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Introduction
It seems like just last month that I was preparing my Chairman's
Report for 2003. Each year I ask myself whether this should be an annual report on
the activities of the Department, a strategic plan to guide the direction of the
Department over the next 5 to 10 years, or a chat room that updates alumni on the
activities of individuals in the group including those who have retired. Within the
past two years we have had the Harvard Medical School Dean's review (the essence of
which was summarized in my Chairman's Report of last year) and more recently an RRC
programmatic review with an analysis of our request to increase the residency back
to twelve residents a year for a total of 60 residents. This represents elimination
of the research block (though a research elective is embedded in the new program
design) and the six month chief residency. Each year I worry about droning on about
issues that are not pertinent or of interest. With that caveat I will try over the
next few pages to give you the current status of the musculoskeletal program here
at the Brigham, to talk to you about our strategic plan in musculoskeletal disease
as it fits into the overall plan of the BWF and Partners HealthCare, and then try
to bring you up to date about some of the activities of our past and present members.
Current Clinical Activities
In my report last year I summarized the history of the Department of
Orthopedics and the transition from the Robert Breck Brigham to the Brigham and Women's
Hospital. This past year has been marked by further growth and integration, particularly
in the areas of the Partners Trauma Service, Partners Shoulder Service, and with our
colleagues in Rheumatology.
Partners Trauma Service
 The recruitment of Dr. Mitchel Harris has been a tremendous addition to
the Brigham and Women's Hospital and the Partners Trauma Service. With the help of Drs.
Mark Vrahas, Chief of the Partners Trauma Service, Jim Herndon, and others, we were able
to recruit Mitch to head the BWH Trauma service and be an integral part of the growth
and development of our Spine Service. With his recruitment, Mitch completes the
integration of the Partners Trauma Service, joining Dr. Malcolm Smith at MGH and Dr.
Mark Vrahas, who is both at the BWH and the MGH. The combined Trauma Service at the
two institutions has been an excellent addition to patient care as well as resident
and fellow education. As many of you know, the Chief Residency positions in the Harvard
Program ceased last year and many of the Alumni were quite concerned since this was felt
to be one of the most important differentiators in our program and one of the best
experiences for the graduates. This transition occurred over a period of three years
and its success is a direct reflection of the quality of the Partners Trauma Service.
Our PGY5s spend a significant time on the Trauma Service and benefit from the expertise
of the attendings as well as a very well-trained group of trauma Fellows. Moreover, the
integrated Trauma program is generating excellent prospective data from their registry
that will be a great source of academic productivity on an annual basis. Additionally,
the new program provides continuity of patient care and has developed a growing referral
pattern of complex trauma and "cold /warm" trauma from the New England area.
Partners Shoulder Service
Under the leadership of Dr. J.P. Warner and Dr. Peter Millett, the
Partners Shoulder Service continues to grow at both institutions. In the past year
we have had several visits and academic programs focusing on the shoulder. Dr.
Charles Neer, Dr. Frederick Matsen III, Dr. Gilles Walch and Dr. Russ Warren have
all been recent visitors and a great addition to the training program orchestrated
by the Shoulder Service. There is also a growing research program in areas ranging
from shoulder biomechanics to genomics and proteomics. The Fellowship program has
continued to grow and attract leading national and international candidates. The
Partners Shoulder Service has also been a nucleus for the clinical and academic
activities of several of us at the Brigham and MGH who are interested in the various
aspects of shoulder surgery.
BWH Spine Sevrice
We are hopeful that these two achievements can be replicated in other
areas to further integration within Partners Orthopedics. Our next target is likely to
be the Spine Program because there are many areas of synergy and great opportunities
for integration. Dr. Richard Ozuna is no longer at the BWH. Dr. Greg Brick continues
to be extremely active, dividing his time between arthroplasty and spine. Dr Mitch
Harris is also a strong addition to the spine program. Mitch has great experience in
adult spine and spine trauma. The other superb addition to our spine program over the
past few years has been Dr. Zacharia Isaac of Physical Medicine and Rehabilitation.
Zach's spine practice has grown tremendously and he has been a wonderful resource
for our non-operative spine patients. This includes the offering of clinical
evaluation and all forms of non-operative therapy including epidurals, facet blocks,
etc. There is also a new spine program run by Dr. David Eisenberg of the Harvard
Medical School that will assess the efficacy of many non-operative treatment options
in back pain. This is a well-funded research program and will provide evidenced-based
data on the efficacy of non-operative treatment options for the back. This clinical
research study will be based at the Brigham, and Dr. Stephen Lipson will be coming
back to be an integral part of this non-operative program.
