Orthopaedic Surgery at the Massachusetts General Hospital

Harry E Rubash, MD
Chief, Department of Orthopaedic Surgery
Massachusetts General Hospital, Boston,MA
Harvard Combined Orthopaedic Residency Program, Boston, MA

In the Introduction of my 2010 Chief’s Report, I reported that I had reviewed some of the important aspects of the comprehensive health care reform bill, The Patient Protection and Affordable Care Act, noting that the details of this bill were confusing and perplexing. I was concerned that millions of Americans would be steered to a program that has consistently under-performed for both patients and providers.

In the aftermath of the change in the power balance in Washington following the 2010 mid-term elections, I am optimistic that we will be able to create a health care system that preserves some of the attributes of the current bill, while providing an affordable new health care program that coordinates prevention, wellness, public health activities, and the sophisticated care and value that we are all accustomed to delivering in our academic health care centers. I look forward to the active and lively debate that will occur over the next coming months and I encourage you to get involved. We all have an obligation to be part of this enormously important national discussion. Despite the inevitable changes on the national front, the Department is flourishing academically, clinically, administratively, and financially.

The Massachusetts General Hospital Bicentennial

This year the MGH reached an exciting historic milestone, the 200th anniversary of the hospital’s establishment. On August 20, 1810, Drs. James Jackson and John Collins Warren circulated to the residents of Boston, a petition calling for the founding of a hospital. They appealed to the community for support and funds by wielding words crafted to incite empathy and compassion: “When in distress every man becomes our neighbor”. In 1811 the Massachusetts State Legislature granted a charter for the incorporation of the MGH. Fund-raising began in earnest and gifts arrived in kind. One such gift, believe it or not, was a 273 pound sow. Today, the words of Drs. Jackson and Collins still continue to guide the MGH’s mission to care for patients and to make strides in the world of medicine. The MGH and our Department are incredibly proud and gratified to celebrate these last 200 years of compassionate care-giving, health care innovation, groundbreaking research and deep involvement with the local communities.

In March 2011, the MGH celebrated the release of a new book detailing the hospital’s history through the present: “Something in the Ether: A Bicentennial History of Massachusetts General Hospital, 1811-2011”, by local author, Webster Bull, and his daughter, Martha Bull. This 527-page hardcover commemorates the 200 years of medicine, service and innovation fostered by the MGH, our nation’s third oldest general hospital. I am pleased to have shared in the numerous innovations that have taken place in our Department, thanks to the diligence and perseverance of our eminent former colleagues and current members of our group.

Campaign for the Third Century of MGH Medicine,
and the Lunder Building

Last fall the MGH launched the largest fundraising campaign in its 200 year history and the largest capital campaign among health care institutions in the area. The three-year effort to raise $1.5 billion is called the “Campaign for the Third Century of MGH Medicine.” Funds raised will enable the MGH to continue to deliver the highest quality care to patients, conduct pioneering biomedical research, address pressing health needs locally and globally, educate the caregivers of tomorrow, and help develop and test ways to resolve complex national health policy issues. The five priorities for this far-reaching Campaign are: building and enhancing medical facilities; supporting a wide range of clinical disciplines and medical specialties; promoting innovative research; enhancing medical education; and sustaining the hospital’s ability to respond efficiently to any situation that may arise.

An important part of the Campaign is the opening of the new Building for the 3rd Century of MGH Medicine, the Lunder Building. Peter and Paula Lunder of Maine donated $35 million toward the building and received naming rights to the tower. For the last three years, we have been watching this impressive structure take shape in the site of the former Vincent and Clinics Buildings. This new state-of-the-art environmentally-friendly facility occupies nearly 500,000 square feet and will house Radiation Oncology, Radiology, Inpatient and Outpatient surgery, and a cutting-edge surgical center with new operating rooms. We eagerly anticipate the 14 new Orthopaedic Surgery Operating Rooms with advanced imaging and lighting systems as well as information technology and robotic equipment. The top five floors will offer increased inpatient capacity for Cancer, Neurology, and Neurosurgery.

