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Introduction
A wise man once said “Do not tell people your problems
because half of them do not care and the other half are actually
glad you got them.” As a country we are trying to crawl
our way out of a recession but it appears that the global
economy may prolong this recovery effort. The Healthcare
Affordability Act has been signed into law. I am certain that
each of you struggles, as do I, with the mere size of the bill
and the staggered starts. It will clearly bring change and I
think that the leadership at AAOS has done a credible job in
informing the membership in support of part of the legislation
and expressing concern over other parts. Changes in
healthcare in Massachusetts may in fact pose a greater threat
to us, particularly at academic medical centers. This seems
to happen on a cyclical basis and, to-date, things have always
seem to work out.
We have just emerged from the long winter and our
spring has been beautiful except for the Red Sox who seemed
to have decided to fold earlier than usual.
The Brigham and Women’s Hospital remains strong as
does the Orthopedic Department. Our president and CEO,
Dr. Gary Gottlieb left to become our president of Partners
Healthcare, now overseeing our entire Health System. Dr.
Elizabeth Nabel was successfully recruited from the NHLBI to
be our new president and CEO. Betsy is a cardiologist trained
at the Brigham and is a proven leader in healthcare. The
Department of Orthopedics has undergone further administrative
change. Mr. Jonathan Beauchesne was recruited this
past year to be our new department administrator. He has
added some new faces in the administrative team and I am very
pleased with our current organizational structure. We still are
at multiple campuses including the Brigham, 850 Boylston
Street, Faulkner Hospital, Braintree Hospital and Foxborough.
The educational program in the Harvard combined residency
will graduate another outstanding group of residents in a
few months. They have all been accepted to outstanding fellowships
throughout the country. Our fellowship program continues
to grow with graduating fellows in joint arthroplasty, hand
and upper extremity, shoulder, sports, spine, foot and ankle and
trauma. We also had an outstanding recruiting year, both for
the new residents in the combined program and the fellows.
TRAUMA
The Combined Trauma Program reports as a single group
and will be found in this document.
DFBWH Musculoskeletal Oncology Service:
The musculoskeletal oncology service has undergone a significant change. Dr. John Abraham has accepted the position
as chief of musculoskeletal oncology at Jefferson Medical
College and the Rothman Institute. He will relocate there
this summer. We have been fortunate to recruit Dr. Marco
Ferrone to replace Dr. Abraham. Dr. Ferrone is a graduate
of the McGill Orthopedic Program. He then completed a
spine fellowship at the Hospital for Special Surgery and is
now completing a musculoskeletal oncology fellowship at the
Massachusetts General Hospital. Marco has both clinical and
academic interests in skeletal metastasis and will join John
Ready, the chief of orthopedic musculoskeletal oncology at
the Dana-Farber/Brigham and Women’s Hospital, adding to
the continued growth in the sarcoma program and integration
with the Spine Service for treatment of spinal metastasis.
Hip and Knee Arthroplasty Service
The Arthroplasty Service at the Brigham continues its
traditional role as one of the most active divisions of the
department. The fellowship awaits three new fellows, who are
the first to navigate the arthroplasty match.
Dr. Richard Scott and Dr. Thomas Thornhill are still
active and operating three days a week. Dr John Wright has
led most of the initiatives focusing on efficiency, outcomes
and bundled payments that will be essential in dealing with
the new healthcare economy. Dr. Wolfgang Fitz has focused
his interest on unicompartmental and bicompartmental knee
arthroplasty. Dr. Tom Minas bridges the transition from
sports medicine to arthroplasty as director of the Cartilage
repair Center. This center is nationally and internationally
recognized for its clinical and research efforts. In addition,
the ConforMIS custom knee is becoming a widely used and the
I-duo knee is in its final stages of design for use in total knee
arthroplasty. Dr. Andreas Gomoll has joined that service and
has been very productive academically and clinically.
Dr. Daniel Estok, who is the Chief of Arthroplasty division,
has the most active revision practice in the area. Dr.
