Houston Methodist Orthopedics & Sports Medicine Annual Report 2013

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2013 YEAR IN REVIEW

LEADING ORTHOPEDICS & SPORTS MEDICINE CARE


A PROUD TRADITION OF EXCELLENCE, WITH A NEW NAME. The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.

THAT’S THE DIFFERENCE BETWEEN PRACTICING MEDICINE AND LEADING IT.


CONTENTS

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LEADING MEDICINE: AN OVERVIEW

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PURSUING MEDICAL DISCOVERIES

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BREAKING NEW GROUND

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DELIVERING BETTER OUTCOMES

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EDUCATING FOR TOMORROW

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Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

ABOUT HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE Our patients range from professional athletes and performing artists to “weekend warriors” to student athletes — and everyone receives the same superior level of care from the moment they walk through our doors. Houston Methodist Orthopedics & Sports Medicine exists to provide our patients with outstanding, comprehensive orthopedic care. We do this through unparalleled expertise combined with innovative research, sophisticated technology and a dedication to compassionate patient care. Our center exemplifies orthopedic excellence and is recognized as a hub of knowledge and progress where patients, educational institutions, governing bodies and the medical research community can turn for the best in current orthopedic treatments and rehabilitation.

A NATIONAL LEADER IN ORTHOPEDIC EXCELLENCE Ranked within the top 25 in the nation in 2013 by U.S. News & World Report, Houston Methodist Orthopedics & Sports Medicine is one of the largest, most active and comprehensive orthopedic centers in the United States. The center is comprised of a multidisciplinary team of orthopedic surgeons, primary care sports medicine physicians, rehabilitation therapists, occupational therapists and athletic trainers who collaborate in the delivery of superlative care to patients with musculoskeletal diseases and disorders. Our expansive network of clinical programs is directed by renowned, board-certified and fellowship-trained orthopedic specialists.

The center has emerged as a national leader due to its high quality of clinical care, dedication to resident and fellow education, and state-of-the-art clinical and scientific research.

BLAZING THE PATH OF FUTURE ORTHOPEDIC MEDICINE Houston Methodist Orthopedics & Sports Medicine has developed or improved many orthopedic devices, procedures, and therapies that have been translated into clinical practice worldwide. Our ongoing commitment to orthopedic research, through vigorous collaborations with numerous research partners, helps to ensure our continuing leadership in the diagnosis and treatment of orthopedic conditions.

THE LEADERS OF TOMORROW Through our primary academic affiliation with Weill Cornell Medical College and NewYork-Presbyterian Hospital, Houston Methodist Orthopedics & Sports Medicine provides fully accredited resident and fellowship programs. Our curricula are designed to prepare the next generation of orthopedic specialists through hands-on training and extensive research programs.

HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE 2013 AT A GLANCE

43,704 2,397 9

TOTAL CASES

JOINT REPLACEMENT PROCEDURES

$1.4 5

ACTIVE CLINICAL PROTOCOLS

OVER

MILLION IN GRANT FUNDING

ACADEMIC FELLOWSHIP AND RESIDENCY PROGRAMS

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Orthopedics


MESSAGE FROM THE CHAIR Dear Colleagues, Expertise, compassion, innovation and patient focus are just a few of the reasons why patients seek treatment at Houston Methodist Orthopedics & Sports Medicine. I am extremely honored and proud to share our accomplishments and highlights over the past year. In 2013, we used our close clinical association with elite athletes and performing artists to translate knowledge of repetitive and overuse injuries to our “weekend warriors.� In addition, we saw therapies that were originally reserved for professional athletes, such as platelet-enriched plasma procedures, cross over and benefit our orthopedic surgery patients. At the Surgical Advanced Technology Laboratory, we are persisting in our work on a breakthrough technique that will significantly improve the way critical bone fractures are treated. Using a novel, regenerative approach to fractures that combines the mechanical advantages of biodegradable synthetic polymers with the biological function of natural biomaterial scaffolds, we are witnessing rapid healing in limbs that would previously have required amputation. We have been able to proceed with this research on bionanoscaffolds through a grant from the Defense Advanced Research Project Agency (DARPA). We are helping to establish new surgical pathways for thumb joint replacements. We continue to stand at the leading edge in the advancement of sophisticated ankle implants through incorporation of a recently developed, three-component prosthetic that requires less bone resection and allows for greater joint rotation. In 2013, we also witnessed major advancement in cartilage replacement techniques for both the ankle and knee. Our commitment to leading medicine compels our motivation toward excellence in orthopedic research, innovation and education. Our compassion and dedication to our patients inspires our aspirations for excellence in care. The accomplishments at Houston Methodist Orthopedics & Sports Medicine are made possible by the outstanding work of our physicians, nurses, administrators and staff. We invite you to browse inside these pages and explore the exciting developments in our realm of orthopedic care. Warm regards,

