HSS Orthopedic Annual Report 2016

Hospital for Special Surgery Department of Orthopaedic Surgery 2015–2016 Annual Report

Dedication.

Precision.

Impact.

Contents 3

Message from the Surgeon-in-Chief

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A Legacy of Dedication

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Leading the Way in Healthcare Quality and Efficiency

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Discovering New Pathways to Healing

11 Transforming Orthopaedics Across the Globe Through Education 12 A Patient-Centered Culture 14 Achievements 15 Our Focus Areas 16 Adult Reconstruction and Joint Replacement Service 18 Foot and Ankle Service 20 Hand and Upper Extremity Service 22 Hip Preservation Service 24 Limb Lengthening and Complex Reconstruction Service 26 Metabolic Bone Disease/ Musculoskeletal Oncology Service 28 Orthopaedic Trauma Service 30 Pediatric Orthopaedic Service 32 Spine Service 34 Sports Medicine and Shoulder Service 36 Department of Biomechanics 38 Endowed Chairs, Professorships and Fellowships 39 Department of Orthopaedic Surgery 40 About Hospital for Special Surgery

Dedication Since 1863, HSS has been dedicated to the advancement of musculoskeletal medicine through specialized patient care, innovation and education. Our commitment to the most advanced basic, translational and clinical research enables us to deliver the most sophisticated patient-centered care, helping to prevent injury, diagnose and treat patients most reliably and efficiently, and maximize patient wellness and performance.

Precision Precision defines our clinical pathways. It is not only essential while performing surgery, but it is also the way we approach making a diagnosis, avoiding unnecessary surgery, planning a procedure and preventing complications. We are constantly refining our pathways to improve patient care and the reliability of outcomes.

Impact By advancing science and patient care, and sharing knowledge and protocols with medical professionals in 145Â countries, HSS is increasing quality, value and opportunity across the field of Orthopaedics. The implications of this are profoundly important at a time when musculoskeletal care has become among the largest and fastest-growing costs in an overburdened and underperforming healthcare system. Through continuing unmatched investments and achievements in patient care, research, innovation and education, we intend to amplify that impact into the future.

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Message from the Surgeon-in-Chief Now that I’m about to begin my third year here, I can’t really say I’m “new” to HSS anymore. Yet every day I still feel a sense of excitement about the work here. And it’s not just me. At HSS, people who have been serving patients for two decades tell me they feel the same way.

It’s not easy to explain to others what makes HSS so unique.

But let me try to do it by focusing on a few key concepts: First, there’s dedication. Yes, I know, most clinicians are dedicated. But at HSS, the dedication to excellence and service is institutionalized at such a high level that it almost hits you when you walk through the front door. There’s a sense that we have to do more for patients and the field than anyone else.

It’s an obligation that challenges all of us. There’s nothing we do for patients that’s too small or too big to somehow be done better or more conveniently. I like to say we’re “advantaged” at HSS in that we focus entirely on musculoskeletal care. If we can’t take that care to the next level, who’s going to do it?

Then there’s precision. Of course, there’s precision on the operating table, and we’re achieving it through the use of everything from robotics to stereotactic guidance. But we’re determined to bring even more precision to patient care.

That means more precise diagnoses and better surgical planning — new ways to “pre-hab” patients so they’re in better shape for surgery. It also means innovations in rehabilitation that increase the chances of the best possible outcomes.

With the guidance of Catherine MacLean, MD, PhD, our Chief Value Medical Officer, we evaluate every clinical pathway, carefully observing and measuring the impact of any deviation from the expected. This allows us to constantly hone our processes. Patient surveys are an essential part of our clinical care, and we scrutinize the results for opportunities to improve care and outcomes.

In 2016, our quest for precision led us to implement the widely acclaimed Epic electronic medical record system. This required an enormous commitment by our staff to incorporate the very latest in information technology into clinical care. One major outcome: We are better able to measure performance and improve clinical decision-making.

Finally, there’s impact. At the simplest level, there’s our impact on a patient’s body. But we’re also keenly aware of our ability to have an impact on a patient’s life — the way we can restore a person’s sense of being fully capable, of feeling him- or herself again in every way. And then there’s our impact on society: We help people return to productivity.

We’re also having an impact on a growing number of communities by making our cutting-edge care more accessible for patients. In 2016, we partnered with Stamford Health System to open HSS Sports Rehab Provided by Stamford Health in Stamford, CT. Our new outpatient center in White Plains, NY, is set to open in 2017.

As we expand domestically, we want to make a difference in the lives of patients around the world. Our partnerships with hospitals in South Korea and Brazil enable us to play a role in advancing the practice of orthopaedics in those countries. In 2015, we formed a new educational partnership in China, and we’re considering additional alignments with hospitals in Asia, the Middle East and Latin America.

Perhaps our greatest impact, however, will ultimately come from our research. Our Precision Medicine Laboratory in Orthopaedics, which was introduced in 2016, is poised to transform our ability to restore function to patients.

Every day, orthopaedic surgeons improve the lives of countless people. To deliver even better care, however, we will need to collaborate in a variety of ways. Sharing our collective knowledge is the best way to advance the field — and provide the highest quality care for patients.

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

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A Legacy of Dedication All of the things that make HSS unique — ​our caring culture, our emphasis on research and our tradition of excellence — ​can be traced to the influence of Philip D. Wilson, Jr., MD. Dr. Wilson served as the Hospital’s Surgeon-­in-Chief from 1972 to 1989 and passed away on June 29, 2016. “He was a world-­renowned leader, teacher and surgeon,” says Charles N. Cornell, MD, Attending Orthopaedic Surgeon and Clinical Director of Orthopaedic Surgery. “His mantra was to improve patient care.”

Dr. Wilson was appointed to the HSS staff in 1951 and joined his father’s practice. Philip Wilson, Sr., MD, who served as Surgeon-­in-Chief from 1935 to 1955, established the Hospital’s first Research Division. Taking a cue from his father, Dr. Wilson sought to strengthen HSS’s research program. One of his most notable accomplishments was to transform HSS into a leading joint replacement center. He introduced total hip replacement to the Hospital in 1967, garnering national news coverage, and expanded the Biomechanics Department. He recruited engineers to collaborate with orthopaedic surgeons on developing custom implants, enabling patients with debilitating arthritis to find relief.

Dr. Wilson also introduced new protocols for preventing infections in the operating room, as well as improvements in anesthesia practices. He encouraged young physicians to obtain specialty training before joining HSS, which led to the Hospital’s focus on highly specialized orthopaedic care.

And he launched a joint replacement registry of more than 1,200 patients to find out how hip replacement improved patients’ quality of life over a 40-year period.

During his tenure as Surgeon-­in-Chief, Dr. Wilson became Director of Resident Training. He served as a role model for Residents and Fellows and was considered a surgical mentor and teacher. “When I was a senior resident and trying to decide on a subspecialty, Dr. Wilson called me into his office,” recalls Dr. Cornell. “I had applied for a fellowship in shoulder and elbow replacement, but he wanted me to stay at HSS and fill a needed role in Trauma. He got my career started, and I feel grateful to him.” Later, Dr. Wilson wrote letters of recommendation to

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help Dr. Cornell obtain research grants. He also supported the research of Jo Hannafin, MD, Attending Orthopaedic Surgeon and Director of the Women’s Sports Medicine Center. “Even though I wasn’t an arthroplasty surgeon, Dr. Wilson would stop me in the hall and ask about my research,” she recalls.

“He referred children and grandchildren of his patients with sports-related injuries to me. He was so gracious.”

The caring culture at HSS can, in part, be attributed to Dr. Wilson. “He established it in the way he took care of patients, the way he praised people for doing the right thing and the way he took people to task if they weren’t doing the right thing,” says Dr. Hannafin, who recalls that Dr. Wilson would admonish a Resident or Fellow who was not clean-­shaven.

Dr. Wilson referred T. Gordon Young, who was President of HSS from 1954 to 1977, to Dr. Hannafin. He told her that in the 1970s, he and Dr. Wilson would make and serve pancakes to staff members when staff had to stay at the Hospital during severe snowstorms. Dr. Wilson’s legacy will not be soon forgotten.

Says Dr. Hannafin: “Dr. Wilson knew everyone — ​the guys painting the hallways, the transport people, the X-­ray staff, the faculty — ​and always made an extra effort to engage people.”

Impact of: Value-Based Care Research Global Education Culture

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Leading the Way in Healthcare Quality and Efficiency

“ We do the right intervention the first time,” says Todd Albert, MD, Surgeonin-Chief and Medical Director. “We choose the most appropriate therapy — ​as well as one that is durable.”

As the healthcare market shifts from a focus on the individual elements of care to the episode of care overall, HSS is setting the benchmark for quality and value. Our mission is to return patients to good health and productivity most reliably and efficiently. By investing our unmatched knowledge and expertise in the four pillars of healthcare value — ​prevention, diagnosis, treatment and recovery — ​we are able to achieve a high rate of successful outcomes. Compared to similar hospitals in the Press Ganey database, HSS has scored in the 99th percentile on “Likelihood to Recommend” — ​a key indicator of customer satisfaction — ​for 33 consecutive quarters.

The healthcare system and providers bear the substantial economic burden of not keeping patients healthy and active in the first place. So we are using our expertise in musculoskeletal medicine to improve prevention strategies.