Partners Orthopaedics
Having just described many of the existing and potential Partners
Orthopaedics programs, there has also been a change in Partners Orthopaedics and its
integration with the Harvard Combined Residency Program. Dr. Jim Herndon has recently
completed his successful year as President of the AAOS. He has resigned as the Chairman
of the Partners Department of Orthopaedics but will continue to work with the Executive
Committee and serve as head of the residency program. Dr. Harry Rubash at the MGH and
I are now the Co-Directors of Partners Orthopaedics and we will integrate into Partners
Healthcare through Dr. George E. Thibault, Sheridan Kassirer and a soon to be appointed
Administrative Assistant at Partners. We all recognize the value in this integration
between the two academic medical centers and plan not only to continue that integration,
but also to further our work in integration throughout the Partners Healthcare network.
Executive Committee
Dr. Mark Gebhardt, in assuming the Chairmanship of Orthopaedics at the
Beth Israel Deaconess Medical Center, has now joined the Executive Committee as we work
through all of the changes brought about by programmatic growth, compliance with resident
work hours and continuing our emphasis on education. We have just completed a very
successful resident match and each of us is very positive about the program. Our
orthopedic CORE educational lecture series held on Wednesdays after Grand Rounds has
been a great success not only for the residents but also for fostering integration
amongst the faculty at the various institutions. Another very positive aspect of the
residency has been the formation of the residents' council. This was started within the
past year. Comprised of residents from all levels of the program, the council meets to
discuss not only minor issues that occur within the program but also to help elucidate
major issues. The residents' council will meet individually with the Chiefs and also on
an ad hoc basis with the executive committee. Their input has been invaluable as we look
at new strategic initiatives for the residency program.
Harvard Combined Residency Program at BWH
 The residency training program at the Brigham has changed to accommodate
changes in orthopedic residency programs nationally. We have been very fortunate to have
Jim Herndon's leadership, as it given us an "inside track" to respond and comply with
new regulations. Now that the Chief Residency no longer exists, we have an Administrative
Resident who coordinates many of the resident activities at the Brigham. Dr. Jim
O'Holleran served in this role in the last half of 2003 and Dr. Brandon Earp has been
our Administrative Resident for the past six months. We are in full compliance with
the PGY-1 regulations and the three PGY-1 orthopedic residents currently at the Brigham
are having a good year. We have adopted a night float system throughout the residency
program and it has been essential in allowing us to comply with the new resident
work-hour mandates. While the residents are active in all aspects of our program, the
growth of the Partners Trauma Program at BWH has been outstanding.
BWH Physician Assistants Program
 One of the most valuable additions to our clinical program has been
an expansion of our physician assistant activities. This has been under the leadership
of Nomee Altschul and Dr. John Wright. This program has allowed us to expand all of
our services and to better integrate with our three-campus strategy. Moreover, we are
instituting an educational program for the Physician Assistants, and they are turning
out to be a valuable addition to our staff both in the operating room and in the
outpatient dept. The physician assistants, many of whom are new to us last year,
include: Nomee Altschul, Shari Altamuro, Kelly Bruno, Kristina Chaves, Jamie Jacobs,
Elizabeth Lynch, Mei Xu.
BWH Clinical Program
Our clinical volume continues to grow at each of our major sites. We
currently see patients at the Brigham and Women's Hospital, the Faulkner Campus, 850
Boylston St (on Route 9) and at Braintree Rehabilitation Hospital. We have a growing
inpatient practice at the Brigham, Faulkner and a robust outpatient practice at both
institutions. We are currently developing a strategy for enhanced outpatient facilities
and have many different iterations which will come on line within the next year or so.
As we move more of our procedures to the outpatient area, we still have over 3,000
discharges per year at the Brigham and Women's Hospital. We performed approximately
5,800 procedures at the Brigham this past year and an additional 1,500 at our Faulkner
campus. Additionally, we do over 300 joints a year at the New England Baptist Hospital.
I will briefly outline the major clinical programs but will mercifully save you too much
detail.
Joint Arthroplasty
The arthroplasty service is led by Dr. Richard Scott, and we maintain
a balance of primary and revision hips, knees, shoulders and elbows. The service
includes Dr. Scott, Dr. Gregory Brick, Dr. Dan Estok, Dr. Scott Martin, Dr. John Ready,
Dr. John Wright and Dr. Wolfgang Fitz. Oh yes, and me... Dr. Fitz has been spearheading
our program in minimally invasive and computer assisted/navigation systems. We have an
excellent group of Fellows, both national and international, and they continue to be
very active clinically and academically.
Hand and Upper Extremity Service
Dr. Barry Simmons continues to head this service which is thriving and
growing and has assumed added responsibility at the VA as well as Harvard Vanguard.