Kevin Varner, MD Interim Chair Houston Methodist Orthopedics & Sports Medicine

Opthalmology

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Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

NEW HIRES

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JOSHUA HARRIS, MD

JEFFREY KOZAK, MD

DANIEL LE, MD

SHARI LIBERMAN, MD

Joshua Harris, MD, joined Houston Methodist Orthopedics & Sports Medicine after completion of his medical and orthopedic residency at Ohio State University College of Medicine in Columbus, Ohio. He proceeded to complete his fellowship in sports medicine at Rush Medical Center in Chicago, where he was assistant team physician for the Chicago Bulls, White Sox, and DePaul University. Dr. Harris’ clinical and research interests include arthroscopic hip preservation, cartilage restoration techniques, stem cell therapy, the healing properties of plateletrich plasma, endurance medicine and care of elite athletes. He has published over 60 articles in peer-reviewed journals, presented at various national and international symposia, and has been a journal reviewer for numerous publications including American Journal of Sports Medicine, The Physician and Sports Medicine and the Orthopedic Journal of Sports Medicine.

Jeffrey Kozak, M D, joined the team of Houston Methodist Orthopedics & Sports Medicine after completing his fellowship in primary care sports medicine at Houston Methodist. He completed his orthopedic residency at the University of North Texas Health Science Center College of Osteopathic Medicine in Fort Worth, Texas and his primary care residency at Texas A&M University in College Station, Texas. During his fellowship, Dr. Kozak worked extensively with the Houston Dynamo, H o us t o n Aeros, Rice University, RodeoHouston®, as well as community and high school athletic organizations.

Daniel Le, MD, joined Houston Methodist in September of 2013 after completing his training at New England Baptist Hospital, in Boston, Massachusetts. During his residency, Dr. Le estimates he performed approximately 750 joint replacement surgeries. He is one of the few orthopedic surgeons in the country who currently performs minimally invasive hip replacement surgery known as the superior capsular or SUPERPATH approach. The superior capsular procedure preserves the integrity of the capsule and significantly limits postoperative hip restrictions. In collaboration with Brad Weiner, MD, vice chair (Academics) of the Department of Orthopedic Surgery, Dr. Le is developing a new total joint replacement rotation for residents in 2014.

Shari Liberman, MD, joined Houston Methodist Orthopedics & Sports Medicine after completing her orthopedic surgery residency at Baylor College of Medicine in Houston, Texas, and her hand and upper extremity fellowship at Stanford University School of Medicine in Stanford, California. Dr. Liberman’s clinical interests include Dupuytren’s disease, traumatic wrist injuries and peripheral nerve injuries of the upper extremity.

Orthopedics


HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE MEDICAL STAFF Kevin E. Varner, MD, Interim Chair

ORTHOPEDIC SPORTS MEDICINE Winfield Campbell, MD Joshua Harris, MD David Lintner, MD Mark W. Maffet, MD Patrick McCulloch, MD Bruce Moseley, MD John Seaberg, MD Timothy C. Sitter, MD

PRIMARY CARE SPORTS MEDICINE David A. Braunreiter, MD Vijay Jotwani, MD Jeffrey A. Kozak, DO Scott Rand, MD Kenneth M. Renney, MD Christian Schupp, MD Gregory M. Seelhoefer, MD

NECK & SPINE HoSun Hwang, MD Anthony J. Muffoletto, MD Bradley Weiner, MD Jeffrey B. Wood, MD

HAND & WRIST Evan Collins, MD D. Dean Dominy, III, MD Korsh Jafarnia, MD Shari Liberman, MD Vincent C. Phan, MD

JOINT REPLACEMENT William J. “Bill” Bryan, MD Plinio Caldera, MD Mark Franklin, MD Carl A. Hicks, MD Stephen Incavo, MD Daniel Le, MD Ken Mathis, MD Eddie T. Matsu, MD James Pyle, MD Christopher K. Smith, MD Leland Winston, MD

FOOT & ANKLE Pedro Cosculluela, MD Travis Hanson, MD Ray R. Valdez, MD Kevin E. Varner, MD