If a patient develops a condition, we ensure an accurate diagnosis by employing the most sophisticated imaging techniques. We are partnering with GE Healthcare to advance imaging knowledge and practices, helping patients to avoid costly and devastating subpar diagnoses. Identifying a patient’s condition accurately enables us to deliver the most effective treatments, helping patients to function at their highest possible level more reliably and efficiently. “We do the right intervention the first time,” says Todd Albert, MD, Surgeon-in-Chief and Medical Director. “We choose the most appropriate therapy, whether it’s surgery or an injection — ​as well as one that is durable, meaning it doesn’t require a revision.” We also minimize the risk of costly setbacks and complications. HSS ranks in the 99.9th percentile nationally in Major Orthopaedic Surgery based on avoided complications, according to CareChex®, an informative service of Quantros, Inc. To advance value-based care, HSS is delivering the most appropriate therapies. In an HSS pilot study, 26 percent of patients who were told they needed surgery and came to HSS for a second opinion were advised to try a nonsurgical alternative, helping them to avoid a costly, possibly unnecessary procedure. To avoid the use of inappropriate procedures — ​such as X-rays and surgery — ​in spine care overall, HSS has developed a fast-track program for acute back pain patients. With the program, which is based on evidencebased guidelines, a patient will see the appropriate HSS care provider within 24 hours of calling HSS. For most patients, this will be a nurse practitioner and/or a physical therapist, who will provide the indicated conservative management. “We will provide value to the larger population of back pain patients by helping patients feel better while avoiding unnecessary, costly and potentially harmful diagnostic tests and therapies,” says Catherine MacLean, MD, PhD, Chief Value Medical Officer. The program is expected to launch in early 2017.

HSS patient Patricia Muir of Peoria, AZ, is back to rock climbing — ​painfree — ​after having a lumbar fusion.

To help HSS physicians make even better-informed treatment decisions, our Value Management Office is tracking patient-reported outcome measures (PROMs). For years, HSS has collected PROMs on many of our patients through a large number of research registries. By the end of 2016, all patients who undergo a procedure at HSS will complete the same general health survey tool — ​the PROMIS® Global. Hip and knee replacement patients will also complete the HOOS JR and KOOS JR before and after their procedures. By the end of 2017, all patients at the main campus in New York City will complete the PROMIS Global, as well as a relevant disease-specific survey at appropriate time intervals. Says Dr. MacLean, “Data from these measures will enhance efforts based on our registry data to accurately predict patient outcomes, helping the physician and patient determine which therapy is most appropriate based on patient preferences and goals.”

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Discovering New Pathways to Healing From stem cells to genomics, HSS’s cutting-edge research is having a major impact on the field of musculoskeletal medicine. In 2015–2016, HSS physicians and scientists made many breakthrough discoveries, which will eventually help patients return to work and their favorite activities more quickly.

HSS researchers Camila Carballo, PT, MSc, (right) and Amir Lebaschi, MD, (left) investigate whether intrinsic stem cells can be used to repair injured tendon tissue.

In Sports Medicine, Scott Rodeo, MD, Attending Orthopaedic Surgeon, is making progress in understanding how tendons can be repaired. One of the most exciting findings is that intrinsic stem cells — ​which are probably involved in early tissue formation — ​may help heal injured tendon tissue.

When these cells are stimulated, new blood vessels form, cells proliferate and the tissue becomes stronger. “It is a totally novel approach to cellbased therapies,” says Dr. Rodeo. “We are the first to use these cells in any musculoskeletal tissue.” Now HSS researchers are investigating whether intrinsic stem cells could play a role in meniscus and cartilage repair.

Other groundbreaking research is focusing on periprosthetic joint infections. Attending Orthopaedic Surgeons Mathias Bostrom, MD, and Geoffrey Westrich, MD; Assistant Attending Orthopaedic Surgeon Michael Cross, MD; HSS infectious disease specialists; and Laura Donlin, PhD, of the Precision Medicine Laboratory (PML), are investigating how these infections develop — ​and how to best treat them. Dr. Bostrom is developing a model of periprosthetic infections to better understand what causes this challenging — ​and devastating — ​clinical problem. And Drs. Cross and Westrich are investigating the diagnosis and treatment of such infections, as well as the risk factors.

Great strides are also being made in understanding the mechanical factors that can contribute to the development of osteoarthritis. Scientists and clinicians in Biomechanics, Imaging and Sports Medicine are collaborating on research to determine why some patients develop osteoarthritis after removal of the meniscus following meniscal injury. In a recent pilot study, HSS researchers, led by Suzanne Maher, PhD, Associate Scientist and Associate Director of the Department of Biomechanics, determined that patients with areas of high contact stresses in the knee joint will most likely experience tissue degeneration later. The goal is to predict a patient’s risk of osteoarthritis using computer-based models and MRI scans. Eventually, a surgeon might be able to treat not only the site of injury but also the areas that are at risk of developing osteoarthritis.

In Spine, Chitra Dahia, PhD, Assistant Scientist, is studying the key developmental pathways involved in the formation and development of spinal discs. She hopes to create a biological therapy that could reawaken the aged or degenerated discs’ own (dormant) cells to regenerate them. A $1.9 million NIH grant is funding her work. Dr. Dahia has created genetic models that will help illuminate the cellular, molecular and biomechanical changes associated with disc degeneration, as well as the mechanisms associated with regenerating the disc.

Another important accomplishment is the creation of the Precision Medicine Laboratory in Orthopaedics, which is directed by Assistant Scientist Miguel Otero, PhD. The PML is involved in two key projects. In one, a multidisciplinary team led by Timothy Wright, PhD; Hollis Potter, MD; Matthew Koff, PhD; Alessandra Pernis, MD; and Paul Purdue, PhD, is trying to determine ways to prevent the dissatisfaction and pain that occur in 15 percent of knee replacement patients nationwide. In another study, led by Dr. Rodeo, scientists are investigating biological approaches to improving orthopaedic outcomes, such as platelet-rich plasma. Says Lionel Ivashkiv, MD, Chief Scientific Officer, “The idea is to take precision medicine/genomics approaches and be among the first — ​if not the first — ​to apply them in orthopaedic research.”

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“ We are the first to use intrinsic stem cells in any musculoskeletal tissue,” says Scott Rodeo, MD, Attending Orthopaedic Surgeon.

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“ It’s part of our mission to be world leaders,” says Laura Robbins, DSW, Senior Vice President, Global and Academic Affairs. “We have an obligation to help other hospitals be better at what they do.”

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HSS providers visit their counterparts at partner Bumin Hospital in Busan, South Korea. From left to right: HSS physical therapist Erica Fritz, DPT, OCS; Michael Cross, MD, Assistant Attending Orthopaedic Surgeon; and Joseph Oxendine, MD, Assistant Attending Anesthesiologist

Transforming Orthopaedics Across the Globe Through Education HSS not only delivers the highest quality care to patients in the U.S.; our physicians also help to bring those standards to hospitals around the world. This year, we formalized our strategy for increasing our global presence. HSS now works with global hospitals and healthcare systems in several different ways to advance patient care — ​in an advisory role; by creating networks of orthopaedic hospitals; and through business ventures.

“It’s part of our mission to be world leaders,” says Laura Robbins, DSW, Senior Vice President, Global and Academic Affairs. “We have an obligation to help other hospitals be better at what they do.”

In the advisory role, HSS is transferring best practices to partner hospitals in South Korea and Brazil. The effect has been significant: “The strides Hospital Alvorada [in São Paulo, Brazil] has made in terms of their care delivery are spectacular,” says Mathias Bostrom, MD, Attending Orthopaedic Surgeon.

A year ago, HSS began working with the hospital on enhancing the data they collect so they have more meaningful outcomes.

When hospitals meet certain standards, such as high-­quality outcomes, they can become an HSS Global Orthopaedic Alliance member, a program that was launched in 2015. The first member was the Bumin Hospital Group in South Korea, and the second was Hospital Alvorada. Member hospitals display the “HSS Global Orthopaedic Alliance Member” sign at their institutions. “We’re trying to establish a global network where everyone is achieving high quality standards in education, research and clinical care,” says Michael B. Cross, MD, Assistant Attending Orthopaedic Surgeon.

If an Alliance member meets an elite level of care delivery — ​meaning it has certain high standard outcomes in quality and care delivery, as well as educational programming and clinical pathways — ​it can become an “HSS Center of Excellence.” This designation can also be achieved through an HSS business venture, which may involve co-­owning a hospital, managing the institution’s orthopaedic services, or helping to build a hospital. HSS is currently exploring potential relationships with institutions in Asia, the Middle East and Latin America.

HSS also has another type of partnership: an academic and clinical exchange and collaboration. In 2015, we launched our first official collaboration with a Chinese hospital. We are conducting routine case studies, participating in a second opinion program, and doing exchange visits with The Second Affiliated Hospital, Zhejiang University School of Medicine in Hangzhou, China.

Over the past six years, we have had an educational partnership with China called the HSS China Orthopaedic Education Exchange. Chinese physicians, the HSS China Exchange Fellows, come to HSS for two months and learn from our joint replacement surgeons. We also have Live Grand Rounds via videoconference with three premiere orthopaedic institutions in Beijing.

There are now two extensions of this program: the HSS-­China Research Exchange, in which our researchers are discussing ways to collaborate with their Chinese counterparts; and the HSS-­China Rehabilitation Exchange, in which Chinese physical therapists come to HSS for training, knowledge exchange and education.

HSS also offers educational symposia for orthopaedic surgeons and physical therapists around the world. “When I meet surgeons from other countries, I’m amazed to see how much respect they have for HSS,” says Dr. Cross. “They really pay attention to our research and integrate it into their own clinical practices. I’m proud to be part of HSS and our global development.”