The integration with the program at Children's Hospital continues to be a valuable
asset to this service. One of our current fellows, Dr. Donald Bae, will be joining
the staff at Children's Hospital. Don was a truly outstanding resident in the Harvard
program and will be a great addition to the Longwood Medical Area. Moreover, Dr. Phil
Blazar, Dr. Simmons and Dr. Mark Koris here at the Brigham as well as Dr. Peter Waters
at Children's have formed one of the best clinical and educational fellowship training
programs in the country.
Foot and Ankle Service
Dr. Michael Wilson and Dr. Chris Chiodo of Orthopaedics and Dr. Jim
Ioli of Podiatry have developed a foot and ankle program based predominantly at
Faulkner Hospital. They have had an outstanding group of fellows and have been a
great growth opportunity for the Brigham and Women's Program. We are currently under
discussions to expand this program both clinically and academically and it has been
a major portion of our Faulkner strategy.
Musculoskeletal Oncology
Dr. John Ready has cut back somewhat on his VA commitment because of
an increasing clinical load at the Brigham and at the Dana Farber. We are currently
in a joint recruiting effort with the Department of Surgery and the Dana Farber to
expand our sarcoma program. Dr. John Ready will continue to be a major focus of our
Dana Farber effort. I am also pleased to announce that John was voted by the residents
as the teacher of the year this past year. This prestigious honor is given by the
residents to one faculty member in the program each year and this is a fitting
recognition of John's work in resident education.
Sports Medicine
The Sports Medicine program is centered at our 850 Boylston Campus
but plays an integral role at each of our inpatient and outpatient sites. Dr.
Charlie Brown continues his clinical and research efforts predominantly centered
about the knee, while Dr. Scott Martin divides his time between the knee and the
shoulder. Dr. Tammy Martin continues to be active with a subspecialty interest in
women's musculoskeletal injury. Over the next year the BWH will be developing the
Gretchen and Edward Fish Women's Center at 850 Boylston St. and a major portion of
that program will be devoted to Women's musculoskeletal injury. This will be a
combined program with Orthopedics, Rheumatology, Endocrinology and Women's Health.
Dr. Peter Millet, who I mentioned as an integral part of the Partners Shoulder
Service, is also an important part of the Sports Program. With his training at both
HSS and at Steadman Hawkins, and his experience as a physician for the US Ski Team,
Peter is well versed in knee injuries as well as shoulder problems.
Cartilage Repair Center
One of the premier clinical and research programs new to the Brigham
over the past few years has been the Cartilage Repair Center under the direction of
Dr. Tom Minas. Tom has put together a clinical and research program that is one of
the best in the country. Starting with his interest in autologous chondrocyte
implantation and his training in joint arthroplasty, he has truly bridged the gap
between athletic injury and arthritis. He has a tremendous clinical volume in
osteotomy, OATS, mosaicplasty, and both cell-based and marrow derived therapies.
Moreover, his work with Dr. Carl Winalski of the Radiology Department has led to
some groundbreaking research on imaging both of degrading and repairing cartilage.
Working with his research nurse, Tom has kept an excellent prospective database
which has been a source of many papers and will continue to be very pivotal in our
understanding of cartilage repair.
BWH Musculoskeletal Strategic Initiatives
We have recently completed a four-month long analysis of the BWH under
the leadership of our President and CEO, Dr. Gary Gottlieb. At our recent retreat the
musculoskeletal program was outlined as one of the five strategic initiatives of the
BWH and BWF. The BWF is the organization that includes the Francis Street BWH campus,
the Faulkner campus at Faulkner Hospital and 850 Boylston St. It becomes a little
confusing and is reminiscent of the difficulties we have always had with understanding
the merger of the Peter Bent Brigham Hospital, The Robert Breck Brigham Hospital and
the Boston Lying-In into the BWH. Interestingly, the three campuses form a triangle
and one side of that triangle is a portion of Boston's famous "Emerald Necklace".
Those of you familiar with Boston will recognize this as the work of the famous
landscape architect, Frederick Law Olmsted. The musculoskeletal strategic plan
involves growth at each of these campuses. At the BWH campus, we will renovate our
area and maintain our close association with our rheumatology colleagues. The first
expansion, however, will be at 850 Boylston as we grow our Sports Medicine and
Cartilage Repair programs and begin our program in Women's Musculoskeletal Disease.
There is a planned addition at the Faulkner, which will allow for significant growth
in our Foot and Ankle program as well as other aspects of our musculoskeletal program.
This will be an aggressive program but I am extremely pleased that musculoskeletal
disease remains one of the core businesses of this institution.
BWH Research
Last year I reviewed the Orthopedic Research Programs in some detail.
We continue to expand our research efforts along many parallel and interrelated paths.
I highlighted many of the activities of this program in my report last year and in
order to stay within my allotted space I have included a summary of the seven major
programs that represent our research initiative. The Department's research space
totals 7,831 net assignable square feet between two sites; two floors of the MRB and
the Center for Molecular Orthopaedics space at BLI.