The Lunder Building offers patients, visitors, and staff the ability to traverse the MGH campus through connecting walkways. These new walkways allow passage from the “front” of the campus to the “back” without walking outside. From the Charles/MGH MBTA station on Cambridge Street, pedestrians enter the Yawkey Center for Outpatient Care, travel along the second floor corridor to walk to Fruit Street and the main hospital entrance via a new pedestrian walkway, called the Bander Bridge – named for Kay Bander, an active member of the MGH Ladies Visiting Committee and her late husband, Martin, who was the Vice President of MGH Public Affairs for many years, in recognition of their generous gift to the Lunder Building construction. This important pedestrian pathway makes it possible to travel to the ground level Emergency Room and the Lunder Building lobbies, which both connect to the White Lobby.

The Sumner M. Redstone Department of Emergency Medicine will be located in the Lunder Building and will nearly double in size. The new in-patient space will facilitate moving patients more efficiently.

Best Doctors in America

Based here in Boston, Best Doctors in America was founded in 1989 by physicians affiliated with Harvard Medical School to provide expert medical consultation services. Today, Best Doctors serves members in more than 30 countries with physician experts across over 400 specialties and sub-specialties, representing the top five percent of physicians and affiliations with the top medical institutions across the country. For over 20 years Best Doctors has conducted the largest, continuous, peer-to-peer survey of the medical profession to build a professional roster of the best minds in medicine. In addition, their research team performs rigorous reviews and evaluates physicians’ specific areas of expertise including special research and published work. I’m pleased to report that 17 of our surgeons were named to the Best Doctors in America 2011-2012: Drs. Peter D. Asnis, Dennis W. Burke, Richard J. de Asla, Andrew A. Freiberg, Thomas J. Gill IV, Francis J. Hornicek, Jesse B. Jupiter, Joseph C. McCarthy, Frank X. Pedlow, David C. Ring, Harry E. Rubash, R. Malcolm Smith, Dempsey S. Springfield, Mark S. Vrahas, Jon J.P. Warner, Kirkham B. Wood, and Bertram Zarins. Congratulations to each of you on this noteworthy achievement.

Hospital and Department Administration

For the past ten years I have had the distinct honor to work with Ann Prestipino, the Senior Vice President Surgical and Anesthesia Services and Clinical Business Development at the MGH. In her role, Ann had direct responsibility for all administrative and financial aspects including the clinical, educational, and research programs in the Departments of Surgery, Orthopaedic Surgery, Anesthesia and Critical Care and Pain Medicine, and Emergency Medicine.

Last year Dr. Gary Gottlieb, Partners’ President and CEO, asked Ann to establish the Office of Strategy Implementation for the Partners HealthCare System and serve as its Director. In this new role, Ann oversees a Partners-wide strategic cost control plan focused on reorganizing care while preserving the highest standards of quality and safety. With these additional new responsibilities came reorganization in the administrative functions; Orthopaedic Surgery is now working directly with Greg Pauly, Chief Operating Officer of the MGPO.

Ann, members of our Department, and I have collaborated on many truly amazing projects including: the development of our Orthopaedic sites in the Yawkey Building, the establishment of the Orthopaedic Ambulatory Surgery Center at Mass General West, the opening of the Sports Medicine Center, and the offering of MGH’s Orthopaedic Services at the Brigham and Women’s/Mass General Health Care Center at Patriot Place.

At our April 7th Staff Meeting our Department honored Ann for her work over the years with our group. Ann was presented with a framed photograph of the Bulfinch Building which was signed with personal notes from all of our Attendings.

Ann is the most talented and innovative hospital Vice President that I have had the privilege to work with over the years. Thank you, Ann!