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

THE FUTURE OF MOBILITY : BIONANOSCAFFOLDS Physicians and scientists in the Houston Methodist Surgical Advanced Technology Laboratory are at work on a breakthrough technique that will significantly improve the way critical bone fractures are treated. In place of the traditional bone graft, allograft, or artificial implant, orthopedic surgeons at Houston Methodist are using a novel regenerative approach called BioNanoScaffolds. This research has been made possible through a $7.9 million grant from the Defense Advanced Research Project Agency (DARPA), an agency of the U.S. Department of Defense responsible for the development of new militar y technologies. “BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic polymers with the biological functions of natural biomaterial scaffolds. This approach achieves the correct strength requirements while enhancing the regeneration of healthy bone tissue at the fracture site,” says Bradley K. Weiner, MD, professor and vice chairman of the Department of Orthopedic Surgery and medical director of the Surgical Advanced Technology Lab. BioNanoScaffolds provides rapid and complete healing within four weeks of bony leg injuries that would normally result in amputation. “The polymer shell is made of a new material called polyether urethane, or PEU, which is the most durable known material that can be safely reabsorbed in humans over time. The shell holds the bone immobilized and works in concert with a novel collagen-based scaffold that is loaded with bioactive nanoparticles. This will allow accelerated bone healing,” says Weiner. The success of this research has resulted in further funding. Currently, testing has been done using sheep as models. Increased funding will provide for human clinical trials in both military and civilian patients.

“BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic polymers with the biological functions of natural biomaterial scaffolds. This approach achieves the correct strength requirements while enhancing the regeneration of healthy bone tissue at the fracture site.” Bradley K. Weiner, MD Vice Chair, Department of Orthopedic Surgery (Academics) Medical Director, Surgical Advanced Technology Lab

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STEM CELLS : REVOLUTIONIZING SURGICAL REPAIR Houston Methodist Orthopedics & Sports Medicine physicians are using stem cells to help accelerate healing and recovery after surgery. The ability of stem cells to differentiate into specialized cells and divide continuously allows them to replenish damaged tissue and promote healing within the body. A primary use of stem cells in orthopedics is in the treatment of rotator cuff injuries, which are classically refractory to complete healing and rehabilitation. “There is a lot of literature to indicate that stem cells have great potential to induce and accelerate healing,” said David Lintner, MD, orthopedic surgeon and chief of sports medicine at Houston Methodist Hospital. During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this channel to induce healing through replacement of damaged cells and replenishment of injured tissue. “Stem cells hold a great deal of promise in orthopedics,” says Mark Maffet, MD, orthopedic surgeon at Houston Methodist Sugar Land Hospital. “Right now, their use is cutting-edge but I believe they will ultimately play a huge role in the success of surgical repair.” The efficacious combination of rotator cuff surgery and stem cell therapy has caused orthopedic surgeons at Houston Methodist to broaden its application. Lintner says the surgery has been so successful in shoulders that he has begun to use stem cells in anterior cruciate ligament (ACL) and meniscus repair surgeries. “For ACL repair, the graft is soaked in a concentrate full of stem cells and other growth factors prior to fixation,” says Maffet. “In other cases, we can simply suture the torn ligament and inject the stem cell concentrate into the affected area.” “It seems advantageous to use stem cells when a muscle, tendon, or ligament might otherwise have a limited ability to heal, which is often the case with rotator cuff repairs,” says Lintner.

During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this channel to induce healing through replacement of damaged cells and replenishment of injured tissue.


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

MAXIMIZING HUMAN PERFORMANCE CARTILAGE RESEARCH: A BEND OF THE KNEE Physicians at Houston Methodist Orthopedics & Sports Medicine are at the forefront of orthopedic research in their ongoing studies of cartilage repair, resurfacing and regeneration. Articular cartilage lines the bones within all joints and, due to its lack of blood supply, cannot heal when torn or injured. In addition, articular cartilage consists of only one type of cell capable of renewal - the chondrocyte - that becomes less active with age and injury. As a consequence, joint repair that involves cartilage damage has been a longstanding challenge for orthopedic surgeons. “We are currently involved in a multicenter study that is researching hystotechnologies and tissue-engineered cartilage for articular defects. The research is focused on the meniscus — how it behaves when it is torn and when it is repaired, how best to rest to restore it and how best to rehabilitate it,” says Patrick McCulloch, MD, orthopedic surgeon. Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different angles. The x-rays are then combined to create 3-D images and measure the movement of the beads. “In contrast to our original hypothesis, we found that meniscal repair sites did not gap when the knee was taken through high flexion, or bent at a 90 degree or higher angle. We determined that it is not necessary to restrict flexion after surgical meniscal repair,” says McCulloch. “We have subsequently performed several studies using this new technique to look at the movement of the meniscus to evaluate the effects of weight bearing, use of crutches, and different types of surgery, such as root repairs and the meniscus transplantation.”

Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different angles. The x-rays are then combined to create 3-D images and measure the movement of the beads. 8

Orthopedics

m1

Educating For Tomorrow


m2 ORTHOPEDICS IN SPACE Space travel can be extremely hard on the human body. The collaboration between Houston Methodist and NASA is addressing this through supervision of a teaching program that instructs astronauts how to do in-flight musculoskeletal ultrasounds. The purpose of the program is to identify soft tissue injuries that might occur in space where the use of other scanners or x-ray equipment is not possible.

tibia beads

“We also provide the decision-makers at NASA with the highest level of orthopedic screening and evaluation possible, applying the same techniques we use with professional athletes to ensure a healthy astronaut corps,” says McCulloch, serves as the orthopedic surgical consultant for NASA.

PLATELET-RICH PLASMA: A HEALING ELIXIR Houston Methodist continues to implement new clinical breakthroughs in orthopedics such as regenerative medical treatment with platelet-rich plasma (PRP) injection therapies. The theoretical use of PRP lies in the efficacy of certain growth factors found in PRP that help in healing and tissue repair. PRP can be used when cortisone shots and viscosupplementation with hyaluronic acid injections stop working. Results so far have been good.

“In fact, European two-year studies show PRP has significant benefit over both of those therapies. PRP is a promising, safe and effective treatment that can help repair rotator cuff injuries, Achilles’ tendon injuries, arthritis and a number of other diagnoses. Many surgeons are hesitant to use this therapy because it is so new, but as leaders in orthopedics, the surgeons here at Houston Methodist are comfortable with implementing innovative procedures,” says Josh Harris, MD, orthopedic surgeon.

THE SLAP TEAR Researchers and physicians leveraged the relationships with professional sports teams to initiate research topics. Orthopedic surgeons at Houston Methodist generated the first research papers from this unique partnering, looking specifically at injury outcomes in professional athletes. “To evaluate the best way to treat a common throwing injury known as the SLAP tear, we merged the stats of players who were treated surgically and those treated with nonsurgical rehabilitation,” says David Lintner, MD, chief of sports medicine. “We found that players perform much better with non-surgical treatment, and the research confirmed what many team physicians had suspected but not documented.”


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

LEADING INNOVATIONS IN JOINT REPLACEMENT Houston Methodist Orthopedics & Sports Medicine is a leader in the advancement of joint replacement, taking arthroplasty beyond the need for functionality into the desire to preserve and even optimize performance for a lifetime. Cutting-edge science and clinical research provide scientists and physicians the ability to accurately recreate normal function and motion of a joint, while continually pursuing the latest innovations in joint replacement technology.

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Orthopedics

Delivering Better Outcomes

Educating For Tomorrow


THE NEWEST IDEAS IN KNEES The population’s current health and longevity is steadily increasing the demand for joint replacements as Baby Boomers seek to continue a robust and active lifestyle. Knee cartilage is often the first to go. And, although surveys indicate that 85% of those who receive a knee replacement are satisfied, this leaves 15% of this cohort unhappy. “I believe that number is too high. We need to be asking important questions such as, ‘What are the best methods to determine the proper implant for a given lifestyle? How can normal knee function be maintained or recreated with implants that allow patients to run, jump, and climb –not just walk? Should ACLs and PCLs be preserved?’” says Kenneth Mathis, MD, orthopedic surgeon and joint replacement specialist. Current models of implants are in the process of evaluation with more sophisticated tools of assessment. “Using fluoroscopy, we can validate the computer-driven models to determine how accurately we recreate function in a new implant. This has clear advantages over the evaluation of cadaver models and guessing that implants will fit correctly in patients,” says Mathis. In addition, the practice of severing the ACL and PCL is undergoing reevaluation. “In the past, we only evaluated implants based on decreased pain and the duration of the implant,” says Mathis. “Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may lead to increased satisfaction.” Mathis has also contributed to the creation of a 120-question patient survey that helps quantify the best implant match for each patient.