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A Patient-Centered Culture In an era of hospital mergers and acquisitions, independence is enabling HSS to maintain its focus wholly on advancing patient care — ​within its walls and beyond. This unique concentration encourages collaboration among our physicians and scientists, which advances the field. Surgeons and clinicians work with imaging specialists to make the most accurate diagnoses, and engineers team up with surgeons to design state-of-theart implants. “Our physicians are allowed to practice in a place without distraction,” says Todd J. Albert, MD, Surgeon-in-Chief and Medical Director.

“There’s no competing with the needs of general surgeons, urologists or cancer specialists. We’re all trying to achieve the same goal: improvement in musculoskeletal care.”

At HSS, we are fortunate that our independence makes it possible for our physicians to share a never-ending quest to improve patient care. “Here, everyone from PAs to physical therapists specializes in orthopaedics,” says Jo Hannafin, MD, Attending Orthopaedic Surgeon and Director of the Women’s Sports Medicine Center. “As an example, our PAs in the OR are not only just focused on orthopaedics as compared to general heart surgery, but most who work with sports medicine surgeons are further subspecialized with a focus on orthopaedic sports and shoulder procedures. HSS physical therapists are also subspecialty trained, whereas many other institutions have general PTs. That specialization at every level makes a big difference for patients, who benefit from our providers’ level of expertise.”

Being “better” is not just a philosophy at HSS; it’s the art and science of helping people return to their favorite activities efficiently and at the highest achievable level. We are exploring how to improve patient care from the initial consult — ​and even beforehand, in terms of wellness — ​until months after discharge.

Our relentless focus on improving care delivery benefits patients, who have fewer infections, complications and readmissions than those at other leading hospitals. More than 90 percent report relief from pain after total knee or hip replacement and ACL reconstruction, according to HSS Arthroplasty and ACL registries. Our commitment to clinical pathways has helped to eliminate variability and reduce risk in patient care. “Every member of the healthcare team at HSS knows what should be happening, as do patients,” says Charles N. Cornell, MD, Attending Orthopaedic Surgeon and Clinical Director of Orthopaedic Surgery.

To help raise the standard of care around the world, we are exploring research collaborations with pioneers in other countries, such as China. And we are increasing our support to hospitals worldwide that seek to adopt our best practices. In a recent example, we helped Hospital Alvorada, in São Paulo, Brazil, improve their OR efficiency, transforming their orthopaedic care delivery.

HSS patients are aware of our unparalleled dedication and how they benefit in the short- and long-term. “They feel they’re getting the best care here, so they’re more motivated to comply with treatment,” says Frank Schwab, MD, Chief, Spine Service. “When patients encounter our researchers, they realize their care is being closely monitored and their outcomes are being tracked. They think, ‘This institution really takes this stuff seriously. So I will make sure I do everything right.’ Patients realize they play an important role in aiding their recovery.”

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S. Robert Rozbruch, MD, Chief, Limb Lengthening and Complex Reconstruction Service, explains how he helped correct fitness trainer Laticia Nish’s bow leg.

“ Patients feel like they’re getting the best care here, so they’re more motivated to comply with treatment,” says Frank Schwab, MD, Chief, Spine Service.

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Achievements

#1

IN THE U.S. FOR ORTHOPAEDICS for the seventh consecutive year

by U.S. News & World Report “Best Hospitals”

#1

(2016–2017 rankings)

ORTHOPAEDIC RESIDENCY PROGRAM in both reputation and research output by the professional healthcare network Doximity

#1

IN THE NATION FOR MEDICAL EXCELLENCE in both Major Orthopaedic Surgery and Joint Replacement for four consecutive years by CareChex®, an informative service of Quantros, Inc. (2014, 2015, 2016, 2017)

The newly created Complex Joint Reconstruction Center is the first of its kind in the world.

Under the leadership of Thomas P. Sculco, MD, Attending Orthopaedic Surgeon and Surgeon-in-Chief Emeritus, this multidisciplinary and collaborative Center will provide best-in-class diagnosis and treatment of the most challenging cases in joint reconstruction. It will also conduct leadingedge research on the causes and prevention of implant failure. The Thomas P. Sculco, MD Chair in Orthopaedic Surgery, established through the generosity of friends and donors, provides enduring support for the Center.

THREE CONSECUTIVE YEARS HSS was named One of Healthgrades® America’s 100 Best Hospitals for Spine Surgery™ for the third consecutive year (2015–2017).

FOUR CONSECUTIVE YEARS Winner of the 2013–2016 Press Ganey Guardian of Excellence Award® — a nationally recognized symbol of achievement in patient experience — for the fourth consecutive year.

SEVEN CONSECUTIVE YEARS HSS goes above and beyond mandated protocols to prevent infections post-surgery. We have had significantly lower infection rates than the New York State average for hip replacement for seven consecutive years.

TEN CONSECUTIVE YEARS HSS received Healthgrades® 5-star rating for Total Hip Replacement for the 10th consecutive year (2008–2017).

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FOUR CONSECUTIVE MAGNET® DESIGNATIONS by the American Nurses Credentialing Center, the highest award for nursing excellence HSS is the first hospital in New York State and one of only 37 hospitals in the U.S. to achieve the Magnet designation four consecutive times.

SIX TOP HONORS In its 2017 Report to the Nation, Healthgrades® recognized HSS with six top honors: America’s 100 Best Hospitals for Spine Surgery, Excellence Awards in Joint Replacement and Spine Surgery, and 5-Star Ratings for Total Hip Replacement, Back Surgery and Spinal Fusion Surgery.

99th PERCENTILE For 33 consecutive quarters, HSS has scored in the 99th percentile on “Likelihood to Recommend” — a key indicator of customer satisfaction in many industries — when compared to similar hospitals in the Press Ganey database.

Our Focus Areas Adult Reconstruction and Joint Replacement Service Foot and Ankle Service Hand and Upper Extremity Service Hip Preservation Service Limb Lengthening and Complex Reconstruction Service

Orthopaedic Trauma Service Pediatric Orthopaedic Service Spine Service Sports Medicine and Shoulder Service Department of Biomechanics

Metabolic Bone Disease/ Musculoskeletal Oncology Service

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Adult Reconstruction and Joint Replacement Service Physicians in the Adult Reconstruction and Joint Replacement Service at HSS perform more joint replacement procedures than any other hospital in the country. Our surgeons use the latest technologies to help patients return to a pain-free, active lifestyle quickly.

CHIEF Douglas E. Padgett, MD CHIEF, HIP SERVICE Mathias P. Bostrom, MD CHIEF, KNEE SERVICE Steven B. Haas, MD CHIEF, SURGICAL ARTHRITIS SERVICE Mark P. Figgie, MD

Clinical Highlights In 2015, with the help of generous donors, a new Complex Joint Reconstruction Center (CJRC) was established to serve as a single point of access to medical care for patients with complex joint disorders. Under the leadership of Thomas Sculco, MD, the CJRC has hired an assistant director of research and a clinical manager; developed a revision-­specific education course; and created standardized order sets, as well as a postoperative note template. The CJRC is currently establishing a revision registry.

The Adult Reconstruction and Joint Replacement (ARJR) Service participated in Medicare’s voluntary Bundled Payment for Care Improvement (BPCI) initiative and transitioned to the Comprehensive Care for Joint Replacement model, effective July 1, 2016. Through BPCI, there has been an increase in Medicare patients discharged to their homes and a decrease in skilled nursing facility length-­of-stay. The latter is attributed to the creation of a “preferred” network of skilled nursing facilities that are committed to following HSS protocols.

Alexander McLawhorn, MD, joined the ARJR Service as an Attending Surgeon.

Dr. McLawhorn recently completed his

ARJR Fellowship at HSS. He is based primarily in Stamford, CT.

Research Initiatives The Service joined the American Joint Replacement Registry. Douglas Padgett, MD, was appointed as the American Academy of Orthopaedic Surgeons representative on the Board of Directors.

Stephen Lyman, PhD, and ARJR co-­ investigators reduced the number of questions on the Hip disability and Osteoarthritis Outcome Score (HOOS) and the Knee injury and Osteoarthritis Outcome Score (KOOS) from 42 to 6 and 7, respectively. HOOS/KOOS-­ JR was accepted as a functional assessment by CMS. Both papers were published in Clinical Orthopaedics and Related Research.

Michael Cross, MD, received a grant from The Price Family Foundation to conduct a multi-­center study investigating the treatment of joint replacement infections in one stage instead of two. Currently, two-­stage revisions — ​in which the infected prosthesis is removed and reinserted weeks later after a course of antibiotic treatment — ​are considered the gold standard in North America. A one-­stage procedure, which involves removing the infected prosthesis and

FROM LEFT TO RIGHT: Douglas E. Padgett, MD; Mathias P. Bostrom, MD; Steven B. Haas, MD; Mark P. Figgie, MD; Michael M. Alexiades, MD; Friedrich Boettner, MD; Robert L. Buly, MD; Charles N. Cornell, MD; Michael B. Cross, MD; Alejandro Gonzalez Della Valle, MD; Allan E. Inglis, Jr., MD; Seth A. Jerabek, MD

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inserting the new one during the same operation, is gaining favor outside of North America.

Five groups of HSS physicians received ARJR Marmor Research Grants totaling $50,000.

Edwin Su, MD, received the Young Investigator Award from The Knee Society for his paper “Thrombogenic Risk of Unicompartmental Knee Versus Total Knee Replacement.”