Henry J. Mankin, MD, Chair in Orthopaedics

We continue to make excellent progress on establishing the Henry J. Mankin, MD, Chair in Orthopaedics. Dr. Henry Mankin was Chief of the Department of Orthopaedic Surgery from 1972-1996. He is a world-renowned leader in orthopaedic oncology, cartilage research, and bone transplantation for tumors.

In his distinguished career, Dr. Mankin cared for patients with tumors and metabolic bone diseases and conducted innovative research on biologic, oncologic, and metabolic issues. The Chair in Orthopaedics is a fitting tribute to his many contributions to the field of Orthopaedic Oncology.

By establishing the Henry J. Mankin, MD, Chair in Orthopaedics, we will honor Dr. Mankin’s legacy in perpetuity ensuring that generations of young surgeons will be taught by clinician-scientists who exemplify his intellect, energy, and empathy. I hope you all will join with me, my colleagues in the Department of Orthopaedic Surgery, and Dr. Mankin’s former students and patients in making a gift to establish this endowed Chair. Thank you for your support in meeting this goal. To make your tax-deductible gift, or for information on other ways to give, please contact Bob O’Brien in MGH’s Development Office at 617-726-0991 or rhobrien@partners.org.

Carol Mankin, wife of Henry J. Mankin, MD, retired from the MGH late last year after 35 years of truly dedicated service. In January the Treadwell Library hosted a wonderful reception in honor of Mrs. Mankin. In addition to her important work for the Treadwell Library that spanned over three decades, Mrs. Mankin graciously served as the Librarian for the Orthopaedic Department, keeping the Smith-Petersen Library in top-notch shape. We thank Mrs. Mankin for her tireless efforts for our Department and the MGH.

The Mass General/North Shore Center for Outpatient Care

The Mass General/North Shore Center for Outpatient Care in Danvers celebrated its second year anniversary in May. Conceived and constructed as a joint effort with the North Shore Medical Center, this facility is located on Endicott Street in Danvers, just off of Rt. 128, and includes both an 80,000 square foot medical office building and a 125,000 square foot ambulatory surgery care center. Dr. Brian Grottkau, Chief of Pediatric Orthopaedics, is the Medical Director of the Orthopaedic Program in this facility. Other Orthopaedic Surgeons seeing patients at The Mass General/North Shore Center for Outpatient Care include: Drs. Gleeson F. Rebello, Francis J. Hornicek, A. Holly Johnson, and Saechin Kim. At this facility our surgeons offer care in the areas of Pediatric Orthopaedics, Hand and Upper Extremity, Orthopaedic Spine, Orthopaedic Oncology, and Foot and Ankle.

Brigham and Women’s/Mass General Health Care Center at Foxborough

The Brigham and Women’s/Mass General Health Care Center at Foxborough has been open for just over two years and provides outstanding care to patients south of Boston. Located at Patriot’s Place, this 1.3-million square foot development is adjacent to Gillette Stadium and houses a four-story center with physician offices, advanced diagnostic imaging, and four operating rooms for outpatient surgery.

Services available at the center include Primary Care and specialties: Cardiology, Dermatology, General and Gastrointestinal Surgery, Orthopedic Surgery, Pain Management, Plastic Surgery, Rehabilitation and Sports Medicine. A growing list of our surgeons are seeing patients at this facility including: Drs. Eric M. Berkson, Richard J. de Asla, Thomas J. Gill IV, Thomas F. Holovacs, Chaitanya Mudgal, Gleeson F. Rebello, and Joseph H. Schwab. In October the Center opened an urgent-care facility to offer walk-in treatment for the evaluation and management of common illnesses, minor cuts, broken bones and work-related injuries.

