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Introduction
This past academic year at the Brigham and Women’s/
Faulkner Hospitals (BW/F) has been marked with continued
growth and expansion clinically as well as in research and education.
There has been a change in our department administrative
structure and we are pleased that Tom Gakis, Administrative
Director, and Peter Cerbone, Director of Finance, have joined
our department. Tom is the administrative leader of the department;
he brings to the department over 10 years of experience
at the Brigham and a strong skill set from his most recent work
with the BW/F Center for Clinical Excellence. Peter now directs
the financial operations, planning, and analysis for the department.
Peter brings 20 years of experience in finance management
within healthcare to the department, most recently with
Quest Diagnostics. Karen Young has been promoted within the
management team. Karen has been with the department for
over 8 years, most recently as practice administrator for several
of our largest ambulatory centers. In her new role, Karen
directs all clinical ambulatory operations and administrative
staffs throughout our distributed campus.
Under the leadership of Dr. Gary Gottlieb, president and
CEO of BW/F, musculoskeletal disease has been named one
of the five major core businesses in the strategic plan of our
institution. This will allow us to further build upon the unique
relationship between orthopedics and rheumatology, which was
started at the Robert Breck Brigham Hospital. The Departments
of Orthopedic Surgery and Rheumatology continue to share
administrative leadership through the Orthopedic and Arthritis
Center. Moreover, part of the BW/F strategic plan is to create
a BWH Research Institute to coordinate research efforts across
our expanding campus. This initiative has been lead by Dr.
Michael Brenner, Chairman, Division of Rheumatology and it
will allow us to integrate a robust research initiative in each
department as we all compete for precious wet and dry lab
space on the BW/F campus as well as to buffer a decreasing
federal grant support.
BRIGHAM AND WOMEN’S ORTHOPEDIC AND ARTHRITIS CENTER
The Brigham and Women’s Orthopedic and Arthritis
Center, one of the largest centers of its kind in the world, provides
comprehensive orthopedic and rheumatologic care for
patients with orthopedic conditions, joint diseases and bone
disorders such as osteoporosis.
Over the next year, the Orthopedic and Arthritis Center will
undertake a collaborative effort with the Institute for Healthcare
Improvement (IHI) and the BWF Center for Clinical Excellence.
The effort is grant funded by the Rx Foundation. The aim of
this project is to optimize the Center’s operational systems and
processes and to further develop staff to enhance the operational
capabilities of the Center and patient experience.
DEPARTMENT OF ORTHOPEDIC SURGERY PROGRAMS AND SERVICES
Adult Reconst ruction Service/Joint Replacement
The Joint replacement Service at the BW/F remains a sentinel
part of our Orthopedic Program. It is based on the rich
tradition of the Robert Breck Brigham Hospital and, while the
implants have changed, the quality and commitment to excellence
in arthroplasty is strong. It is interesting that when I first
started at the Robert Breck Brigham Hospital, 80% of our joint
arthroplasty patients were rheumatoids and 20% osteoarthritic.
Our profile now is strongly weighted to non-rheumatoid conditions
and reflects roughly the national demographics. Part of
that change is the fact that rheumatoid care is not as centralized
as it was many years ago. Moreover, the success of the
disease modifying agents (DMARDS) is beginning to foster a
demonstrable decrease in the incidence of arthroplasty in rheumatoid
patients. Those of you who remember the Robert Breck
Brigham will remember the severe rheumatoid who might
require 8-10 total joints. Fortunately, we do not see those
patients anymore yet our combined musculoskeletal research
in inflammatory arthritis remains a focus at this institution.
The Joint Arthroplasty Fellowship run by Dr. Richard
Scott and Dr. Tom Minas, has had another strong year. Todd
Borus will be going to Portland OR, Drew Noble will relocate to
Concord, NC and Shahan Yacoubian will join his brother in Los
Angeles, CA. We continue to have an outstanding International
Fellowship. Drs. Quang Dao and Darren Chen have been our
International Fellows for the past 6 months. They are both
from Australia and have done an excellent job. Quang will
remain at Children’s Hospital for the next 6 months working
with Dr. Min Kocher.