Education Updates

Resident William Schairer, MD; Dr. McLawhorn and Dr. Padgett were given the Frank Stinchfield Award for the study “Total Hip Arthroplasty for Femoral Neck Fracture is Not a Typical DRG 470: A Propensity-­ Matched Cohort Study.”

In February 2015, the Service held its annual multi-­disciplinary research retreat with 47 HSS attendees. They represented ARJR, as well as Administration, Anesthesia, Biomechanics, Infectious Disease, Radiology and the Osteolysis Research Laboratory.

The Service established an Arthroplasty Clinical Review Panel chaired by Service Research Director Geoffrey Westrich, MD, in April 2016 to expedite the research review process, in which a study’s protocol and scientific quality are evaluated.

The ARJR Fellowship program continues to be strengthened under the leadership of Mathias Bostrom, MD. It was established more than 40 years ago to train future thought leaders in total joint replacement surgery. There were 150 applicants for eight Fellow positions for the 2017–2018 academic year.

In 2015, HSS hosted the 27th Annual Holiday Knee and Hip Course at New York City’s Grand Hyatt. It attracted 154 attendees, including 37 U.S. and international faculty members.

9,911 SURGERIES

45,899 PATIENT VISITS

8 FELLOWS

84 STUDIES PUBLISHED

In the fall of 2015, HSS hosted the John N. Insall Traveling Fellows, sponsored by The Knee Society.

All data is from 2015 unless otherwise specified.

In 2015, the Service hosted Wayne Paprosky, MD, as the Wilson Visiting Professor. The topic of his lecture was “A Systematic Approach to Revision Total Hip Arthroplasty.”

In 2016, the Service was honored to host Thomas Fehring, MD, as the John Insall Visiting Professor. His lecture was entitled “Infection in Knee Arthroplasty.”

FROM LEFT TO RIGHT: David J. Mayman, MD; Alexander S. McLawhorn, MD, MBA; Michael L. Parks, MD; Paul M. Pellicci, MD; Amar S. Ranawat, MD; Chitranjan S. Ranawat, MD; Eduardo A. Salvati, MD; Peter K. Sculco, MD; Thomas P. Sculco, MD; Edwin P. Su, MD; Geoffrey H. Westrich, MD; Russell E. Windsor, MD (NOT PICTURED: Bryan J. Nestor, MD)

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Foot and Ankle Service The Foot and Ankle Service is the largest program of its kind in the United States. Its surgeons have expertise in deformity correction, trauma, sports injuries and arthritis.

CHIEF Matthew M. Roberts, MD

Clinical Highlights The Foot and Ankle Service is composed of nine orthopaedic surgeons and one nonoperative podiatrist. In addition to practicing general foot and ankle medicine, our members have unique areas of expertise, such as ankle replacement, ankle ligament reconstructions using hamstring autografts, talus osteochondral defect repairs, complex flatfoot and forefoot reconstructions, severe trauma and revision Achilles repair.

Constantine Demetracopoulos, MD, became the Service’s Epic Service Champion. He helped create a user-­ friendly portal for patients and a more efficient way for colleagues to navigate the software.

We are planning to expand our outpatient clinical space on HSS’s main campus and at the HSS Stamford Outpatient Center.

After serving as an Associate Attending for 47 years, Walther Bohne, MD, retired on June 8, 2015.

Research Initiatives Under the leadership of Scott Ellis, MD, and Jonathan Deland, MD, our Service revamped our patient outcomes database, known as the Rose Registry,

which is generously supported by the Susan and Elihu Rose Foundation.

We converted our record database to REDCap, reducing our annual registry operating costs, and implemented NIH PROMIS CATs, a nationally accepted, more accurate outcomes instrument that takes less time for patients to complete. Our Service presented data comparing CATs to the Foot and Ankle Outcome Score at the American Orthopaedic Foot and Ankle Society (AOFAS) Specialty Day in Orlando, FL. The improved registry allows the Service to focus on operative patients. With the help of our research assistants, our Service developed a workflow to capture surgeon-­specific data from the OR after each case. The registry also enables our group to collaborate with AOFAS’s Orthopaedic Foot and Ankle Research Network (OFAR) to determine the best practices for data gathering and outcomes reporting.

Our Service finalized the development of and validated the instrumentation of a state-­of-the-­art Foot and Ankle Gait Simulator, which was made possible

by Herbert Black and another generous donor, who are supporting this and other innovative projects. In 2015, our

FROM LEFT TO RIGHT: Matthew M. Roberts, MD; Jonathan T. Deland, MD; Constantine A. Demetracopoulos, MD; Mark C. Drakos, MD; Andrew J. Elliott, MD; Scott J. Ellis, MD; John G. Kennedy, MD; David S. Levine, MD; Martin J. O'Malley, MD; Harvey Strauss, DPM, FACFAS

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Service published a study confirming that using the Simulator to conduct research is comparable to studying real-­life walking. Since then, our Service has been able to launch multiple studies comparing hindfoot and ankle fusion to ankle replacement. We have used the Simulator to assess motion in the joints of the hindfoot after ankle fusion and ankle replacement. We have also used it to investigate the problems that can occur when the ankle is replaced and the subtalar joint is fused.

All three Fellows — ​Stuart Saunders, MD; Rachel Shakked, MD; and Andrew Rosenbaum, MD — ​presented their research at the 2016 AOFAS annual meeting in Toronto. Projects included the “Foot and Ankle Health Literacy Survey”; “Results of Griend versus Traditional Lateral Column Lengthening to Treat Adult Flatfoot”; and “Use of Autograft Hamstring to Reconstruct the Lateral Ankle Ligaments.”

Education Updates Designed by Andrew Elliott, MD, the curriculum for the 16 Residents who rotate through the Service each year offers broad clinical and operative training. They spend two days per week in the office seeing patients and three days per week in the operating room.

Clear, written expectations are set at the beginning of the Residents’ rotation. Preand post-­exams are administered orally.

A weekly one-­on-one conference with all nine Attendings provides Residents and Fellows with a personalized and in-­depth learning environment.

Our yearlong Fellowship program, directed by David Levine, MD, enables the three Foot and Ankle Fellows to train with the Attendings, who help them develop their clinical, operative and research skills.

Led by Mark Drakos, MD, the Bioskills Education Laboratory (BSEL) remains an important part of our Resident and Fellow curriculum. The BSEL, which was recently renovated thanks to a gift of the S & L Marx Foundation, complements the didactic experience. It provides anatomy sessions for junior Residents and allows Fellows to practice advanced surgical procedures.

2,624 SURGERIES

20,127 PATIENT VISITS

3 FELLOWS

50 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

There were 65 national presentations in 2015.

In 2016, Timothy Daniels, MD, Chief of the Division of Orthopaedic Surgery at St. Michael’s Hospital in Toronto, spoke about multi-­directional ankle instability for the Rose Honorary Lecture in Foot & Ankle. The Lecture is part of the HSS Visiting Professor Lecture Series.

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Hand and Upper Extremity Service The Hand and Upper Extremity Service is internationally renowned for its treatment of adults and children suffering from bone and soft-­tissue conditions of the hand, wrist, forearm, elbow and shoulder.

CHIEF Edward A. Athanasian, MD

Clinical Highlights Duretti Fufa, MD, was the Epic Service Champion.

All four of the Service’s Fellows graduated in high standing and have launched practices in Wisconsin, California and Kansas.

Subspecialty clinics in Trauma, Pediatric and Congenital Hand, and Brachial Plexus Injury continue to serve increasing numbers of patients.

Research Initiatives The Service has patient registries in seven key areas: Basal Joint, Distal Radius, Carpal Tunnel, Neoplasia, Pediatrics, Brachial Plexus and Elbow.

In 2015, the Service received IRB approval for 11 research projects.

Collectively, the Service has been awarded more than $265,000 in local, regional and national competitive grant funding for research activities.

In a study published in the Journal of Hand Surgery, HSS researchers found that adult patients who have undergone brachial plexus reconstruction continue to gain range of motion and strength in the shoulder and elbow well beyond two to three years after surgery, contrary to previous studies. The researchers found that range of motion and strength in the patients’ elbows and shoulders were significantly improved 11 years after surgery, compared with two years postoperatively. HSS study authors included Scott W. Wolfe, MD; Joseph H. Feinberg, MD; and Steve K. Lee, MD. In a study conducted at HSS, researchers developed a clinically relevant, valid and reliable survey to measure the physical and psychosocial expectations of patients seeking treatment for thumb carpometacarpal (CMC) arthritis. Lana Kang, MD, was the lead author. Other HSS authors were Joseph Nguyen, MPH; Dr. Lee; Andrew J. Weiland, MD; and Carol A. Mancuso, MD.

FROM LEFT TO RIGHT: Edward A. Athanasian, MD; Michelle G. Carlson, MD; Aaron Daluiski, MD; Duretti T. Fufa, MD; Robert N. Hotchkiss, MD; Lana Kang, MD; Steve K. Lee, MD; Andrew J. Weiland, MD; Scott W. Wolfe, MD

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Michelle G. Carlson, MD, received The Julian M. Bruner Award for Outstanding Poster at the American Society for Surgery of the Hand’s 71st Annual Meeting in Austin, TX, in 2016. The presentation was entitled “Dorsal Scaphoid Subluxation on Sagittal MRI as a Marker for Scapholunate Ligament Tear.”

Education Updates In 2015, the Service hosted Shawn W. O’Driscoll, MD, PhD, Consultant in Orthopaedic Surgery and Professor of Orthopaedics at the Mayo Clinic in Rochester, MN. He gave the Lee Ramsay Straub, MD, Honorary Lecture in Hand Surgery as part of the HSS Visiting Lecture Series. His presentation was called “Intercepting the Inflammatory Response to Surgery.”