The Stephan L. Harris Center for Chordoma Care

The Stephan L. Harris Center for Chordoma Care, under the direction of Dr. Francis J. Hornicek, has been open for two years and continues to bring advanced multidisciplinary expertise to the diagnosis, evaluation, treatment, and support of chordoma patients. The orthopaedic oncologists at the Center are joined by dedicated nurses, radiation and medical oncologists, neurosurgeons, plastic surgeons, radiologists, pathologists, ENT surgeons, and researchers. Chordoma is a rare malignant bone tumor with a complex treatment program including chemotherapy, radiation therapy, and surgical intervention. Approximately 300 new cases of chordoma are diagnosed in the U.S. each year. This is the first center in the world with a singular focus on chordoma care. Congratulations to Dr. Hornicek and his team on the amazing work they are doing.

Newton-Wellesley Hospital/Massachusetts General Hospital Collaborations

The Jim & Ellen Kaplan Center for Joint Reconstruction Surgery at Newton-Wellesley Hospital (NWH) continues to grow and prosper under the leadership of its Director, Dr. Joseph C. McCarthy. He is joined at the NWH by Adult Reconstructive Surgeon, Dr. Hany S. Bedair, and Foot and Ankle Surgeon, Dr. John Y. Kwon. Newton-Wellesley Hospital also houses an important Pediatric Orthopaedic Clinic which is run by Dr. Maurice Albright. We continue to expand our important relationship with the outstanding physicians at NWH.

MGH Primary Care Orthopaedics Course

This year’s annual MGH Primary Care Orthopaedics Course under the Direction of Dr. David C. Ring, MD, PhD, and Co-Directors Drs. Thomas J. Gill IV, Richard J. de Asla, Brian E. Grottkau, R. Malcolm Smith, and George Theodore, was held in April at the Holiday Inn on Beacon Hill. This Harvard Medical School accredited program has been offered by the MGH Department of Orthopaedic Surgery for nearly 25 years and delivers the fundamentals of musculoskeletal medicine to primary care providers. The course includes didactic lectures, physical examination sessions, discussion groups, and casting and splinting workshops. As one of the few courses of its kind, it is enormously popular and continues to attract new national and international participants in addition to its regional base. Congratulations to Dr. Ring and the Course Directors on another fantastic year!

Annual Department Retreat

This year’s annual Department Retreat was held in June at the Chatham Bars Inn on Cape Cod. The program featured guest speakers on the topic of “Accountable Care Organizations: Strategy, Design and Implementation.” We also reviewed and validated our Strategic Plan to place a new emphasis on “value-based orthopaedic surgery.” I will have more to report in next year’s update!

New Faculty Updates

We were pleased to have Dr. Hany S. Bedair join the Department of Orthopaedic Surgery in 2009. Dr. Bedair works closely with Andrew A. Freiberg, MD, Chief of the Adult Reconstructive Surgery Service, and the surgeons at The Jim & Ellen Kaplan Center for Joint Reconstruction Surgery at Newton-Wellesley Hospital. Dr. Bedair’s areas of interest are adult reconstructive surgery of the hip and knee, including complex primary and revision surgery, and his research interests focus on periprosthetic infections, arthrofibrosis, and clinical outcomes.

Since joining the Department, Dr. Bedair has been nationally recognized and received the 2010 Mark Coventry Award from the Knee Society. Dr. Bedair and co-authors conducted a study on the diagnosis of early postoperative infection following primary total knee arthroplasty, entitled “Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis.” Dr. Bedair was also one of two surgeons representing North America who traveled to the United Kingdom for the 2010 Hip Society British Traveling Fellowship.

Dr. Bedair has been named as one of the Co-Directors of the Harvard Annual Advances in Arthroplasty Course. He redeveloped the “Meet the Faculty” sessions, which have been well received by the attendees.