Dr. Dan Estok has been the backbone of the hip revision
service. Dr. Tom Minas does about 100 osteotomies a year in
addition to his work in cartilage repair. Dr. Wolfgang Fitz has
led our computer assisted surgery program and several members
of the arthroplasty service have been involved in the minimally
invasive hip, knee and shoulder arthroplasty program.
Dr. Richard Scott, Chief of the Implant Service, has recently
published a book reviewing is many years of experience with
Total Knee Arthroplasty. It has been a great teaching aide for
the residents, fellows and attendings.
Cartilage Repair Center
The cartilage repair center continues to care for disabled
patients with large chondral defects. Since the first patient
undergoing Autologous Chondrocyte Implantation (ACI) in
March 1995 at the Brigham and Women’s Hospital June 2006
marks the 400th patient transplant. Patients from all over North
America, Europe and as far away as Tibet, have come to the
Brigham and Women’s Hospital for their definitive care.
Our web site, www.cartilagerepaircenter.org , is now the
number one hit web site in the world for cartilage repair with
40 to 45,000 hits per month. This educational web site has
enabled patients to understand more about the available treatment
options for those young individuals seeking alternatives
to prosthetic arthroplasty.
Their research is focused on noninvasive assessment of
cartilage repair procedures to assess the quality of tissue with
proteoglycan content indirectly by Degemeric MRI anaylsis.
This is being performed clinically and is being validated by a
basic science animal research model.
Dr. Carl Winalski of the Department of
radiology, is heading up this effort.
We look forward and welcome
Dr. Andreas Gomoll to join our team
this August 2006. He is presently
completing a sports fellowship at Rush
Medical Center in Chicago. He will be
complementing our group with his
expertise in cartilage repair and sports
medicine surgery.
Foot and Ankle Service
The Foot and Ankle Service provides foot and ankle care to
patients age 15 and older. Surgeons with a specialty in foot and
ankle surgery, along with podiatrists, physical therapists, and
radiologists provide comprehensive care for a wide variety of
foot and ankle disorders and treatment for all acute and chronic
problems including fractures, foot deformities, tendon disorders
and sports injuries. We are pleased to announce that Dr.
Chris Chiodo has been elected President of the Massachusetts
Orthopedic Association, the State’s Orthopedic specialty society.
Founded in 1981, the Massachusetts Orthopedic Association
has over 400 members. In addition to ongoing physician and
patient educational initiatives, it also monitors and promotes
both state and national legislation affecting orthopedists and
orthopedic patients. As President, Dr. Chiodo will also work
closely with the American Academy of Orthopedic Surgeons
and the Massachusetts Medical Society, and as well participate
in the National Orthopedic Leadership Conference in
Washington, D.C.
Hand and Upper Extremity Service
The service continues to be very active. We have expanded
with the addition of Dr. Brandon Earp, who just had a new
child, and is taking a very active role in patient care at BWH,
VAH and now HVMA. She has also participated in the residency
selection process.
Dr. Phil Blazar continues to run the conferences for
our service has been increasingly active in ASSH and AAOS.
Dr. Mark Koris continues to have an extremely busy practice
and continues to handle many of the complex shoulder and
elbow problems, including primary and revision shoulder and
elbow replacements.
We, once again, had a very successful match and look forward
to continuing the educational accomplishments and goals
of a very successful, highly competitive fellowship.
Dr. Barry Simmons continues to be active clinically and
administratively. He had the honor of being the 17th annual
Richard J. Smith lecturer at the MGH.
Perhaps, most exciting, was the 25th anniversary of our
fellowship. We have educated over 50 fellows and approximately
80% returned for the event. Organized by the hand surgery
staff both at BWH and CHMC, lead by Peter Waters, Co-Director
of the fellowship, a superb scientific day was held with many
interesting and innovative presentations. On the evening of
the arrival there was a welcoming dinner at Peter Waters’ home.
However, the highlight of the event might have been dinner
prepared by Laura Simmons at the Simmons house. Over 75
people indulged in her culinary delights, especially the desserts;
it was a fantastic evening.