“In the past, we only evaluated implants based on decreased pain and the duration of the implant. Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may lead to increased satisfaction.” Ken Mathis, MD Orthopedic Surgeon


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

MULTIPLE APPROACHES TO HIP REPLACEMENT

Houston Methodist is one of the nation’s busiest and most progressive centers for hip replacement and complex revisionist hip surgery. Here, dedicated orthopedic surgeons perform extensive hip replacement procedures that are based on state-of-the-art techniques and represent the best outcomes with an equal focus on perioperative pain management and rapid rehabilitation. At Houston Methodist, hip replacement is accomplished through one of several minimally invasive techniques. The mini-posterior approach splits rather than cuts the muscle and eliminates the need for numerous instruments. Many believe the mini-posterior approach is the simplest and easiest approach to hip arthroplasty and provides the greatest safety margin for the patient. The anterior approach also splits rather than cuts the muscles and allows access to the hip joint from the front. “In addition, we perform hip replacements via the anterolateral approach, which is also a less invasive procedure. In this technique, a minimal amount of muscle-tendon insertion is detached from the front or the side of the femur to provide safe access to the hip joint. Patients at a high risk for dislocation may benefit from the anterolateral approach because there is no posterior disruption of the soft tissue,” says Stephen J. Incavo, MD, orthopedic surgeon and section chief of adult reconstructive surgery. Houston Methodist continues to provide high quality patient care in all aspects of reconstructive joint surgery. “Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which is expected to result in improved recovery and rehabilitation,” says Incavo. Orthopedic surgeons here are also investigating methods to streamline operating room efficiency through the use of dedicated surgical teams and disposable instruments. “Our equipment demands are enormous for joint replacements. It’s manual labor to get them in the OR and working properly. The more we can streamline this process, the better it will be for the patient,” says Incavo.

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“Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which is expected to result in improved recovery and rehabilitation.” Stephen J. Incavo, MD Section Chief, Adult Reconstructive Surgery Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College Program Director, Adult Reconstructive Surgery Fellowship



Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

NOVEL APPROACHES TO CARE IN HAND AND UPPER EXTREMITY NEW SURGICAL TECHNIQUES Arthritis of the first carpometacarpal (CMC) joint of the hand is a fairly common and frequently debilitating condition. Surgeons at Houston Methodist are forging new operative techniques to correct problems of the CMC joint when surgical resection of the trapezium is required. “We are augmenting the tendon repair with a device called the Mini TightRope. This provides a unique and less invasive way to suspend the thumb metacarpal after partial or complete trapezial resection. We use this technique for treatment of CMC arthritis, thumb CMC instability, and to correct proximal migration

after a failed tendon reconstruction,” says Korsh Jafarnia, MD, orthopedic surgeon and clinical assistant professor. “We look forward to achieving outcomes beyond expectations with minimally invasive and percutaneous techniques that maximize function. A new, less invasive technique that demonstrates this philosophy is endoscopic correction of radial nerve compression. “Rather than making an open incision beginning at the elbow, an endoscopic cannula is inserted proximal to the radial nerve. We are then able to work on the radial nerve from the inside, guided by the endoscope,” says Jafarnia.

“We are augmenting the tendon repair with a device called the Mini TightRope. This provides a unique and less invasive way to suspend the thumb metacarpal after partial or complete trapezial resection. We use this technique for treatment of CMC arthritis, thumb CMC instability, and to correct proximal migration after a failed tendon reconstruction.” Korsh Jafarnia, MD Clinical Assistant Professor, Baylor College of Medicine

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TREATING THE UNCONVENTIONAL ATHLETE The Center for Performing Arts Medicine (CPAM) encompasses the expertise of more than 100 physicians with specialized knowledge and skills who provide integrated care to the particular needs of performing artists. Working with a research-driven team to provide specialized care to professional performing artists, Evan Collins, MD, orthopedic surgeon and vice chair of CPAM, speaks nationally on the repetitive stress injuries and conditions frequently experienced by musicians and the need for protocols specific to this unique population. Dedicated to this effort, Collins and CPAM work in collaboration with the Shepherd School of Music at Rice University on an original research project. The study focuses on mechanical and biological impact, the role of “capacity” in repetitive stress, and overuse injuries and conditions musicians experience over the course of their long career. The study is an extension of a recently completed paper Collins co-authored with colleagues; Effective Hand & Upper Extremity Treatments for Performing Artists and Musicians: Identifying Evidence Based Research. The goal of the study is to establish evidence-based protocols and a “gold standard” level of care for a unique type of “athlete” currently not represented in sports medicine protocols developed for “traditional athletes.” This data will support development of early training programs and preventive care integral for the lifelong careers of musicians and broader performing artist population. It will also contribute to a global database and translate into a higher standard of care and universal protocol for non-musician patients experiencing similar tendinopathic and repetitive stress conditions. “Our research on repetitive and overuse syndromes with professional musicians will easily translate to the general population. These initiatives at Houston Methodist are just the beginning of a real shift in the paradigm of how we care for patients,” says Collins.