It is a great pleasure to congratulate Young-Min Kwon, MD, on his recent Kappa Delta Young Investigator Award, given at this year’s American Association of Orthopaedic Surgeons (AAOS) Annual Meeting. The Kappa Delta Award, the highest award in orthopaedic research, is bestowed by the AAOS for outstanding research and recognizes the significance and impact of the recipient’s work. Dr. Kwon, who joined the Department in 2009, received the prestigious Kappa Delta Award for his work entitled, “Evidence-Based Approach in Understanding ‘Pseudotumors’ in Metal-on-Metal Hip Replacements.” This important work clearly demonstrated the mechanisms involved in adverse reactions in metal-on-metal joint replacements, which are commonly used to treat young, active patients with significant hip osteoarthritis. Although the research has shown a 95% or greater success rate for these patients, Dr. Kwon focused attention on the infrequent complications of these devices. Specifically, the failures involving abnormal periprosthetic soft-tissue masses, also known as pseudotumors. These complications cause serious damage to local tissue and often require additional extensive corrective surgery. Dr. Kwon’s research concluded pseudotumors develop as a reaction to the metal debris generated from the wear of metal-on-metal implants and that excessive wear, as a result of sub-optimal placement, can lead to damage of the soft tissues in susceptible patients.

Recently, the FDA released a statement of concern informing all implant manufacturers of Metal-on-Metal Total Hip Replacements who market implants in the USA that they are now required to survey all their patients. We have created the Center for Metal-on-Metal (MoM) Total Hip Replacement (THR) at the MGH. Our mission is to provide excellence in clinical care to MoM patients by integrating various specialized tests (analysis of blood samples for metal ions, imaging studies, and specialized gait studies) to determine whether an adverse reaction to MoM THR implants is present and if so, to formulate the best treatment. The Center brings together the multi-disciplinary expertise that exists in the Department of Orthopaedic Surgery and the Harris Orthopaedic Laboratory (HOL) to provide state-of-the-art comprehensive care to patients with metal-on-metal total joint replacements and to conduct cutting-edge research. Our physicians and researchers strive to transform basic discoveries into clinical practice and provide critical evaluation and specific advice for patients with metal-on-metal implants. If you would like to refer a patient, friend, or family member to our Center please contact us at 877-644-3889 or visit our website at http://www.massgeneral.org/ortho/metal-on-metal.

Dr. Kwon has already made an important impact on our translational research in the Department. We look forward to his continued contributions.

Dr. Luke S. Oh also joined the Department in 2009. He is the newest member of the Sports Medicine and Shoulder Services, specializing in advanced arthroscopic procedures of the shoulder, elbow, and knee as well as complex reconstructions of those joints. Dr. Oh’s clinical and research interests include treatment of elbow and shoulder injuries in the throwing athlete, complex arthroscopic and reconstructive surgery of the elbow/shoulder/knee, elbow and shoulder joint replacement, rheumatoid elbow, and knee ligament and meniscus surgery. Dr. Oh is a Team Physician for the Boston Red Sox and the New England Revolution, as well as Associate Team Physician for the New England Patriots. He is an orthopaedic consultant for the Boston Bruins and Harvard University Athletics.

Dr. Oh was identified as an emerging leader by the American Orthopaedic Association (AOA) and was one of 15 individuals selected nationally for participation in the Clinician-Scientist Development Program sponsored by the American Academy of Orthopaedic Surgeons (AAOS), the Orthopaedic Research and Education Foundation (OREF), and the Orthopaedic Research Society (ORS). Dr. Oh is also the recipient of the 2010 Melvin Post Award for Excellence in Clinical Research from the American Shoulder and Elbow Surgeons and a member of the MGH research team that received the 2009 O’Donoghue Award (Best Research in Sports Medicine) from the American Orthopaedic Society for Sports Medicine (AOSSM).

Last year I was pleased to welcome John Kwon, MD, to the Department and the Foot and Ankle Service. Dr. Kwon specializes in foot and ankle trauma, deformity correction, and the treatment of arthritis. In addition to Dr. Kwon’s busy clinical practice he is deeply committed to research and teaching.