Orthopedic Oncology Service
The Orthopedic Oncology Service,
part of Dana-Farber/Brigham and
Women’s Cancer Center, specializes
in the treatment of patients with bone
and soft tissue cancers as well as
patients with musculoskeletal complications
related to the disease. Patients
are diagnosed and treated by a multidisciplinary
team that cares for them
through each phase of their treatment.
We are excited that Dr. John Abraham will be joining
the Orthopedic Oncology Service upon completion of his
Musculoskeletal Oncology Fellowship here in Boston. John
was an outstanding resident and the recipient of the William H.
Thomas Award which is given annually to the Senior Resident
who best exemplifies excellence in orthopedics, devotion to
patient care, collegiality and teamwork. Both Dr. Ready and
Abraham will be working with the expanded Dana Farber/BWF
Sarcoma Service.
Spine Surgery Service
Dr. Christopher Bono has been recruited and will join our
faculty as Chief of the Spine Service at Brigham & Women’s
Hospital. Dr. Bono is currently at Boston University School of
Medicine. He did his orthopedic residency
at New Jersey Medical School
and a spine fellowship with Dr. Steven
Garvin in San Diego. In the 4 years
since completing his fellowship, he
has been extremely productive and
has contributed 49 articles to the peer
review literature as well as over 50
reviews, book chapters, etc. He will
be joining Drs. Greg Brick and Mitch
Harris who continue to be active on the
Spine service. We have received a large foundation grant that
will greatly boost our Spine Center integrating with Physiatry,
Rheumatology, Neurosciences and Rehabilitation. Dr. Zac Isaac
continues to run a very busy spinal physiatry program.
The Spine Center offers comprehensive services to evaluate
and manage treatment for patients with back, neck and spine
problems. Working collaboratively with physical therapists,
pain specialists, surgeons, radiologists and other providers at
Brigham and Women’s Hospital, the physicians of The Spine
Center evaluate a wide range of problems. Patients who are coping
with sprains and strains of the lower back, work-associated
low back pain, sciatica, scoliosis, whiplash and other conditions
can make an appointment at The Spine Center for evaluation
and any necessary treatment. Orthopedic and neurosurgery
services are readily available for innovative surgical solutions to
difficult spine problems.
Sports Medicine Program
In December 2005 we were fortunate
enough to recruit Dr. Laurence
Higgins, MD, as Chief of BWH Sports
Medicine & Shoulder Service in the
Department of Orthopedic Surgery
and co-chief of the Harvard Shoulder
Service with Dr. JP Warner. Dr. Higgins
joins BWH from Duke University
where he was an Assistant Professor
of Surgery of Orthopedics and the
Orthopedic Team Physician for Duke University and North
Carolina Central University. He completed his residency at the
Hospital for Special Surgery in New York City and was a fellow
in Sports Medicine and Shoulder Surgery at the Center for
Sports Medicine, University of Pittsburgh Medical Center. His
clinical interests include rotator cuff injuries, shoulder instability,
shoulder replacement and knee instability, especially ACL,
PCL and complex ligamentous injuries. Also, he is trained in
cartilage and meniscal repair. In addition to surgical accomplishments
and interests, Dr. Higgins is active in both clinical
research and the education of residents and fellows. He has
published nearly 50 peer-reviewed papers, and is very active in
the national orthopedic community where he is a member of
the American Shoulder and Elbows Surgeons, The American
Orthopedic Association, The Eastern Orthopedic Association,
and the International Cartilage Repair Society.
The Sports Medicine Program is located primarily at our
850 Boylston Street campus. Moreover, the Sports Medicine
Program will be a major player in the development of the
Women’s Musculoskeletal Unit and will include Dr. Scott Martin
and Dr. Tamara Martin. Dr. Tamara Martin has also done an
outstanding job in taking over as Chief of Orthopedics at the
West Roxbury VA program. We are in the midst of making substantial
changes with new recruitment at the Boston VA Center
and currently have residents from both the Harvard and BU
orthopedic programs.
