093 Research Division Lionel B. Ivashkiv, MD, Chief Scientific Officer 212.606.1171

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Recognition and Influence

#1 Orthopaedic Hospital Nationally The Hospital is ranked #1 in the country for orthopaedics by U.S. News & World Report Best Hospitals 2014–2015 rankings.

Top Residency Program in the U.S. Doximity is the largest community of physicians in the country; over 60% of U.S. doctors are verified members. The HSS Orthopaedic Surgery Residency Program was recognized as the top orthopaedic surgery residency program in the U.S. on Doximity’s Residency Navigator reputation and research list for the second consecutive year.

Leaders in Orthopaedic Research The Orthopaedic Research Society (ORS) is one of the most prestigious and wide-reaching orthopaedic research societies in the world. It provides a forum for presenting cutting-edge musculoskeletal research, education, and outreach, which includes publication of the top-tier, peer-reviewed journal, Journal of Orthopaedic Research.

HSS is extremely proud that two of its research faculty members are consecutive Presidents of the ORS. Dr. Mary Goldring served as ORS President for 2014–2015, and Dr. Mathias Bostrom is President for 2015–2016.

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Outstanding Publication Frequency in Top-Tier Orthopaedic Journals During the past year, HSS researchers and clinicians authored or co-authored 529 articles in peerreviewed medical journals. The HSS Department of Orthopaedics faculty were lead authors on 236 (45%) of those articles relating specifically to orthopaedics. Impact factors are measurements used to evaluate journal ranking — ​the higher, the better. There are 72 orthopaedic journals that have impact factor rankings; lower-ranking journals may have no impact factor at all. Of the 236 HSS Orthopaedics articles published: • 28 were published in orthopaedic journals with the 10 highest impact factors • 80 were published in orthopaedic journals with the 15 highest impact factors • 103 were published in orthopaedic journals with the 20 highest impact factors

Game-Changing Breakthroughs in Improving Patient Reported Outcome Compliance Obtaining complete postoperative data from patients is critical to identifying the best care delivery methods, optimizing postoperative therapy, and improving cost efficiencies. However, patient compliance with completing long postoperative surveys has always been challenging — ​until now.

Working collaboratively with HSS physicians and biostatisticians, the HSS Healthcare Research Institute developed short-form Patient Reported Outcome (PRO) surveys for hip and knee patients based on the top validated hip (HOOS) and knee (KOOS) surveys. With the validated HOOS, JR. and KOOS, JR. surveys, patients need only complete six and seven questions, respectively, instead of the 40 and 42 required by HOOS and KOOS. The HOOS, JR. and KOOS, JR. have received tremendous interest from the orthopaedic community.

Their brevity encourages better patient compliance, and they can be conveniently administered in a variety of ways depending on patient preference, including through smartphones.

For more information, visit: hss.edu

Message from the Surgeon-in-Chief

Dr. Leon Root (1929–2015)

All at Hospital for Special Surgery were deeply saddened by the loss of Dr. Leon Root in September. Dr. Root’s extraordinary leadership and vision in advancing patient care, providing for the community at large, championing medical education, and overseeing groundbreaking research will be felt well into the future. Dr. Root spent almost five decades of his medical career at HSS. He joined the staff in 1967, and in 1970 he became the Hospital’s first chief of pediatric orthopaedic surgery, essentially creating the Service. He served in

Like all surgeons, I think about my patients every day. And, of course, like all physicians, I try to keep up with the advances that could allow me and my colleagues here to do even more for patients tomorrow than we could today.

But as I move well into my second year here at HSS, I’ve come to reflect on what it is about my job that feels a bit unique. I think I’d summarize the answer this way: As part of HSS, I feel a special responsibility to the field of orthopaedics.

Meanwhile, leadership and advancement have never been more critical to the field.

These are challenging times for medicine, involving rapid change and growing pressures to deliver more value. Far from being isolated from these changes and pressures, orthopaedics is likely to end up at the heart of the whirlwind. On one hand, there is a likely tsunami of growth heading our way in the burden of degenerative joint disease and reduced bone quality because of an aging population.

On the other, medicine is being pushed to focus on the major chronic diseases.