John Ready, who is dually trained both in arthroplasty and
musculoskeletal oncology, is a leading authority in the area of
joint resurfacing
BWH Hand/Upper Extremity Service
The Hand and Upper Extremity Service, directed by Barry
P. Simmons, MD and including Philip E. Blazer, MD, Brandon
E. Earp, MD, and George S.M. Dyer, MD., has had a robust
year continuing efforts in education, research and patient
care. Our close affiliation with Children’s Hospital continues
with Peter M. Waters, MD, director of the Hand and Upper Extremity service and now Clinical Chief of Orthopaedics, and
Donald S. Bae, MD. The combination of BWH and Children’s
continues to offer a spectrum of fellowship training that is
unrivaled. We also are continuing the valuable cross rotation
of the fellows with the Hand Service at MGH.
We celebrated the 28th year of our fellowship in the spring
of 2009 and over 50 former fellows and their guests attended
the festivities. This year we hosted the Richard J. Smith, MD,
lecture and Peter M. Waters was the celebrated guest lecturer.
In addition, we appreciated the visit of Mark J. Koris, MD, who
spoke at the meeting. We continue to attract a large number of
fellowship applicants and will maintain educating 5 fellows (3
at BWH and 2 at MGH) for the coming academic year.
Following Haiti’s large earthquake on January 12th 2010,
Dr. Dyer was deployed twice to that country to assist with relief
efforts. Dr. Dyer worked in a Haitian hospital undamaged
by the earthquake but overwhelmed with critically injured
patients. His team performed more than 200 life and limbsaving
operations in 2 weeks. He returned to Haiti 8 weeks
later on March 20th, to follow up on some of those same
patients and also to help establish a long-term project to assist
the Haitian government to train Orthopaedic surgeons in the
future. Back home, since joining the VA as Chief of Upper
Extremity surgery, Dr. Dyer has dramatically expanded the
scope and scale of shoulder, elbow, wrist and hand surgery to
meet the needs of needs of veteran of all conflicts, but particularly
those injured recently in Iraq and Afghanistan
The Harvard Combined Orthopaedic Fellowship, which
includes the Hand and Upper Extremity service at Children’s
Hospital, continues to attract a large number of talented applicants.
Now in its 27th year, and planning for our second alumni/
ae reunion in 2009, we continue to train 3 fellows a year. The
cross-rotation with the fellowship at the MGH, started in 2000,
remains enormously beneficial and has allowed us to participate
in educating over 70 fellows. Our current fellows, Michael
Garcia, Ross Richer and Farnaz Yassaee joined us after completing
residencies in Chicago and New York respectively.
BWH Spine Service
The spine service continues to progress in many different
arenas. Educationally, the combined MGH-BWH spine surgery
fellowship has gained a tremendous amount of momentum.
Our young spine fellowship appears to be in competition
with many long-standing top fellowships in the country.
In addition, our previous fellows continue to be active in
research, publications, and resident education at their respective
institutions.
Spine research has exploded at Brigham and Women’s Hospital. Currently, we have at least six IRB-approved clinical
research projects underway. These include an analysis of
operative and nonoperative treatment of epidural abscesses,
vertebral artery injuries and their treatment after cervical
trauma, a retrospective study of drain use after anterior
cervical disectomy, and a prospective randomized controlled
trial of short versus long postoperative restrictions following
discectomy. These Brigham originated studies often involve
other spine centers in the Harvard community, such as MGH
and BIDMC.
The spine research that has been completed has achieved
both national and international attention during presentations
at scientific meetings. We have had a very strong showing
at the recent annual meetings of the American Academy of
Orthopaedic Surgeons, International Society for the Study
of the Lumbar Spine, and the North American Spine Society
(NASS). In particular, two of the studies that we performed
were presented at the “best paper” session at the NASS annual
meeting in San Francisco. Another study, led by Dr. Mitchel
Harris, has been featured in Orthopaedics Today in a discussion
of cervical spine clearance after trauma.
The Spine service attendings at BWH have enjoyed many
personal achievements. Since January, 2009, Dr. Mitchel Harris
has published 15 peer-reviewed articles, some of which will
likely be classic studies, such as “Mortality in elderly patients
after cervical fractures” which appeared in the March issue
of JBJS-American. During the same period, Dr. Christopher
Bono has published 24 peer-reviewed articles across a variety
of topics such as cervical trauma, evidence-based guidelines,
and the outcome of lumbar fusion in the elderly. Dr. Bono and
Dr. Harris have co-authored numerous book chapters, which
usually involve of the fellows or residents from out program.