Partners Harvard Shoulder Service
The Partners Harvard Shoulder Service, under the direction
of Dr. J.P. Warner at MGH and Dr. Laurence Higgins at the
BW/F, has had another outstanding clinical, academic and surgical
year. The International Fellowship program is extremely
popular and this service annually surpasses its goals both clinically
and academically.
There are several new research initiatives that are underway.
A prospective database has been created to collect preoperative,
intra-operative and pos-operative data on surgical
cases generated through both physician and patient entry.
Additionally, hospital records, including but not limited to
radiology images and reports as well as anesthesia data will be
seamlessly incorporated into the database. This will facilitate
rigorous analysis of surgical outcomes and provide a mechanism
to enter this data into the registry.
The second initiative is to collect 3-D fluoroscopic analysis
on patients who have undergone total shoulder arthroplasty.
With this technique, contact and force analysis can be ascertained
for a variety of shoulder prosthesis, in an effort to optimize
surgical reconstruction of the shoulder.
Finally, radiostereometric analysis (RSA) of total shoulder
replacements will commence. By placing small radioopaque
beads into the glenoid component, wear patterns of total shoulder
arthroplasty can be made within a fraction of a millimeter.
This will provide invaluable data on how componets function
in vivo and provide opportunities to prolong the lifespan of
shoulder arthroplasty.
CENTER FOR ARTHRITIS AND JOINT DISEASES PROGRAMS AND SERVICES
Arthritis Center
BWH’s Department of Orthopedic Surgery and Division of
Rheumatology, Immunology and Allergy this spring launched
a new Center for Outcomes Research in Musculoskeletal
Disorders (CORe). The new center builds on a long-standing,
productive research program in MSK disorders led by Jeffrey N.
Katz, MD, MSc, who was named director of the Center.
The new center will encompass clinical research across the
spectrum of orthopedic and musculoskeletal problems using a
wide range of disciplines including clinical trials, epidemiology,
policy analysis, translational research, cost effectiveness analysis,
computer simulation modeling and others.
Through the center, BWH will lend its voice to national
discussion and debate on policy relative to the recognition and
clinical management of musculoskeletal disorders. Specifically,
CORe research will pay attention to osteoarthritis, spinal and
regional MSK disorders, total joint replacement and other surgical
interventions, rehabilitation and technology assessment.
In addition, the center will focus research to understand better
the nature of racial, ethnic, gender and socioeconomic disparities
in the outcomes of musculoskeletal conditions.
“Through our research at CORe, we aim to improve osteoarthritis
management and prevention and identify appropriate
utilization of surgeries, such as joint replacements,” Jeff said.
“And we expect to improve quality and safety while optimizing
access for vulnerable populations.”
In addition to Jeff Katz, Elena Losina, PhD, will join
MSK-CORE this summer as Co-director and Director of
Methodology. Losina is an associate professor of biostatistics
and medicine at Boston University’s School of Public Health.
Also, Elizabeth Wright, PhD, was named director of Data
Management. Several more BWH faculty in Orthopedic Surgery,
Rheumatology, Pharmacoepidemiology, Musculoskeletal
Radiology, Rehabilitation and Physical Therapy and Orthopedics
Research will collaborate with CORe investigators.
Orthopedics Research
The Department of Orthopedics at BW/F has an active
research program in several areas. Moreover we are increasingly
collaboration with our rheumatology colleagues, who
have a robust musculoskeletal program ranging from clinical
trials in inflammatory arthritis to basic mechanisms of inflammation
and control of immune mechanism. While the list is
not complete, it will give you a sense of our areas of interest.
They are listed by investigator and much of this is in their own
words.
Dr. Myron Spector, Director – My efforts continue in the
research and development of collagen devices for tissue engineering
of musculoskeletal and nerve tissues. I am currently
implanting chondrocyte-seeded type II collagen scaffolds in
cartilage defects in a goat model. Previously, we have shown
the advantage of an off-the-shelf collagen tube as a substitute
for nerve autograft in treating peripheral nerve injuries. A
clinical trial is being planned with colleagues at the San
Raffaele Hospital in Milan, Italy. I have received a grant from
the Veterans Admnistration as a PI 6/2006-5/2009; $480,000
total direct costs “Brain Tissue Engineering: A Collagen-GAG
Implant for Tissue Loss” Investigates collagen scaffolds with
stem cells and genes for treating defects in the brain.