The Service is emphasizing Fellow training in microsurgery, as well as pediatric and congenital hand problems.

In 2015, Mark Winston, MD, Hand and Upper Extremity Fellow, traveled to Coimbatore, India, to participate in an

intense, two-­week microsurgery training course. Dr. Winston spent time at Ganga Hospital, where he was exposed to a high volume of OR cases. He also participated in conferences, where he learned both technical and philosophical principles of microsurgery.

Hand Fellows participate in a weekly pediatric hand clinic supervised by Aaron Daluiski, MD. Monthly Fellow research meetings supervised by Dr. Lee, Research Director, have resulted in presentations at regional and national meetings and journal publications.

The Service is enhancing Resident training, specifically at the PGY 3 level.

The Service has increased the Resident case load and exposure to trauma cases to improve the overall experience.

2,899 SURGERIES

20,547 PATIENT VISITS

4 FELLOWS

42 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

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Hip Preservation Service The Hip Preservation Service and the Center for Hip Preservation are dedicated to understanding the causes and long-­term effects of hip degeneration and injuries.

CHIEF Robert L. Buly, MD

Clinical Highlights Service and Center members include specialists trained in orthopaedic surgery, physiatry, physical therapy, sports medicine, radiology and biomechanics. Patients benefit from their collaborative approach to diagnosing complex hip pain early and accurately. When a diagnosis is made early, there are often more treatment options.

In 2015, we performed more than 700 hip arthroscopies, more than 350 hip replacements and more than 300 hip resurfacing procedures. We also performed many periacetabular and femoral osteotomies.

Research Initiatives The Service continues to partner with the Healthcare Research Institute to study the long-­term impact of hip arthroscopy on femoroacetabular cartilage preservation. We are using quantitative MRI, along with clinical evaluation and patient-­reported outcome measures, at two and five years postoperatively under the auspices of an R01 grant.

The Service routinely assesses preoperative and postoperative patients with patient-­reported outcome measures. We ask patients to answer more than 70 questions at regular intervals to gather information. To make the process less onerous and boost compliance, we are working with the Healthcare Research Institute to create a comprehensive short-­form survey.

It is expected to be completed by the fall of 2017.

EOS imaging, which delivers high-­ quality orthopaedic scans with a reduced radiation dose, is being used to assess the role of pelvic positioning — ​ such as lumbar lordosis and pelvic sagittal balance — ​in patients with femoroacetabular impingement. There is evidence that patients with the condition may be able to compensate for their bony abnormality to some degree with increased flexibility of the lumbar spine. This research may help identify patients who might benefit from conservative treatment.

The Service is investigating hip mechanics, including the impact of femoral torsion on patellofemoral

FROM LEFT TO RIGHT: Robert L. Buly, MD; Struan H. Coleman, MD, PhD; David L. Helfet, MD; Bryan T. Kelly, MD; Dean G. Lorich, MD; Douglas N. Mintz, MD; Peter J. Moley, MD; Danyal H. Nawabi, MD; Anil S. Ranawat, MD; Ernest L. Sink, MD; Edwin P. Su, MD; David S. Wellman, MD

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contact pressures. Previous studies have shown that internal rotation of the femur may increase patellofemoral contact pressures, which may account for the onset of knee pain after hip arthroscopy.

Our goal is to provide insight into the relationship of anterior knee pain to hip morphology.

We are trying to determine whether hip stability is compromised after capsular repair. The Service is investigating the impact of two surgical approaches — ​ interportal and T-­capsulotomy.

Education Updates The Service has a yearlong Hip Preservation Fellowship. We teach the diagnosis and nonoperative and operative treatment of pre-­arthritic hip pain. The Fellow attends weekly academic conferences and rotates with the majority of the Attending Surgeons on the Hip Preservation Service. There is a weekly cadaver session to facilitate learning in open and arthroscopic procedures.

meeting. He or she is offered a Preceptorship at the Schulthess Klinik in Zurich, Switzerland, for which funding is provided. Schulthess is one of the leading orthopaedic institutions in Europe and a pioneer in many hip preservation procedures used today.

The Fellow has the opportunity to pursue a two- to three-­week clinical rotation with hip arthroscopy expert Michael Leunig, MD, to broaden his or her perspectives and create a sense of global engagement.

The Service offers a Resident Elective and typically has one Resident per year.

Service Attendings participate in weekly conferences, including Case Presentations, Morbidity & Mortality and Journal Club/Research. They are regularly invited to serve as international and national faculty for Hip Preservation courses and visiting professorships.

1,500 SURGERIES

22,113 PATIENT VISITS

1 FELLOW

32 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

Our physicians regularly host national and international academic visitors.

The Fellow attends the annual International Society for Hip Arthroscopy

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Limb Lengthening and Complex Reconstruction Service The Limb Lengthening and Complex Reconstruction Service (LLCRS) is the only comprehensive limb lengthening and deformity program that is part of an academic orthopaedic surgery department in the United States.

CHIEF S. Robert Rozbruch, MD

Clinical Highlights The Service is actively recruiting a third member.

In 2015, the Service formed the Limb Salvage and Amputation Reconstruction Center (LSARC), which provides integrated care for patients at risk of losing a limb and those who have already undergone an amputation. Our orthopaedic surgeons work with other key HSS professionals, including certified prosthetists, physical therapists, counselors and psychologists, to provide state-­of-the-­art treatment.

This integrated care begins before surgery and continues until the patient has achieved maximum mobility.

HSS surgeons continue to use and innovate applications for limb lengthening. New motorized, remote-­ controlled intramedullary (IM) nails can lengthen the femur and tibia without the need for an external fixation frame, which can lead to infection, pain and joint stiffness. This represents a new paradigm for limb lengthening.

FROM LEFT TO RIGHT: S. Robert Rozbruch, MD; Austin T. Fragomen, MD

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The Service continues to advance methods of knee and ankle joint preservation. We are performing joint realignment, joint distraction and cartilage regeneration.

Research Initiatives Limb lengthening and reconstruction is rarely considered a separate clinical Service in an academic department of orthopaedic surgery, but a recent study conducted at HSS and published in Clinical Orthopaedics and Related Research in 2015 found that there is an important role for such a Service.

The researchers — ​including S. Robert Rozbruch, MD, and Austin T. Fragomen, MD — ​examined data on the number of surgical cases and outpatient visits from 2005, the year the Service was established, to 2013. During that time, outpatient visits increased by 120 percent and surgical volume increased by 105 percent. Service staff members published 49 peer-­reviewed articles and 23 book chapters, review articles and web-­based publications.

Future research will investigate whether such a focused service leads to improved patient outcomes, efficiency and value.

The Service is participating in two clinical trials focusing on osteointegration, a new approach to amputation surgery.

Instead of using a socket to connect the prosthesis to the patient’s residual limb, the physician attaches the prosthesis to the person’s remaining bone. It’s more comfortable for the patient and improves function. The Service will begin offering the procedure in 2017.

Current projects include comparing the internal lengthening nail to the older technique of lengthening over a nail (LON) with external fixation for femur lengthening. We are analyzing clinical outcomes and cost differences.

We are comparing the internal lengthening nail to the older technique of lengthening and then nailing (LATN) with external fixation for tibia lengthening.

The Service is investigating predictors of success in the treatment of chronic osteomyelitis.

We are analyzing psychological parameters before and after limb lengthening.

Education Updates The Service trains a PGY-3 HSS Resident and two orthopaedic Fellows annually.

626

Service physicians made six contributions to HSS eAcademy.

SURGERIES

In March 2016, Dr. Rozbruch spoke at the Japanese Association of External Fixation and Limb Lengthening’s 29th Annual Meeting in Kanazawa, Japan. His lecture was entitled “Advances in Limb Lengthening and Reconstruction Surgery.”

3,027 PATIENT VISITS

2 FELLOWS

In June 2016, Dr. Rozbruch and Dr. Fragomen spoke at the Ilizarov Reading International Meeting at the Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics in Kurgan, Russia.

Scholarly work in 2015 included the Limb Lengthening and Reconstruction Surgery Case Atlas (Springer International), edited and with multiple chapters contributed

by Drs. Rozbruch and Fragomen. Also published were seven peer-reviewed articles in orthopaedic journals.

7 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

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Metabolic Bone Disease/ Musculoskeletal Oncology Service The Metabolic Bone Disease/ Musculoskeletal Oncology Service is focused on the prevention and treatment of osteoporosis and related bone disorders, including fragility fractures. It unites practitioners from multiple disciplines, including orthopaedics, rheumatology, physiatry, endocrinology, nephrology and pediatrics.

CHIEF Joseph M. Lane, MD

Clinical Highlights In 2015, we developed and improved our Fracture Liaison Service, championed

by Joseph Lane, MD. As one of only a few institutions in the country to endorse this program as a standard of care, we have been able to provide our patients with the highest quality care available. In this program, a team of Nurse Practitioners, Registered Nurses and PGY1 Residents performs in-­house metabolic bone disease consultations on all patients who have suffered a fragility fracture or are at risk for osteoporosis at both HSS and NewYork-­Presbyterian/ Weill Cornell Medical Center. Patients are worked up, then referred to the appropriate providers to ensure their underlying bone disease is addressed.

The goal is to prevent a future fracture.

We have performed a retrospective, as well as prospective, review of the data to better understand the strengths and weaknesses of the program. Currently, we are expanding the program to include osteoporosis patients who are having orthopaedic procedures.