On the editorial side, Dr. Bono as the editor for the recently
released ICL Spine 2 from AAOS. He is also in the final stages
of completing a new book on the practical application of evidence-
based medicine to spinal surgery entitled Prove It, to be
published by Wolters Kluwer.
Both Dr. Bono and Dr. Harris have given numerous grand
rounds lectures at various institutions across the country. In
addition, they have both been extremely active in moderating
at national meetings as well as organizing and chairing
courses. Dr. Bono is the program chair for the upcoming Spine
Study Group in West Palm Beach.
The Spine service attendings are highly active in many
professional organizations. Dr. Harris is a member of several
committees in the North American Spine Society and the
Leadership Committee of the AAOS. He has recently been
asked to chair a Spine Tumor symposium for AO Spine North
America and has been promoted to the associate editorial position
of The Spine Journal. Dr. Bono is active on many NASS
committees and currently serves on the Board of Directors.
Dr. Bono is not only the chair of the Adult Spine Evaluation
Subcommittee for the AAOS. He is also the Deputy Editor for
Orthopedics for The Spine Journal and has recently been asked
to be the Deputy Editor of CME for the JAAOS.
Dr Greg Brick continues to have an active practice split
between Total Joint Arthroplasty and Spine.
BWH Foot and Ankle Division
The Foot and Ankle Division has enjoyed another industrious
year. The staff sees patients at all four campuses, now
including Foxboro. With continued growth in volume, the
division is pleased to announce that Eric Bluman, MD, PhD
has been hired as full-time faculty. Dr. Bluman comes from
the Madigan Army Medical Center where he served as Chief of
the Foot and Ankle Division. He has advanced training in foot
and ankle as well as trauma surgery, and served in Iraq. He is
already very busy both clinically and academically. Also joining
the division is Stuart Kigner, DPM. Dr. Kigner is an experienced
podiatrist and sees patients for us at the main campus.
He also practices at the Mass General and in Framingham.
On the academic front, the Division continues to be very
productive. Its research on tendon injury and patient satisfaction
has been presented at the Annual Meetings of the AAOS
and at the American Orthopedic Foot and Ankle Society. At
AAOS, Drs. Chiodo and Bluman also chaired an Instructional
Course Lecture on tendon transfers about the foot and ankle.
Numerous review articles and chapters have also been published.
Michael Wilson, MD continues to run the Orthopaedic
Service at the Faulkner. He has also been nominated to
the American Orthopaedic Association. Dr. Chiodo chaired
the AAOS Clinical Guideline Committee on Achilles Tendon
Rupture. He has also been appointed to be Chair of the AOFAS
Evidenced-based Medicine Committee. Dr. Bluman has been
appointed content editor for the foot and ankle section of
Orthopaedia.com. He also is a member for the AAOS taskforce
on non-physician education of orthopaedic residents.
Finally, Jim Ioli, DPM, our Brigham Podiatry Chief, leads our
Faulkner Podiatry Division.
BWH Orthopedic Surgery Sports Medicine/Shoulder Service
The Sports Medicine/Shoulder Service is currently composed
of four Attending Physicians: Dr. Laurence Higgins
(Chief of the Service), Dr. Andreas Gomoll, Dr. Scott Martin
and Dr. Thomas Minas. The care for patients has spread out with services provided at the BWH Main Campus, 850
Boylston Street Clinic, Faulkner Hospital, BWH at Foxboro
and the outpatient surgical center in Foxboro. Each of our
physicians are active in the Harvard Combined Orthopedic
Residency Program training residents, medical students and
fellows. The two Fellowship programs continue to be run
within the Service: The ACGME accredited Harvard Sports
Medicine Fellowship program and the Harvard Shoulder
Service Fellowship Program. The Shoulder Fellowship rotates
3-4 full time Fellows through the program each year and collaborates
with Dr. Jon JP Warner from MGH and includes an
international experience working with leading shoulder surgeons
throughout Europe.