Sonya Shortkroff, PhD has accepted a position at
Histogenics, a biotech firm developing techniques for tissue
engineering of cartilage. Dr. Shortkroff has been in the department
of Orthopedic Surgery at BWH since 1980 and as Dr.
Sledge’s Research Associate ran the Radiation Synovectomy
project.
She received her PhD in 2000 and was promoted to
Instructor in 2001. Her research interests have included cartilage-
synovial tissue interactions, the effects of radiation on
synovitis, and the effects of biomaterials on synovial tissue and
cartilage.
Her recent investigations as member of the Nanotechnology
Group have included the biocompatibility of nano-structured
biomaterials and particulates and development of nano-structured
scaffolds for cartilage tissue engineering. In the past two
years, she has been collaborating with Karen Yates, PhD on Dr.
Yates’ studies investigating the impact of glycosaminoglycans
on Wnt signal transduction in aging and in patients with osteoarthritis.
In addition, she has worked with Dr. Mark Brezinski
to evaluate the potential of optical coherence tomography as a
micro-imaging technique to assess injury and regeneration of
various joint tissues. She has also continued her long-standing
collaboration with Dept of Radiology as a co-investigator
on a project that evaluated novel MRI contrast agents for detection
of early changes in osteoarthritic cartilage.
Over the years she has served on the thesis committee
of three PhD candidates at MIT and has supervised several
graduate students from Harvard Dental School. She also has
served on the BWH Research Career Development Committee
since its inception and has been the Safety Officer for the BWH
Orthopedic Research Lab.
Chris Evans, Ph.D. - Center for Molecular Orthopaedics:
The funding position has improved considerably with the
awarding of an additional RO1; moreover we have just received
word that our latest RO1 application has received a very competitive
priority score. Including everything, the Center for
Molecular Orthopaedics now brings in well over $1 million per
year, direct costs, in external funding. Most of this pays the full
BWH indirect.
As a result of increased funding we have been able to
accommodate several new recruits. Ryan Porter, PhD and
Fangjun Liu, MD, Post-doctoral Fellows, and Francois Kwang,
MD, a Post-Graduate Student, are working with me. Vida Bil
de Arce a Post-Graduate Student, Jinsoo Joo a Technician, and
Chris Southgate, PhD, a Research Fellow, are working with
Keith Crawford. This brings the total personnel to thirteen.
Oliver Betz, PhD was recently promoted to the faculty rank of
Instructor and has just submitted his first R21 application.
As a sign of our increasing productivity, the publication
rate continues to climb and during the past twelve months
we have placed articles in The Proceedings of the National
Academy of Science, The Journal of Bone and Joint Surgery,
Molecular Therapy, Arthritis Research and Therapy and Gene
Therapy, among others.
The focus of the research continues to be gene therapy,
proteomics, genomics and related technologies applied to the
study and treatment of arthritis, bone healing, cartilage repair,
ligament healing and others. With an emphasis on translational
research, we are anxious to collaborate with interested clinical
faculty in advancing this agenda and are pleased to note the
involvement of Drs. Thomas Thornhill, Jeff Katz and Philipp
Lang in studies of osteoarthritis, Drs. Mark Vrahas and Mitch
Harris in studies of bone healing, Dr. Martha Murray (Children’s
Hospital) in studies of ligament healing and Dr. Mark Gebhardt
(Beth-Israel Deaconess) in studies of Ewing’s Sarcoma. These
types of collaborations between individuals from different disciplines
and institutions are essential.