“Our research on repetitive and overuse syndromes with professional musicians will easily translate to the general population. These initiatives at Houston Methodist are just the beginning of a real shift in the paradigm of how we care for patients.” Evan Collins, MD, MBA Vice Chair, Center for Performing Arts Medicine


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

TACKLING THE DAMAGED ANKLE NEW ALTERNATIVES TO OLD TECHNIQUES: OPTIONS FOR PATIENTS Specialists at Houston Methodist Orthopedics & Sports Medicine are leading the way in the advancement of sophisticated ankle implants and cartilage replacement techniques. Here, the orthopedic surgeons and dedicated surgical team treat a variety of ankle injuries, from acute trauma to chronic problems that result from old injuries or surgeries performed elsewhere that have failed. The ankle has historically been a difficult joint to replace, primarily due to the large amount of bone resection required and the lack of excess tissue necessary for adequate healing and recovery. Working with a recently developed three-component implant that requires less bone resection, known as the Scandinavian Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion in the ankle compared to traditional fusion. Cartilage replacement is a new technique in use at Houston Methodist when arthroscopy of the ankle fails. “The problem with an ankle sprain is the cartilage is often damaged which can cause chronic, long-term consequences such as arthritis. The articular cartilage can be bruised when too much pressure is exerted on it but the injury to the cartilage doesn't manifest until months later,” says Pedro Cosculluela, MD, orthopedic surgeon. “The damaged cartilage or exposed bone can be replaced by small cylinders of cartilage and bone that are obtained from areas that are not weight-bearing, or from allografts or cadaveric tissue. A second option is to use cadaver grafts and remove a plug to cover the hole that’s in the patient’s ankle,” says Kevin Varner, MD, interim chair of the Department of Orthopedic Surgery. “Both ankle replacement with the STAR prosthesis and cartilage replacement are new, viable alternatives to standard ankle repair that consisted primarily of joint fusion,” says Varner.

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Delivering Better Outcomes

Educating For Tomorrow


Wor k i n g w i t h a re cen t ly developed three-component i m p la n t t h a t re qu i re s le s s b on e re s e c t i on , k n ow n a s the Scandinavian Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion i n t h e a n k le com p a re d to traditional joint fusion.


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

Educating For Tomorrow

CARING FOR THE UNIQUE NEEDS OF ATHLETES, FROM ELITE PROFESSIONALS TO STUDENT ATHLETES The specialists at Houston Methodist Orthopedics & Sports Medicine aspire to maximize all aspects of human performance through the multidisciplinary collaboration of leading orthopedic surgeons, primary care sports medicine specialists, athletic trainers and physical therapists. Based on its reputation of excellence in sports medicine, Houston Methodist is the destination of choice for Houston’s premier sports teams and fine arts organizations. “We’re extremely proud to be the official health care provider for the Houston Texans, Houston Astros, Houston Dynamo, Rice Athletics, and RodeoHouston,” says David Lintner, MD, chief of sports medicine at Houston Methodist Hospital. “Performers can suffer from injuries as well – not just athletes. And so we are also the official health care provider for the Houston Symphony, Houston Ballet and the Houston Grand Opera. We are able to provide them with the best care available, but we learn from them as well.

Performers and athletes give us unique insights into the extremes of human performance.” Houston Methodist’s commitment to excellence in sports medicine at all levels is evident in its support of the Houston community student athletic programs. Physicians serve as team doctors and consultants to many of the areas middle and high school teams. During the fall sports season, the physicians host Saturday morning clinics to help student athletes quickly get treatment for, and recover from, injuries incurred during a week of practice and games. The clinics provide easy access to specialists and physical therapists as well as on-site imaging and rehabilitative services.

Houston Methodist is the destination of choice for Houston's premier sports teams and fine arts organizations.