Dr. Laurence Higgins, Chief of the Sports Medicine/
Shoulder Service, has been elected into the Herodicus Society
for notable achievement in the field of Orthopedic Surgery
this past year. Dr. Higgins’ practice has been chosen as the
training site for K23 Grant Recipient Dr. Nitin Jain for the
upcoming 2010 Fellowship term. A robust research program
continues to be productive with multiple randomized prospective
studies underway. Currently they are focused on the role
of Vitamin D in Sports Medicine. In addition we have also
received additional funding from the OREF Resident Research
Grant awarded to Dr. Jae Kim to study the effects of NSAID’s
on rotator cuff healing. Dr. Higgins is involved in both
prospective and retrospective research studies including the
study of PRP injections into high grade tendinopathy of the
rotator cuff. Dr. Higgins was asked to serve as Chairman for
the AAOS/ASES Open Arthroscopic Techniques in Shoulder
Surgery Meeting in Chicago in May 2009. In addition, he
participated as an invited lecturer at over fifteen educational
courses and Orthopedic Society meetings across the country
this past year. Dr. Higgins also serves as the Team Physician
for Brookline High School.
Over the past year Dr. Tom Minas has notably performed
the 500th Autologous Chondrocyte Implantation (ACI) on
January, 27 2009 at the Brigham and Women’s Hospital in
Boston. He was also nationally profiled on an interview with
The Early Show on CBS News in December 2009 with the
featured story of Dara Torres after her reconstructive knee
surgery. He has been an invited speaker at ten Orthopedic
Conferences nationally and internationally over the past
year, including the Australia Orthopedic Society Meeting in
October 2009 and the ConforMIS Europe GmbH in Germany
in November 2009. Dr. Minas continues to publish journal
articles and books, in addition to performing live webcast
surgery of ConforMIS iUni for Harvard Annual Arthroplasty
Course on October 30, 2009.
Dr. Andreas Gomoll received grant funding from the AANA
(2009) and NIH (2009-2011) for the research project which he
serves as Principle Investigator on: Does simulator training
improve surgical skills in orthopaedic surgery residents? In April
2009 Dr. Gomoll received the APOSSM Traveling Fellowship
award to serve as a host of a North American Pacific Rim Fellow
from the American Orthopaedic Society for Sports Medicine’s
international program. He has presented as an invited guest lecturer at ten venues over the past year including Grand
Rounds presentations and lectures at international meetings for
Orthopedic Surgery. Dr. Gomoll has recently published his book
on Biologic Joint Reconstruction: Alternatives to Arthroplasty
along with several journal publications and chapters.
Dr. Scott Martin continues to be the team physician for
Bridgewater State College and the New England Revs along
with Tom Gill and Bert Zarins. His work with Mark Brezinski
has made great strides with a recent publication in March 2010
comparing OCT to MRI in evaluating early changes of articular
changes with degeneration.
The Sports Medicine fellowship program was officially
recognized and approved by Partners Educational Committee
in January 2009 and received national accreditation by the
ACGME in July 2009. Last year, the BWH Sports Fellowship
was entered into the National SF Matching program which
will further enhance our ability to compete with other programs
on a national arena.
The department as a whole will continue to work with the
commitment of performing quality research studies, providing
the best orthopedic care to our patient and the best possible
teaching of our residents and fellows while meeting the challenges
the future may present.
Skeletal Biology Research Laboratory
Professor Julie Glowacki is Director of the Skeletal
Biology Research Laboratory, which studies basic, clinical,
and translational aspects of skeletal pathophysiology, skeletal
cell differentiation, effects of age and vitamin D status on bone
physiology, mechanisms of chondro/osteoinduction, and tissue
engineering approaches for skeletal regeneration. In the
past year, the group published several reports on the effects of
age on human marrow cells, obtained from hip and shoulder
tissues discarded during arthroplasty. Following the surprising
discovery by Dr. Shuanhu (Joe) Zhou that vitamin D substrate
is activated in bone marrow and may be part of paracrine
regulation of bone metabolism, we discovered that there is a
age-related decline in the expression of the activating enzymes
that may explain the observed age-related decline in osteoblast
differentiation from marrow cells. We also reported age and
gender differences in constitutive expression of members of
the important WNT pathways that may also underlie skeletal
aging. The group has NIH funding to gain further understanding
of dysregulation of human osteoblast differentiation and
function in order to test ways to rejuvenate bone formation.