Julie Glowacki, Ph.D. – Skeletal Biology: This team is
interested in mechanisms of skeletal aging, vitamin D and
skeletal health, comparison of BMP and Demineralized Bone’s
effects on target cells, and engineering of cartilage, bone, and
joints. Julie Glowacki was invited to speak at the 2006 meeting
of the American Academy of Orthopedic Surgeons on “Vitamin
D-Deficiency and Bone Health” in its symposium on “Bone
Health for the General Orthopedic
Surgeon: Essentials for Your Practice”. Research by this
team is supported by competitive grants and in the last year
resulted in numerous peer-reviewed publications in two major
areas, one concerning aspects of cartilage and bone tissue engineering
in defined media and oxygen concentrations, and the
second area concerning vitamin D and skeletal health. Julie
Glowacki started a 4-year term as reviewer on the NIH study
section on Musculoskeletal Tissue Engineering. She has been
busy locally as Co-Chair of the BWH Biomedical Research
Institute’s Musculoskeletal Research Center, as member of
the research working group for the BWH Center for Women’s
Health, and as representative of Orthopedic Surgery on the
Biomedical Research Institute’s Research Oversight
Committee. Julie was presented with the Hohl Award by the
American Society for Bone and Mineral Research for her efforts
as co-founder of, and first 4-year Chair of the Society’s Ethics
Advisory Committee.
Shuichi Mizuno, Ph.D., devotes his time to cellular
mechanophysiology and tissue engineering for joint tissue. He
published a solo paper on intracellular calcium increased due to
pure hydrostatic pressure and others including chondrogenesis
promoted with low oxygen pressure. Using biophysical stimuli
such as pressure and stress, his unique bioreactor born in our
department, is now used in clinical study for producing neocartilage.
It is funny looking apparatus (may require a hard hat
to look at) but allows the patients’ chondrocytes for 4 hours’
marathon and 20 hours’ couch potato a day for infinite number
of days. Eventually it became a useful platform technology for
not only orthopedic research but also cellular mechanophysiology
(his favorite terminology). Bringing those new idea and
machines, Shuichi has teamed up with our colleagues, Dr.
Mitch Harris on intervertebral disc regeneration and with Dr.
Larry Higgins on meniscal repair as well as interacted on skeletal
system biology with Dr. Glowacki. He was also is taking a
responsibility to run BWH’s laser confocal microscopy core at
LMRC building. Dr. Mizuno was recently promoted to Assistant
Professor, Harvard Medical School.
The Clinical Fellowship Programs at BWH continue to be
very strong. This August we welcome the following Clinical
Fellows to BWH:
Arthroplasty Service:
Jeffrey Zarin M.D. – Harvard Orthopedic Combined Residency Program
Thomas Moyad, M.D. – University of Michigan
Troy Schmidt, M.D. – Emory University.
Foot & Ankle Service:
Rommel Francisco, D.O., - New York College of Osteopathic Medicine.
Hand/Upper Extremity Service:
Eon Shin, M.D. – Yale University School of Medicine
Christine Kuo, M.D. – University of Chicago Pritzker School of Medicine
Adam Mirachi M.D. - Temple University School of Medicine
Partners Shoulder Service:
Nathan Endreas, M.D. - University of Vermont
Sports Service:
Christopher Vinton, M.D. – U Mass Medical Center
Trauma Service:
Kevin Riche, M.D. – Louisiana State University
And finally …alumni news: I had a long chat with Clem
Sledge about a month ago. Clem sounds great and is spending
much of his time on the coast of Maine. Bob Poss continues
to do an excellent job at the JBJS. Reports are that Fred Ewald
is back and forth between Colorado and Massachusetts and is
apparently fitter than ever. Bill Thomas finally sold the house
in Brookline that he bought as a resident, which we were using
as a boarding house for many of our visiting scientist and clinical
fellows. Bill and Dickie have bought a place nearby and still
maintain properties in Naples Florida and Martha’s Vineyard.
The Bill Thomas Award that we set up in 1996 continues to be
one of the sentinel awards at the Resident’s Graduation. It is
given in Bill’s name to the Senior Resident who best exemplifies
excellence in orthopedics, devotion to patient care, collegiality
and teamwork.
I am grateful of the support that we received from many
of the alumni at the reception in Chicago. We look forward to
seeing in next year in San Diego.
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