Emily Stein, MD, joined our Metabolic Bone Disease Team in 2016. She is an

expert in clinical trials and bone mass evaluation. Dr. Stein trained at Weill Cornell Medical College/Memorial Sloan-­Kettering Cancer Center and NewYork-­Presbyterian/Columbia.

Research Initiatives The Service is investigating the effects of bisphosphonate treatment on the development of a transverse, atypical femoral fracture.

The Service received funding from the National Institutes of Health to determine if administering a key component of the PTH hormone (amino acids 1–34) will help increase bone density and strength in patients who have had a pelvic fracture.

The Service will use validated questionnaires to measure factors such as walking speed and grip strength to determine frailty. Our investigators will then determine which bones patients have fractured, such as the hip, ankle, wrist or pelvis, and look for correlations with their frailty.

FROM LEFT TO RIGHT: Joseph M. Lane, MD; Juliet B. Aizer, MD, MPH; Panagiota Andreopoulou, MD; Richard S. Bockman, MD, PhD; Adele L. Boskey, PhD; Azeez M. Farooki, MD; Marci Anne Goolsby, MD; Linda A. Russell, MD; Robert Schneider, MD; Alana C. Serota, MD; Emily Stein, MD

26

A clinical trial will determine whether treatment with an anti-­myostatin antibody will help elderly patients sustain muscle mass during recovery from total hip arthroplasty.

In collaboration with Rheumatologist Lisa Mandl, MD, the Service will investigate the role a hip fracture survivor’s social network plays in his or her functional status. Questionnaires will be used to evaluate patients’ functional status and level of support after total hip arthroplasty.

Kettering Cancer Center. Yi Lu, MD, is a Clinical Fellow in Metabolic Bone. She gained extensive experience in clinical and research work in her native China.

296 SURGERIES

Adele Boskey, MD, has published 15 peer-­reviewed manuscripts and three book chapters. Richard Bockman, MD, has published three peer-­reviewed manuscripts. Dr. Lane has published five book chapters, six peer-­reviewed articles and is section editor for the upcoming Orthopaedic Knowledge Update (OKU)12 series. He received the Philip D. Wilson Teaching Award.

7,313 PATIENT VISITS

4 FELLOWS

Education Updates Residents and Fellows attend Trauma Rounds, which emphasize metabolic bone disease, pathophysiology, diagnosis and treatment. Metabolic Bone Grand Rounds and Journal Club are held monthly. During weekly research meetings, current and pending projects are reviewed.

The Service’s Metabolic Bone Disease Surgical Fellow is Omer Or, MD, who completed his orthopaedic residency at Hadassah Hebrew University Medical Center in Israel and an orthopaedic oncology fellowship at Memorial Sloan-­

Patient education is at the forefront of nearly every aspect of our care. In 2015, we surveyed our patients about vitamin D’s relationship to bone health.

We discovered that a shocking majority were unable to answer even the most basic questions about its importance — ​ despite the fact that nearly every patient was taking the supplement daily and had been counseled about its benefits. Based on this preliminary data, we designed an IRB-­approved study to determine how we can increase patients’ understanding of the benefits of vitamin D.

24 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

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Orthopaedic Trauma Service The Orthopaedic Trauma Service collaborates with NewYork-­Presbyterian/Weill Cornell Medical Center to provide unrivaled orthopaedic emergency care.

CHIEF David L. Helfet, MD

Clinical Highlights David Wellman, MD, was our Epic Service Champion. He helped create a user-­ friendly portal for patients and a more efficient way for colleagues to navigate the software.

Our three Trauma Fellows — ​Gele Moloney, MD; Paul Perdue, Jr., MD; and Yelena Bogdan, MD — ​graduated in high standing.

Research Initiatives The Orthopaedic Trauma Service (OTS) focuses on clinical, radiographic and laboratory-­based research and collaborates with other specialties and scientists. Laboratory research is performed with our institutional partners, including the Biomechanics Department, the Bioskills Education Laboratory and the Computer-­Aided Surgery Laboratory. We perform advanced research imaging (MRI, CT and in vivo MicroCT) with our affiliate, Weill Cornell Medicine Radiology. Funding has come from the Orthopaedic Trauma Association, AO North America and other research organizations.

A major area of interest continues to be minimizing damage to blood vessels during surgery, so we are studying the vessels that feed bone and soft tissues.

To date, we have completed 14 vascular studies. Another four are underway.

In one of our most recent vascular studies, we used quantitative MRI and CT scan imaging to determine the amount of blood the lateral femoral circumflex artery and medial femoral circumflex artery supply to the femoral head and femoral neck.

Other research has focused on the factors that can help predict outcomes during surgery or postoperative care. We have been investigating the long-­term functional and radiographic predictors of acetabular fracture outcomes; the functional outcomes of fractures of the upper and lower extremities, including the shoulder, clavicle, elbow, hip, knee, patella and ankle; and the correction of post-­traumatic deformity, non-­unions and mal-­unions.

FROM LEFT TO RIGHT: David L. Helfet, MD; Gregory S. DiFelice, MD; Duretti T. Fufa, MD; Joseph M. Lane, MD; Dean G. Lorich, MD; John P. Lyden, MD; David S. Wellman, MD (NOT PICTURED: David E. Asprinio, MD; Andrew Grose, MD)

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Education Updates There are five Residents rotating on the Combined Orthopaedic Trauma Service at HSS and NewYork-­Presbyterian/ Weill Cornell Medical Center (NYP) and three Orthopaedic Trauma Fellows.

Our educational program includes the weekly Service conference; weekly Trauma rounds at HSS and NYP; and the monthly Psychomotor Skills Laboratory exercises. There is also a bi-­monthly Journal Club meeting, in which journal articles are discussed. Our Residents and Fellows attend all conferences and teaching sessions.

The Residents and Fellows who are scheduled to participate in a patient’s surgery are required to formulate a preoperative surgical plan, which includes tracings of the fracture, the desired result and a surgical tactic. All operative cases are then discussed in advance with the Attending Orthopaedic Surgeon. In addition, Residents and Fellows are required to learn Ambulatory Orthopaedic Care and are assigned to clinics and Private Attending office

hours. The OTS at HSS functions as a team to deliver better patient care, education and research activities.

The OTS at NYP has expanded dramatically and now provides Residents with a remarkable experience in the management of acute trauma, the elderly and their fractures, tumors and pediatrics. In 2015, HSS Assistant Attending Orthopaedic Surgeon Gregory DiFelice, MD, joined the OTS at NYP. He educates our team about major sports/ligamentous injuries, as well as the repair and reconstruction of complex periarticular fractures and fracture dislocations.

Our Service holds weekly Morbidity & Mortality conferences, during which Residents present cases with potential quality issues for thorough review and analysis. Residents are expected to apply the lessons learned to improve patient care. In some cases, these lessons become instrumental in developing new protocols.

731 SURGERIES

6,736 PATIENT VISITS

3 FELLOWS

36 STUDIES PUBLISHED

All figures refer to HSS data. All data is from 2015 unless otherwise specified.

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Pediatric Orthopaedic Service The Pediatric Orthopaedic Service is an authority in the treatment of conditions that affect children’s bones, joints and muscles.

CHIEF Roger F. Widmann, MD

Clinical Highlights In August 2016, the Lerner Children’s Pavilion welcomed back Peter Fabricant, MD, MPH, as an Attending Pediatric Orthopaedic Surgeon and Clinician Scientist. He is the second Clinician Scientist to join the Service.

Dr. Fabricant’s research interests are pediatric sports medicine and patientreported outcomes. He completed his residency at HSS, pediatric orthopaedic fellowship at Children’s Hospital of Philadelphia, and pediatric sports fellowship at Boston Children’s Hospital.

Daniel W. Green, MD, relaunched the Leon Root Pediatric Outreach Program to continue the mission Leon Root, MD, started 29 years ago. (Dr. Root, who passed away in 2015, was Chief of Pediatric Orthopaedics at HSS for 27 years.) Under Dr. Green’s leadership, the program offers orthopaedic screening, preseason physical exams and injury prevention training to underserved children in New York City public schools.

With the dedicated support of the Pediatric Council, the Lerner Children’s Pavilion hired a Child Life Specialist, Peyton Katz, MS, CCLS. She serves as the Pediatric Patient and Family Care Coordinator.

The Service hired a fourth Pediatric Nurse Practitioner. These Nurse Practitioners — who work with all of our physicians — greatly expand patients’ access to care.

Research Initiatives In 2015, the Pediatric Orthopaedic Society of North America nominated the paper “Long-­Term Clinical Follow-­Up of Arthroscopic Treatment of Symptomatic Discoid Lateral Meniscus in Children” best clinical presentation. Dr. Green was the lead author. The purpose of the study was to examine the long-­term clinical outcomes of arthroscopic partial meniscectomy for the treatment of discoid lateral meniscus in children. The researchers found that 20.6 percent of patients underwent a subsequent

FROM LEFT TO RIGHT: Roger F. Widmann, MD; John S. Blanco, MD; H. Susan Cha, MD; Aaron Daluiski, MD; Emily R. Dodwell, MD, MPH, FRCSC; Shevaun M. Doyle, MD; Peter D. Fabricant, MD; Daniel W. Green, MD, MS, FAAP, FACS; Lisa S. Ipp, MD; Stephanie L. Perlman, MD; Cathleen L. Raggio, MD; David M. Scher, MD; Ernest L. Sink, MD

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surgical procedure on the affected knee.

The modest results demonstrate the challenging clinical problem of discoid lateral meniscus in young patients and illustrate the need for new solutions for meniscus repair or replacement.