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ATHLETIC TRAINING PROGRAM : REGIONAL HEALTH CARE EXTENDERS The Houston Methodist Athletic Training Program has 19 full-time trainers that serve over 500 schools across the region. “Our program is unique because of its purpose and execution,” says Jace Duke, ATC, LAT, operations coordinator of Athletic Training Services. “As regional extenders, our trainers take Houston Methodist’s world-class medical services beyond the walls of the hospital and into communities where top-notch sports medicine care is often unavailable.” In 2013, Houston Methodist expanded its outreach to east and north Texas by partnering with several large school systems to provide athletic trainers to support their athletic programs.

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FULL TIME LICENSED ATHLETIC TRAINERS

OVER

500 1,500

SCHOOLS SUPPORTED THROUGH THE ATHLETIC OUTREACH TRAINING PROGRAM

OVER

COMPREHENSIVE PHYSICALS THROUGH PREPARTICIPATION STUDENT PHYSICALS EVENTS


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION (MITIE ) SM

LEADING MEDICINE

Educating For Tomorrow

HOUSTON MITIE AT A GLANCE MORE THAN

6,300

LEARNERS IN 2013

One of the largest and most comprehensive education and research facilities in the world, MITIE is leading the practice of medicine for physicians and health care providers. MITIE offers multidisciplinary, hands-on learning opportunities using advanced imaging systems and robotics. Surgeons and other health professionals are able to continually refine and acquire new skills that allow them to perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools, our research programs are focused on the development and assessment of emerging technologies and technical skills to improve the care of patients through less-invasive therapies. At MITIE, the finest researchers and clinicians are building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.

40,000 SQUARE FEET OF EDUCATION AND RESEARCH SPACE

26 MORE THAN

SURGICAL SPECIALTIES FROM ACROSS THE WORLD

20,000

LEARNERS SINCE INCEPTION

For more information, visit mitietexas.com

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PREPARING FOR TOMORROW : ORTHOPEDIC SURGERY ACADEMIC PROGRAMS ORTHOPEDIC SURGERY RESIDENCY PROGRAM For over 50 years, Houston Methodist has served as a teaching hospital for Orthopedic surgery residents. Today, the Houston Methodist Orthopedic Surgery Residency Program is accredited by the Accreditation Council for Graduate Medical Education (ACGME) and is under the directorship of Bradley Weiner, MD, vice chair (Academics) of the Department of Orthopedic Surgery. The residency program provides a unique structure designed on a foundation of evidence-based care, surgical mentorship and academics. Our residency program accommodates three residents per year for a total of 15 residents. Our teaching faculty integrates attending physicians in all subspecialties including joint reconstruction, spine, sports medicine, hand and upper extremity, foot and ankle, trauma, pediatrics, oncology and general orthopedics. All attending physicians are fellowship-trained, and their average duration of resident teaching experience exceeds eight years. Orthopedic surgery residents experience hands-on surgical training with subspecialty rotations, mentorship style. Within the Methodist Institute for Technology Innovation and Education (MITIE), considered by many as the top surgical simulation center in the world, cadavers are used to teach anatomy and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical techniques. Residents work exclusively with one or two attending on the service – in clinic, on the floors, in the ORs and in personalized didactic and case sessions. This immersion-style of subspecialty training provides the best possible educational setting for our residents. Our residents are actively engaged in research from their first year of residency, and are required to dedicate four months to Orthopedic research carried out in the Surgical Advanced Technology Laboratory (SATL) with a focus on nanotechnology and tissue engineering.

ADULT RECONSTRUCTIVE SURGERY FELLOWSHIP

Within MITIE cadavers are used to teach anatomy and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical techniques.

A one-year fellowship in Adult Reconstructive Surgery is designed to provide clinical and research experience in total knee and hip replacement, with an emphasis on muscle-sparing reconstructive surgical approaches. “Our fellows get a broad exposure to a high volume of diverse patients. They will see straightforward and complex hip and knee replacement cases and will learn a variety of state-of-the- art techniques and procedures,” says Stephen J. Incavo, MD, orthopedic surgeon and hip and knee replacement specialist. Research is a highlight of the fellowship program, and the Houston Methodist research facilities are available to each fellow to help facilitate investigation that is performed in direct collaboration with teaching faculty and the dedicated staff of engineers, clinical research specialists and computer scientists.


Leading Medicine: An Overview

Pursuing Medical Discoveries

Breaking New Ground

Delivering Better Outcomes

TRAINING THE NEXT GENERATION OF SPORTS MEDICINE SPECIALISTS Houston Methodist provides comprehensive residency and fellowship programs aimed at training the next generation of sports medicine specialists.