That’s appropriate, but it carries a risk

that those outside of orthopaedics will underestimate the field’s huge impact on population quality of life and productivity, and won’t fully recognize the potential benefits of advances in musculoskeletal care, including sufficient access to specialists to avoid long waits for treatment or less than top-quality care.

About Hospital for Special Surgery

This year we took a major step forward in delivering higher-value musculoskeletal care by creating the role of Chief Value Medical Officer. Catherine MacLean, MD, PhD, joined HSS in July 2015 to help us better coordinate many activities that support the delivery of high-value musculoskeletal care. A major focus for Dr. MacLean will be on helping HSS do an even better job at producing highvalue care by more accurately measuring patient health improvement while ensuring we are responsible stewards of our healthcare dollars.

All of us in this field have to step up, and share the burden of leadership, advocacy, and producing advances. We’re acutely aware of it here at HSS, and it drives us to do better in every way possible. Let me share a few of the areas of focus here that I think are having real impact on the field: Design by Addison www.addison.com

Todd J. Albert, MD, FACS Surgeon-in-Chief and Medical Director, Korein-Wilson Professor of Orthopaedic Surgery

That sense of needing to do more for the field, a sense I know I share with all my colleagues here, is one that stems from being with an institution that’s entirely dedicated to musculoskeletal disease and nothing else. Everything that happens here revolves around the field; everyone here is a specialist in it. The sheer volume of patients and surgeries here, and the breadth of orthopaedic services, ensure that it commands our attention 24/7, and provide us with a big picture of patient challenges and outcomes. That institutional focus and perspective compel us to do our share and more in strengthening the field and pushing it forward.

this role for 27 years. Dr. Root thought of himself as an orthopaedic family doctor, caring for his patients from childhood through adulthood. Among his many accomplishments, Dr. Root established New York City’s first clinic for children with osteogenesis imperfecta at HSS, founded New York State’s first Pediatric Orthopaedic Outreach Program, which was named the Leon Root, MD, Pediatric Outreach Program (POP) in his honor, and expanded the Hospital’s Cerebral Palsy Clinic. Dr. Root also served as medical director of the Rehabilitation

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology, and rehabilitation. HSS is ranked #1 in the country for orthopaedics and #3 for rheumatology (in association with NewYork-Presbyterian Hospital)

by U.S.News and World Report Best Hospitals 2015–16 rankings. It is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. Located in New York City, HSS also serves patients in the regional area with outpatient centers in Connecticut, New Jersey, Long Island, and Queens, and serves Florida patients with an outpatient rehabilitation office in West Palm Beach.

Patients choose to come to Hospital for Special Surgery from across the U.S. and from around the world. HSS has one of the lowest infection rates in the country. HSS is a member of

Department at HSS for more than four decades, overseeing its transition into the nationally recognized service it has become today. Former patients and colleagues will remember him best for his outstanding contributions to the field of pediatric orthopaedics, for his deep concern for those under his care and for their families, for his extraordinary ability to mentor and teach, and for his vision and efforts to create a better quality of life for those with musculoskeletal conditions, especially children.

Officers

the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medicine, and as such, all Hospital for Special Surgery medical staff are faculty of Weill Cornell Medical College.

The Hospital’s Research Division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. To learn more, please visit www.hss.edu.

Chair Kendrick R. Wilson III Vice Chair Michael Esposito Thomas Lister Deirdre Stanley President and Chief Executive Officer Louis A. Shapiro Surgeon-in-Chief and Medical Director Todd J. Albert, MD Executive Vice President Lisa A. Goldstein

Attributions

The Department of Orthopaedic Surgery 2014–2015 Annual Report is produced by the Communications Department at Hospital for Special Surgery.

©2015 Hospital for Special Surgery. All rights reserved.

Executive Vice President and Treasurer Stacey L. Malakoff Executive Vice President, Chief Legal Officer and Secretary Irene Koch, Esq. Chairman, Emeriti Richard L. Menschel Dean R. O’Hare Aldo Papone

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Hospital for Special Surgery Department of Orthopaedic Surgery Todd J. Albert, MD, Surgeon-in-Chief, 212.606.1004

The Outsized Impact of Orthopaedics Department of Orthopaedic Surgery 2014–2015 Annual Report