“Long Term Follow Up of Pediatric ACL Reconstruction in New York State: High Rates of Subsequent ACL Reconstruction” was the 2015 High Scoring Poster at the Canadian Orthopaedic Association/ Canadian Orthopaedic Research Society Annual Meeting. Pediatric orthopaedic surgeon Emily Dodwell, MD, was one of the authors. In this study, HSS researchers attempted to determine the rate of revision procedures and non-­ACL knee surgeries in children who already had undergone ACL reconstruction in New York State. They found that 8.2 percent of patients underwent revision ACL reconstruction and 14 percent had subsequent non-­ACL knee surgery.

Education Updates In 2015, HSS residents ranked the Pediatric Orthopaedic Service the #1 Educational Service at HSS. This is an honor, since HSS’s orthopaedic residency program has been ranked #1 in both reputation and research output for two years in a row by Doximity, the professional healthcare network.

3,074 SURGERIES*

22,282 PATIENT VISITS**

We were proud to welcome back Stephen W. Burke, MD, the former Chief of Pediatric Orthopaedic Surgery at HSS, as our 2015 Visiting Professor.

In 2016, we hosted Mininder Kocher, MD, an orthopaedic surgeon at Boston Children’s Hospital.

In 2015, there were 95 presentations and instructional course lectures at major national and international conferences.

Five members of the Pediatric Orthopaedic Service were invited to serve as faculty for instructional course lectures at national conferences and as faculty for the International Pediatric Symposium. They were Dr. Dodwell; Dr. Green; Catherine Raggio, MD; Ernest Sink, MD; and Roger Widmann, MD.

1 FELLOW

37 STUDIES PUBLISHED

* Surgical volume is inclusive of procedures performed at NewYork-Presbyterian/ Weill Cornell Medical Center and NewYorkPresbyterian Queens. ** Patient visits for the year excluded those to NewYork-Presbyterian/Weill Cornell Medical Center and NewYork-Presbyterian Queens. ll data is from 2015 unless otherwise A specified.

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Spine Service The Spine Service is world-­ renowned for its innovative and research-­based treatment of children and adults with all levels of spine disease and deformity.

CHIEF Frank Schwab, MD

Clinical Highlights To optimize patient care, we improved our clinical pathways for all spinal surgical procedures. Under the guidance of Chad Craig, MD, Director of Perioperative Medicine, we developed structured, multidisciplinary care plans outlining the essential steps in the care of spinal patients. This enables us to reduce variability in clinical practice, as well as improve outcomes and length of stay.

To better facilitate the triage of patients with back pain and ensure rapid and appropriate referrals, the Service initiated a pilot program with HSS’s Physician Referral Service. We created a spine care algorithm, as well as a detailed intake questionnaire, to standardize the process for referrals, improve patient flow and increase patient satisfaction when making an appointment.

Research Initiatives In an effort to bridge the gap between academic research and clinical practice, the Spine Service’s standard of care now involves the collection of patientreported outcomes instruments directly within Epic.

“Concordance Between Patients’ and Surgeons’ Expectations of Lumbar Spine Surgery” was selected as one of the Best Papers: Measurement of Surgical Outcomes at the North American Spine Society (NASS) meeting in October 2015. The HSS Lumbar Spine Surgery Expectations Survey revealed that only 2 percent of patients had the same expectations as their surgeons. Agreement regarding surgical expectations is important because it maximizes the likelihood that patients will benefit from surgery and increases patient satisfaction with the outcome.

“Fulfillment of Expectations Two Years After Lumbar Spine Surgery” was also selected as one of the Best Papers: Measurement of Surgical Outcomes at the NASS meeting. In this study of HSS patients, we found that the majority were satisfied with the results of surgery.

Our contributions to spine research were recognized at the 2015 International Meeting on Advanced Spine Techniques, where we received the Whitecloud Award for Best Clinical Paper for the study entitled “Incidence of Proximal Junctional Kyphosis in Patients with

FROM LEFT TO RIGHT: Frank Schwab, MD; Todd J. Albert, MD; John S. Blanco, MD; Frank P. Cammisa, Jr., MD; Matthew E. Cunningham, MD, PhD; James C. Farmer, MD; Federico P. Girardi, MD; Charles B. Goodwin, MD; Russel C. Huang, MD

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Adult Spinal Deformity Fused to the Pelvis: A ScoliRisk-1 Sub-analysis.”

Another study, “Operative Management of Adult Spinal Deformity Results in Significant Increases in QALYs Gained Compared to Nonoperative Management: Analysis of 479 Patients with Minimum Two-Year Follow-Up,” won the NASS’s Value Abstract Award.

Han Jo Kim, MD, and Resident Sravisht Iyer, MD, received a $15,000, one-­ year grant from the Cervical Spine Research Society for a project entitled “Validation of the NIH PROMIS in Cervical Spine Patients.”

Fellow Ashish Patel, MD, and Virginie LaFage, PhD, Director of Spine Research, received a $25,000, one-­year grant from the Scoliosis Research Society for a project called “Motion Analysis in the Axial Plane after Realignment Surgery for Adolescent Idiopathic Scoliosis.”

Education Updates We trained seven clinical spine Fellows in 2015.

3,324

In 2015, the HSS Spine Service was selected as one of the four host sites for the Cervical Spine Research Society Traveling Fellowship Program. The goal of the Program is to enrich and develop the Fellows’ leadership skills and teach them how a leading spine center operates.

SURGERIES

Bradford L. Currier, MD, Professor of Orthopaedics at the Mayo Clinic, was the guest lecturer for the 2015 William R. Salomon Honorary Lecture in Spinal Disease.

The Service held a Cervical Spine Motion Preservation Symposium, which was co-­directed by Darren Lebl, MD, and Matt Cunningham, MD.

18,154 PATIENT VISITS

7 FELLOWS

80+ STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

In 2015, the Service held the HSS Spine Research Retreat, during which we promoted and planned collaborative, impactful research. We also implemented a biannual spine research grant to support spine projects conducted at HSS.

FROM LEFT TO RIGHT: Alexander P. Hughes, MD; Han Jo Kim, MD; Joseph M. Lane, MD; Darren R. Lebl, MD; Patrick F. O’Leary, MD; Bernard A. Rawlins, MD; Andrew A. Sama, MD; Harvinder S. Sandhu, MD; Roger F. Widmann, MD

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Sports Medicine and Shoulder Service Members of the Sports Medicine and Shoulder Service are dedicated to providing the highest level of musculoskeletal care for active and athletic patients of all abilities, including those affiliated with local high school, collegiate and professional teams and organizations.

CHIEF Bryan T. Kelly, MD CHIEF, PRIMARY CARE SPORTS MEDICINE Brian C. Halpern, MD

Clinical Highlights With 28 surgical Attendings and 11 Primary Care Physicians, the Service is busier than ever. Our physicians work with many teams and organizations, including the New York Knicks, New York Giants and the United States Olympic Committee’s National Medical Network.

The Service operates three patient registries — ​Hip Preservation, Shoulder Arthroplasty and Knee — ​in collaboration with the Healthcare Research Institute. We are using the registries to investigate the efficacy of various surgical procedures, such as total shoulder arthroplasty and ACL repair and reconstruction.

Research Initiatives The Service is conducting two prospective clinical studies on the rotator cuff. In one study, we are investigating the importance of vitamin D in the healing process following rotator cuff repair. We are also piloting a randomized study to determine whether mesenchymal stromal cells — ​stem cells from the iliac crest bone marrow — ​can safely improve healing of the torn rotator cuff tendon.

We are investigating postoperative outcomes following bicep tenodesis in young, competitive athletes with Superior Labrum Anterior Posterior (SLAP) tears. We are also evaluating the viability of the horizontal mattress suture for arthroscopic stabilization of a Bankart lesion.

The Service continues to collaborate with the Laboratory for Soft Tissue Research, as well as the Department of Biomechanics. In one study, we are trying to determine whether patients who have had a traumatic shoulder dislocation need to be surgically stabilized immediately or whether they can wait to see if it occurs again. We are evaluating the relative concentrations of circulating biomarkers associated with cartilage damage and inflammation — ​which may lead to early-­onset osteoarthritis — ​in patients who are undergoing stabilization for recurrent and single-­instance shoulder dislocation. In another study, researchers are generating a detailed anatomic, dimensional analysis of the medial and lateral collateral ligament complexes of the elbow. A third study involves comparing the amount of bone removed during drilling for the two

FROM LEFT TO RIGHT: Bryan T. Kelly, MD; Answorth A. Allen, MD; Brian C. Halpern, MD; David W. Altchek, MD; William J. Briner, Jr., MD; Lisa R. Callahan, MD; Struan H. Coleman, MD; Frank A. Cordasco, MD, MS; David M. Dines, MD; Joshua S. Dines, MD; Stephen Fealy, MD; Joseph H. Feinberg, MD; Kenton H. Fibel, MD; Marci Anne Goolsby, MD; Lawrence V. Gulotta, MD; Jo A. Hannafin, MD, PhD; Anne M. Kelly, MD; James J. Kinderknecht, MD; Osric S. King, MD; John D. MacGillivray, MD; Robert G. Marx, MD, MSc, FRCSC

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most commonly used methods of elbow ligament reconstruction (the figure of eight technique versus the docking technique). In a fourth project, which is focusing on ulnar collateral ligament (UCL) reconstruction (Tommy John surgery), researchers are developing a detailed anatomic analysis of the UCL vascular supply. They are trying to determine the impact tunnel drilling has on the blood supply to the region of reconstruction.