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Orthopedics

Educating For Tomorrow


ORTHOPEDIC SPORTS MEDICINE FELLOWSHIP The Orthopedic Sports Medicine Fellowship at Houston Methodist is unique based on its high clinical volume and “hands-on” teaching experience in the clinic and on the field.

The primary care sports medicine fellowship provides a broader understanding of the unique needs of the athletic population – setting a precedent in sports medicine training. Dr. David Braunreiter, MD, CAQSM Director, Primary Care Sports Medicine Fellowship at Houston Methodist Sugar Land Hospital

“We believe that sports medicine is about more than just arthroscopic surgery,” says David Lintner, MD, chief of sports medicine at Houston Methodist Hospital. “Our fellows have huge clinical and surgical volumes. They also cover games and practices for professional and college teams, and spend almost as much time in the training room and on the field as they do in surgery and clinic. Sports medicine is about helping athletes realize their full potential on the field.”

PRIMARY CARE SPORTS MEDICINE FELLOWSHIP This one-year fellowship provides fellows in certain specialties, such as internal medicine, family medicine, pediatrics, emergency medicine and physical medicine/ rehabilitation, with a broader understanding of the unique needs of the athletic population – setting a precedent in sports medicine training. The fellowship operates out of two hospitals in the Houston Methodist system – Houston Methodist Sugar Land Hospital and Houston Methodist Willowbrook Hospital – and is academically attached to the Houston Methodist Family Medicine Residency Program. “Although the primary care sports medicine physicians are under the Department of Orthopedics, our fellowship emphasizes care of the whole athlete,” says Scott Rand, MD, FAAFP, CAQSM, director of the Primary Care Sports Medicine Fellowship at Willowbrook Hospital. More than half of the fellowship training focuses on non-musculoskeletal medical problems in athletes such as metabolic issues, heart screenings, asthma,

concussion management, altitude medicine and medical problems in endurance athletes. Primary care sports medicine is about providing the right care at the right time from the right provider for athletes of all sports. One such example is concussion management which requires more study in the field of neurology than a orthopedist would normally pursue. “We see between three and six concussion patients a day, so we develop the expertise to appropriately treat concussion given this volume. This includes treating the initial injury and understanding sport-specific issues that can influence crucial return-to-play decisions,” says David A. Braunreiter, MD, CAQSM, director of the Primary Care Sports Medicine Fellowship at Houston Methodist Sugar Land Hospital. “This specialty and our fellowship specialize in a population of people, not a specific disease process,” says Dr. Rand. “Athletes typically don’t like to go to the doctor, because they are generally healthy and know a lot about their own body. So we seek the appropriate treatment, which doesn’t always mean surgery. Athletes just want to get fixed when they are broken and become better athletes, and that’s what we help them do.”

PHYSICAL THERAPY RESIDENCY The physical therapy residency is an APTA-credentialed post-professional residency for physical therapists who want to become a board certified sports physical therapist. “In addition to caring for patients in the clinic, our PT residents also participate in structured learning with the orthopedic surgeons and fellows. We have weekly hands-on training on specific topics, including the cadaver lab at MITIE ®. However, they are also covering sporting events out in the fields and on the courts, which are integrated with the athletic trainers and physicians,” says Matt Holland, PT, CSCS, director of the Physical Therapy Residency Program.


HOUSTON METHODIST LEADING MEDICINE YESTERDAY, TODAY, AND TOMORROW At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list. For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list. Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.

FAST FACTS* 132 Operating Rooms

2,157

Licensed Beds (1,721 operating beds)

4,471

Affiliated Physicians

8,150

International Patient Encounters (from 90 foreign countries)

15,791 Employees

85,042 Inpatients in 2013

234,944

Emergency Room Visits in 2013

616,317

Outpatient Visits in 2013 *Houston Methodist data includes five hospitals in Greater Houston

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LEADERS IN RESEARCH Accelerating discovery and delivery to patients

At Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.

More than 840 active clinical protocols $55m TOTAL RESEARCH FUNDING IN 2013 See all the ways we’re leading medicine at hmleadingmedicine.com

Photo courtesy of WHR Architects, Inc. Š Aker/Zvonkovic Photography, Houston, Texas


Houston Methodist Hospital 6565 Fannin Street Houston Texas 77030

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW. At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.

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