Dr. Kwon earned his BA from Wesleyan University in Middletown, CT, and attended medical school at New York Medical College, in Valhalla, NY, where he graduated Alpha Omega Alpha (AOA). He then completed the Harvard Combined Orthopaedic Residency Program (HCORP) and performed a foot and ankle fellowship under the tutelage of Dr. Mark Myerson at the Institute for Foot and Ankle Reconstruction at Mercy Medical Center in Baltimore, MD. Dr. Kwon also did additional training in the Ilizarov techniques using spatial frames.

Dr. Kwon has researched, published, and presented on many topics involving foot and ankle pathology both on the local and national levels. Dr. Kwon has a keen interest in various foot and ankle problems including trauma, post-traumatic deformity correction, flat foot reconstruction, tendon injuries and arthritis. In addition, he has a strong interest in translational and basic science research and already is an anchor in our newly developed Foot and Ankle Laboratory. Dr. Kwon is dividing his time between the MGH, NWH, and the laboratory. He was recently appointed as a consultant for The Journal of Bone and Joint Surgery (Am). Dr. Kwon is a fine addition to the Department and to the Foot and Ankle Service. I look forward to his many future contributions.

Last spring we were very pleased to welcome Kate Robertson our new Administrative Director of Finance and Research to the Department. Ms. Robertson works closely with David Gaynor, Executive Director of the Department, and was hired to oversee and monitor the Department finances related to clinical operations and research including assisting with both the General Hospital and the Physician Organization annual budgets. Ms. Robertson came to the MGH from ECG Management Consultants of Boston, where she was a manager in their Academic Healthcare Division. She holds a Master of Health Services Administration from the University of Michigan. She brings important skills and professional experiences and is an asset to the Department. Welcome, Ms. Robertson!
Photo of Kate Robertson to be included here

Service Updates

Adult Reconstructive Surgery Service
The Adult Reconstructive Surgery Service at the MGH is under the direction of Service Chief and Department Vice-Chair, Dr. Andrew A. Freiberg. Our success this past year was multilateral with gains in clinical activity, research productivity, and faculty recruitment. The Service continues to be a leader in the orthopaedic community, delivering the most up-to-date surgical techniques, evaluation of problem joint replacements, and advanced treatments for infection and peri-prosthetic fractures.

We had a wonderful year in terms of increased productivity and efficiency, with over 500 hip and knee arthroplasties performed at NWH. We achieved this milestone with a team approach by three active surgeons in the Kaplan Center under the leadership of Dr. Joseph C. McCarthy. NWH surgeries represent most of our volume growth and we anticipate this to continue exponentially.

The Adult Reconstructive Surgery Service had another outstanding year at the annual meetings of the Orthopaedic Research Society, The Knee Society, The Hip Society, the American Academy of Orthopaedic Surgeons, and the American Academy of Hip and Knee Surgeons. Our group had numerous podium and poster presentations at these meetings, and it was rewarding to see the academic successes and presence of so many of our former fellows. I was elected as Secretary/Treasurer of the Hip Society and will continue in a national leadership role over the next few years.

Work continues in collaboration with the Bioengineering Laboratory under the direction of Dr. Guoan Li, as we do the ground-work to study new robotic techniques that can be applied to hip and knee surgery. We are confident that these exciting studies will translate into a major clinical program of study. In addition, extensive work with the Harris Orthopaedic Laboratory (HOL) continues as we finish recruitment into our large “Vitamin-E Highly Cross-linked Polyethylene RSA” study and into the “MGH Administered International Multi-Center” study. We continue to focus on extensive evaluation of retrieved cross-linked liners from hip and knee patients.

In other individual staff updates, we should note and celebrate the fact that Dr. Joseph McCarthy is the first President of the newly formed International Society of Hip Arthroscopy, Dr. Young-Min Kwon was awarded the Kappa Delta Young Investigator Award for his important work on pseudotumors in metal-on-metal hip replacements, and, Dr. Hany Bedair completed the British Orthopaedic Society Traveling Fellowship returning with great tales and new knowledge.