Education Updates Education remains a high priority for the Service. The Fellowship program offers seven accredited Sports Medicine positions as well as a non-­ accredited international Fellow. In addition, the Service has a two-­year Fellowship position, which permits a dedicated research Fellow.

A Psychomotor Skills Lab has been implemented. The Lab is designed for one Fellow to take PGY3 and 4 through a structured curriculum. Sessions, which focus on different anatomic areas, enable Fellows to try new techniques and implants. The Service also provides a monthly Fellow’s lab focusing on more advanced topics, such as Total Shoulder Arthroplasty and High Tibial Osteotomy.

Didactic lectures, weekly conferences and one-­on-one education in the clinic and operating rooms remain the primary vehicles for our educational process.

The Service also has a lecture schedule for Residents. The CORE series covers all major sports medicine conditions over the course of the year. There is a session focusing on MRI interpretation and its application to Sports Medicine, especially soft tissue reconstruction.

10,000 SURGERIES

70,000+ PATIENT VISITS

8 FELLOWS

113 STUDIES PUBLISHED

All data is from 2015 unless otherwise specified.

The Service has changed the rotation schedule of the Fellowship program.

We have organized the Service into four “teaching units” — ​shoulder, knee, hip and sports medicine — ​based on clinical interest and team coverage. The goal is to provide mentoring by giving Fellows focused time with Attendings.

The Service has established additional Morbidity & Mortality conferences. The goal is to provide an interdisciplinary review of patient safety and/or systems-­ based issues.

FROM LEFT TO RIGHT: Michael J. Maynard, MD; Moira M. McCarthy, MD; Jordan D. Metzl, MD; Peter J. Moley, MD; Danyal H. Nawabi, MD; Stephen J. O'Brien, MD, MBA; Andrew D. Pearle, MD; Rock G. Positano, DPM, MSc, MPH; Hollis G. Potter, MD; Anil S. Ranawat. MD; Scott A. Rodeo, MD; Howard A. Rose, MD; Daphne Scott, MD; Beth E. Shubin Stein, MD; Sabrina M. Strickland, MD; Samuel A. Taylor, MD; Brett G. Toresdahl, MD; David A. Wang, MD; Russell F. Warren, MD; Thomas L. Wickiewicz, MD; Riley J. Williams III, MD (NOT PICTURED: Jennifer L. Solomon, MD)

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Department of Biomechanics Engineers in the Department of Biomechanics perform research and develop orthopaedic devices and instrumentation with the goal of improving patient care.

DIRECTOR Timothy M. Wright, PhD

Department Highlights Mark P. Figgie, MD, received an Investigational New Drug (IND) approval from the Food and Drug Administration (FDA) for a drug delivery device designed and developed with the aid of the Biomechanics Department. The device is intended to provide sustained delivery of medications, such as pain relievers, directly to the knee joint. The IND approval sets the stage for a clinical trial of the device.

Inventors in the Biomechanics Department received an additional patent for their new total elbow replacement, which allows the surgeon to choose the level of constraint a patient needs during surgery. Another patent was issued for new instrumentation for accurately placing the acetabular component during primary and revision total hip replacement surgery. These inventions resulted from collaborations among Department engineers and HSS orthopaedic surgeons.

In 2015, the National Institutes of Health (NIH) awarded HSS a Small

Business Innovation Research grant for the optimization of an experimental synthetic device for cartilage repair.

The research is a collaborative effort between HSS and a new life sciences company formed by an HSS scientist and an HSS physician.

Research Initiatives HSS scientists determined the biomechanical function of the recently rediscovered anterolateral ligament of the knee. This provides a basic understanding of the stabilizing role of this tissue against provocative rotatory loads on the knee during challenging athletic activities.

Department scientists developed a clinically applicable methodology to better understand the patient-specific mechanical factors related to an increased risk of osteoarthritis after meniscus injury and surgery. The methodology was applied to young, active patients undergoing meniscus allograft transplantation. Electronic sensors are used to measure contact mechanics in the operating room and to

FROM LEFT TO RIGHT: Timothy M. Wright, PhD; Suzanne A. Maher, PhD; Christina Esposito, PhD; Carl W. Imhauser, PhD; Joseph D. Lipman, MS; Marjolein van der Meulen, PhD (NOT PICTURED: Nelly Andarawis-Puri, PhD; Christopher J. Hernandez, PhD)

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compare the results to advanced MRI imaging to assess cartilage health before and after surgery. The goal is to establish benchmarks for successful long-term surgical treatments.

Research published in the Journal of Biomechanical Engineering confirmed the ability of a computational model of the knee to predict subject-­specific motions and soft tissue loads. The model can be used to identify patient-­specific factors critical to successful outcomes following ACL reconstruction and total knee replacement.

Department scientists used EOS imaging — ​in which two low-­dose X-­rays are used to create a 3-D image of a person — ​to help determine the appropriate alignment of the components in a total hip replacement (THR). EOS images can be taken while a patient is standing and sitting, enabling physicians to predict whether the hip joint will remain stable during these activities. Department scientists discovered the importance of considering which THR patients sit with

less posterior pelvic tilt and those who rotate their pelvises forward to achieve a sitting position. Using EOS imaging, both mechanisms were shown to limit or reduce the functional anteversion of the acetabular component in a patient with a THR. This limited motion could, in turn, predispose patients to posterior instability and dislocation after THR.

Education Updates The Department hosted two mechanical engineering students from the U.S. Military Academy in West Point in 2016. The goal is to establish an annual immersion term for cadets interested in coming to HSS to learn about research opportunities in orthopaedic biomechanics.

27 STUDIES PUBLISHED in the 2015–2016 academic year

4 PATENTS ISSUED to Department inventors

All data is from 2015 unless otherwise specified.

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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 Fellowships

Named Chairs and Professorships Korein-Wilson Professorship in Orthopaedic Surgery Todd J. Albert, MD

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

Robert and Helen Appel Fellowship in Biomedical Engineering Natalie Kelly

Benjamin M. Rosen Chair in Immunology and Inflammation Research Mary K. Crow, MD

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

Finn and Barbara Caspersen Fellowship for Spine Research Samuel Z. Grinberg

Joseph P. Routh Professor of Rheumatic Diseases in Medicine Mary K. Crow, MD

Leon Root MD Chair in Pediatric Orthopaedics Roger F. Widmann, MD

Charles L. Christian Research Fellowship Marie-Dominique Ah Kioon, PhD

Richard L. Menschel Chair and Chief Scientific Officer Lionel B. Ivashkiv, MD

Virginia F. and William R. Salomon Chair in Musculoskeletal Research Carl Blobel, MD, PhD

David H. Koch Chair for Arthritis and Tissue Degeneration Research Lionel B. Ivashkiv, MD

Eduardo A. Salvati MD Chair in Hip Arthroplasty Mathias P. Bostrom, MD

Michael R. Bloomberg Chair in Autoimmune Diseases Franck Barrat, PhD

Thomas P. Sculco MD Chair in Orthopaedic Surgery Thomas P. Sculco, MD

Franchellie M. Cadwell Chair Sergio Schwartzman, MD

The Peter Jay Sharp Chair in Lupus Research Alessandra B. Pernis, MD

Mary Rodgers and Henry Guettel Fellowship in Biomedical Mechanics Christina Esposito, PhD

Coleman Chair in Magnetic Resonance Imaging Research Hollis G. Potter, MD

St. Giles Research Chair supporting Theresa T. Lu, MD, PhD

Ken and Jill Iscol Fellowship in Orthopaedic Research Andrew D. Pearle, MD

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

Starr Chair in Mineralized Tissue Research Adele L. Boskey, PhD

Irving and Sally Lipstock Fellowship in Orthopaedic Surgery Alberto Carli, MD

The Anne and Joel Ehrenkranz Chair in Perioperative Medicine Linda A. Russell, MD 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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Starr Chair in Tissue Engineering Research supporting Chitra Dahia, PhD Russell F. Warren Research Chair supporting Suzanne A. Maher, 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

Michael D. Lockshin Fellowship of the Barbara Volcker Center for Women and Rheumatic Disease Xiaoping Qing, MD, PhD Shanthini Kasturi, MD, MSc Ludwig Fellowship for Women’s Sports Medicine Research Elizabeth Selvaggio Stavros Niarchos Foundation — ​ Thomas P. Sculco MD International Orthopaedic Fellowship Vasileios Soranoglou, MD, PhD, FEBOT 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 Academic Director of Orthopaedic Surgery and Vice Chair of Education and Academic Affairs 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 Service Douglas E. Padgett, MD, Chief, Adult Reconstruction and Joint Replacement Service 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 212.606.1653

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About Hospital for Special Surgery

Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopaedics, rheumatology and rehabilitation. HSS is ranked #1 in the U.S. for Orthopaedics and #2 for Rheumatology by U.S. News & World Report “Best Hospitals” (2016–2017 rankings). It is the first hospital in New York State to receive the Magnet® designation for Excellence in Nursing Service from the American Nurses Credentialing Center four 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

Officers Chair Kendrick R. Wilson III Vice Chairs 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 and Chief Operating Officer Lisa A. Goldstein

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

choose to come to HSS from across the U.S. and from around the world. HSS has one of the lowest infection rates in the country. 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.

Attributions The Department of Orthopaedic Surgery 2015–2016 Annual Report is produced by the Communications Department at Hospital for Special Surgery.

Design by Addison www.addison.com

Hospital for Special Surgery Department of Orthopaedic Surgery Todd J. Albert, MD, Surgeon-in-Chief, 212-606-1004