Two NIH grants have built upon the development of
novel mitochondrial-targeted anti-oxidants to mitigate the
irradiation-induced impairment of bone healing. Work to date
in mice models shows that the anti-oxidants stimulate bone
healing in normal mice as well as irradiated mice. Ongoing
work tests their effects on aged animals and aged cells. Tissue
engineering research involves the regulation of chondrocyte
and osteoblast differentiation, optimization of Dr. Shuichi
Mizuno’s tissue bioreactor, and mechanisms of actions with
differentiation agents to enhance histogenesis. Drs. Bueno
and Glowacki published a review of cell-based and cell-free tissue engineering for skeletal applications and have written a
monograph on the biological principles underlying orthopedic
tissue engineering. An OREF grant to Dr. Laurence Higgins
concerns the pathophysiology of rotator cuff arthropathy in
collaboration with Professor Meryl LeBoff. Translational and
clinical research continues our multidisciplinary program
to improve follow-up management of osteoporosis in fragility
fracture patients, expand fracture pathways with other
in-hospital caregivers, the natural history of osteoporosis in
patients with osteoarthritis, importance of vitamin D status
for skeletal health.
Dr. Glowacki continues to serve the department as
Co-Chair of the BWH Musculoskeletal Research Center of
Excellence, representative to the BWH Biomedical Research
Institute’s Research Oversight Committee and the Partners
Steering Committee for the Biospecimens Enterprise for
Translational Research (BETR), and as Professional Standards
Officer for BWH Research Staff. She is a member of
the Harvard Medical School Committee on Promotions,
Reappointments, and Appointments, which concerns promotions
to Assistant and Associate Professor.
ORTHOPEDIC NANOTECHNOLOGY LABORATORY
Anuj Bellare, PhD:
The research of the Orthopedic Nanotechnology Laboratory
has focused on using a structure-property approach to improve
the mechanical and tribological properties of ultra-high molecular
weight polyethylene (UHMWPE) used in total joint replacement
prostheses.
The Orthopedic and Arthritis Center for Outcomes
Research (OrAC ORe):
OrACORE is a clinical and policy research unit established
in the Department in 2006 under the leadership of Drs. Jeffrey
Katz and Elena Losina. OrACORe investigators have several
exciting projects ongoing and others starting up. The MeTeOR
Trial (Meniscal Tear in Osteoarthritis Research; J Katz, PI) is
a seven center randomized controlled trial of arthroscopic
partial meniscectomy vs. a physical therapy based nonoperative
regimen in patients with symptomatic meniscal tear
and concomitant osteoarthritis of the knee. As of July 2010,
75% of the target sample of 340 patients have been enrolled.
BWH is the leading enrolling site, led by Dr. Scott Martin, the
leading MeTeOR enroller nationwide and Dr. John Wright.
Other sites include Hospital for Special Surgery, Cleveland
Clinic, Vanderbilt Unviersity, Mayo Clinic, Rush University and
Washington University.
Dr. Losina leads the Osteoarthritis Policy Model project,
an NIH funded computer simulation study of the costs and
outcomes of osteoarthritis over the lifetime. Dr. Losina and
team have used the model to publish the most comprehensive
cost effectiveness analysis of total knee replacement to date
(Archives of Internal Medicine, 2009). Numerous other analyses
are ongoing including the lifetime costs of osteoarthritis in
the US and the cost effectiveness of disease modifying therapy
in OA and of technical innovations in total knee replacement,
among others.
Finally, several clinical faculty members are collaborating
with OrACORe investigators on clinical projects in the PRIDE
program (Program for Research Incubation and Development).
Two PRIDE projects were published in the last year including
an epidemiologic study of mortality following cervical spine
fracture led by Dr. Mitchel Harris and a comparison of 1-day vs.
2-day epidural anesthesia strategies in patients undergoing total
knee replacement, led by Dr. John Wright. Other projects led
by Drs. Bono, Martin, Thornhill, Earp and others are ongoing.
Center for Molecular Orthopaedic in the Department
of Orthopedic Surgery
Keith D. Crawford, M.D., Ph.D. is the Director of the
Center for Molecular Orthopaedic in the Department of
Orthopedic Surgery. Dr. Crawford’s primary research efforts
are in the areas adult stem cell biology and regenerative
medicine, with a primary research emphasis on the role of
adult stem cells in osteoarthritis. Recently, he discovered a
novel adult stem cell name the ELA stem cell (early lineage
adult stem cell), which is phenotypically and functionally distinct
from mesenchymal stem cells (MSCs), MAPCs, MIAMI,
and VSEL adult stem cells. A publication of his finding is
forthcoming. In addition, Dr. Crawford has identified cellular
mediators in the synovial fluid, which interfere with the ability
of the ELA cell to propagate and differentiate into cartilage.