- Cartilage Repair Center. The focus of the lab is tissue engineering and cartilage
repair. The Director is Dr. Tom Minas.
- Center for Molecular Orthopaedics. The focus of the lab is the application of gene
therapy to the treatment of conditions affecting the bones and joints, with
particular emphasis on osteoarthritis and rheumatoid arthritis. The Director
is Dr. Chris Evans and includes two post-doctoral fellows and a technician.
- Optical Coherence Tomography Laboratory. The Director is Dr. Mark Brezinski
and includes Dr. Debra Stamper, a post-doc and two technicians. Dr. Scott
Martin, a member of the Sports Medicine Service is involved in the Lab and
collaborates with Drs. Brezinski and Stamper on projects
- Orthopaedic Biomaterials and Tissue Engineering. The lab is focused on
musculoskeletal tissue engineering, biomaterials tissue interactions and
the role of joint fluid in the performance of joint replacement prostheses.
The Director is Dr. Myron Spector.
- Orthopaedic Nanotechnology Group. The focus of this lab is the application
of research in nanotechnology to improving the properties of orthopaedic
biomaterials. The Director is Dr. Anuj Bellare and includes the involvement
of three arthroplasty surgeons, Drs. Fitz, Thornhill and Scott, and one PhD
trained scientist, Dr. Sonya Shortkroff.
- Sports Medicine and Tissue Engineering. The Director is Dr. Martha Murray.
The lab's research is directed at enhancing intra-articular tissue (ligament,
meniscus and cartilage) using tissue engineering techniques.
- Skeletal Biology Laboratory. The lab is under the direction of Dr. Julie
Glowachi and includes two PhD scientists, Dr. Shuichi Mizuno and Dr. Karen
Yates. The Lab's research program focuses on cellular aspects of skeletal
growth, repair, reconstruction, and pathophysiology. Experimental and
clinical studies have demonstrated the appropriate applications of
demineralized bone implants for skeletal reconstruction.
Each of our research programs had an active participation at the ORS
and I am pleased to announce that Dr. Chris Evans was chosen to be in line for the
presidency of the ORS. We continue to struggle with problems of space, which is a
major problem at the Brigham and throughout the Longwood Medical Area. In addition
to our recent clinical retreat, our research retreat involving the BWH research
community discussed the challenges and opportunities for our growing research
community.
Additionally there is a very robust rheumatology research initiative
ranging from basic science to outcome studies. Dr. Jeffrey Katz was recently given
a co-appointment in Orthopedics at the Associate Professor level. Dr. Katz has worked
closely with both the spine and joint group and has published some sentinel data that
is widely quoted and points to the effectiveness of many of our orthopedic procedures.
Dr. Katz has been a long-time strength to our program and his co-appointment in
Orthopedics is an overdue recognition of these efforts.
Faculty News
With the exception of the valuable addition of Dr. Mitch Harris to
the faculty, there has been little change in the past year. The "old guard" continues
to do very well. I recently heard from Clem Sledge and Bill Thomas. Both are doing
well. Clem stated that the "Gang of Four" (Thomas, Ewald, Poss and Sledge) had a
reunion weekend at Clem's place in Maine last fall. Clem spends a good deal of time
in Maine pursuing his hobbies of boating, furniture making and photography. He is
continuing as an editor of the Textbook of Rheumatology, which is now in its eighth
edition. He states that this will be his last after a 28-year run. Those of you who
know Clem recognize that he has always had a way with words based on great insight
and a tremendous Oklahoma wit. I must share with you a portion of his recent email:
"As for retirement, it is the best job I ever had! I wake up in the morning with
nothing to do and when I go to bed at night I haven't quite finished it all. I miss
my colleagues at BWH, the residents, the orthopedic staff and patients. Just not
quite enough to come back." On a personal note, I decided to switch from internal
medicine to orthopedics and one of the major drivers for that decision was Clem
Sledge. He had a thriving practice, keen research interests and many outside
interests. As a retirement strategy it is not bad to think about a life in Maine
and Marblehead with boating, furniture making, photography and reunions with old
friends.
Bill Thomas continues to fly back and forth between Naples, Florida
and Martha's Vineyard. He states that Fred Ewald was skiing better than ever and
still spending a good deal of time in Colorado. I do get to see Bob Poss now and
again in his activities with the JBJS. Bob and Anita are doing well and enjoying
their family.
Conclusions
I hope that this brings you up to date with our activities at the
Brigham. It was great to see many of you at the Harvard Combined Residency Program
alumni affair at the Academy.
I think that this was our largest turnout in history and I am
grateful to Diane Sheehan and Karla Pollick for their efforts in the organization
of this affair and for organizing such a nice venue for the event. I am grateful
for the continued support of the Alumni Program and look forward to seeing you
during the coming year.
Links of interest:
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