Furthermore, these cellular mediators have been found to suppress
the growth of a subset of soft tissue cancers.
In addition to Dr. Crawford’s research efforts, he sits on
the Culturally Competent Care Education Committee for the
Combine Orthopaedic Residency Program. The responsibility
of this committee is to foster the development of faculty and
curricula to prepare students and residents with the knowledge,
skill, and attitude to practice culturally competent medicine;
thereby diminishing healthcare disparities. Dr. Crawford
has also been appointed the Director of the BWH sponsored
Summer Training Academic Research and Scholarship
(STARS) and serves as the scientific advisor to the Harvard
Catalyst SCTRP and VRIP Programs. All of these programs are
designed to increase the number of under represented minority
students persuading careers in the healthcare professions,
as well as, diversifying the BWH residency staff.
OPERATION WALK BOSTON
Four years ago, I joined Operation Walk Denver to a mission
in Panama. Operation Walk, patterned after Operation
Smile was started by Dr. Larry Dorr in Iowa and has grown
into many chapters around the country. On the first trip to
Panama, I took 2 colleagues. The next year, we combined Op
Walk Boston and Op Walk Denver for a trip to the Dominican
Republic. For the past 2 years Operation Walk Boston has
returned to the Dominican Republic and is now firmly established
as Operation Walk Boston.
The events in Haiti earlier this year posed both challenges
and opportunities. Several members of our team volunteered
and went to Haiti early after the earthquake. Fortunately, our
group is integrated with Partners in Health, which has been firmly established in Haiti for years with their work on HIV
and multiply drug resistant tuberculosis. This gave our teams
the infrastructure to succeed in the otherwise chaotic environment.
The Haitian relief has been truly a combined effort and
I am pleased with the global response. Several surgeons from
the BWH and MGH Trauma teams were there the first week
and have been back more than once. Many of you have also
contributed to this effort and I think that we can all be proud
of the response from the orthopedic community. The problem
now is to sustain that effort.
The Operation Walk team was concerned about performing
elective total hip and total knees in the Dominican
Republic sitting in the shadows of the Haitian disaster. We
released a large part of our cargo, which helped in the early
relief effort. We have subsequently released much of our rehabilitation
equipment that had been stored in the Dominican
(crutches, walkers, etc.). We recently finished our Op Walk
mission where we performed 60 total hip and total knee
replacements in 5 days with a team of 5 surgeons, 5 anesthesiologists,
nurses, physical therapists, physician’s assistants and
3 Harvard residents. I am pleased that the Operation Walk
Program has been officially adopted by the residents and it is
an opportunity for training residents to become involved in an
international effort during their residency. The Medical leader
this year was Jeremy Smith PGY 4 and the other residents
were Kanu Okike PGY3 and Courtney Dawson PGY5.
SOCIAL EVENTS
Many former residents of my vintage remembered little
about official resident social outings. The golf outing is now
firmly established across the residency. Dr. Gregory Brick
and Dr. John Ready have now been established a ski event at
Waterville Valley. This year was again a success featuring resident
teaching, the downhill race and a chance for the faculty
and residents to gather informally. Finally, Gregory Brick has
become an avid fisherman in Boston Harbor and Stelwagen
Bank.
ALUMNI ISSUES
There is not much to report on the alumni front. Clem
Sledge spends much of his time in Maine and comes down
this way only when necessary. I speak to Bob Poss who has
now left his position with the JBJS and is doing well. You may
remember Nicki Champagne who for 40 years worked at the
Robert Brigham and then the Brigham and Women’s Hospital
keeping all of the orthopedic instruments straight. Nichole
has been an inspiration to all of us and she will be retiring in a
few months. Hopefully, some of the old guard will come to her
event. I saw Bill and Dicky Thomas at a Robert Brigham event
as well as Sarah and Fred Ewald. I am pleased that everyone
is thriving.
I wish you all a happy year and look forward to seeing
you soon.
Sincerely yours,
Thomas S. Thornhill M.D.
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