This year marks our 51st Fellowship Class and some significant changes in our program have occurred. This year, Dr. Young-Min Kwon has been appointed as Fellowship Director and Dr. Hany Bedair was appointed as Director, Arthroplasty Fellowship Education. Although Dr. Andrew Freiberg continues to work closely on all administrative matters including education and fellow supervision, these new faculty members provide great new energy and ability. Our fellows this year were Drs. Ravi Bashyal, James Eberhardt, Bryan Lawless, and Scott Foster. We wish them all great success as they enter practice.

Preparations are underway for the 41st Annual Advances in Arthroplasty Course, “Optimizing Hip and Knee Arthroplasty Using Evidence-Based Medicine: Early Intervention to Complex Reconstructions.” The course takes place October 25-28, 2011 at the Hyatt Regency in Cambridge. Our keynote speaker for the 10th Annual Harris Oration will be Dr. Robert Barrack. We will of course also have the ever popular live surgeries and video vignettes.

All of us in the Arthroplasty Service are integrally involved in the mission of the MGH Center for Metal-on-Metal Total Hip Replacement. We encourage you to refer to our center by contacting us at 877-644-3889 or by visiting our website at http://www.massgeneral.org/ortho/metal-on-metal.

Podiatry Service
The MGH Podiatry Service, under the direction of Dr. Robert J. Scardina provides ambulatory foot care, out-patient surgery, orthotic services, and non-invasive lower extremity arterial testing in the Yawkey Building, at the MGH-affiliated Health Centers (Revere, Chelsea and Charlestown), and non-MGH venues (South End Community Health Center and Lynn Community Health Center). The Service now has nine professional staff members with select members of the group providing in-patient consultation services at the MGH and Spaulding Rehabilitation Hospital. The Service hopes to establish a clinical “high-risk” foot collaborative practice within the MGH Vascular Center soon, and to also develop satellite practices at The Mass General/North Shore Center for Outpatient Care in Danvers and at Mass General West in Waltham. The Podiatry Service also has a close clinical relationship, including referrals and patient care collaboration, with the Foot and Ankle Service.

The MGH Podiatry Residency Program includes a comprehensive and diverse curriculum, with longitudinal training experiences in clinical podiatry and foot and ankle surgery, non-podiatry medical and surgical block rotations, and extensive didactic activities, including on-line courses. Our PGY-II and PGY-III residents receive training in foot and ankle surgery from over 25 faculty members (podiatric, orthopaedic, and plastic surgeons), at the MGH and several training-affiliated regional hospitals.

The 8th Annual MGH Podiatry Service Winter Lecture, “History of the Shoe: Ancient to Modern Footwear,” was held in January. The guest speaker was Ms. Elizabeth Semmelhack, Head Curator of the Bata Shoe Museum in Toronto, Canada. Podiatrists, physical therapists, orthotists, pedorthists, and medical professionals from the MGH and other area hospitals attended the presentation.

The year 2010 marked three historic events for the MGH Podiatry Service. The first was the 55th anniversary of the first podiatrist, Dr. John F. Kelley, appointment at MGH on12/07/55. The second was the 20th anniversary of the Service’s community outreach patient-care program at the Pine Street Inn and the third was that Podiatrists are now appointed to the medical clinical staff at the MGH.

“Mindful of our history and with high expectations for our future at the MGH, our group maintains its dedication to excellence in both patient care and graduate training as we move closer to establishing clinical practices in new and existing MGH and Partners facilities,” notes Dr. Robert Scardina.

Hand and Upper Extremity Service
The Hand and Upper Extremity Service continues to expand in clinical volume, teaching programs, and clinical and basic research. The flexibility of our entire faculty has allowed the Hand and Upper Extremity Service to maintain its high standard of clinical and academic output and excellence.

In March, Dr. Jesse B. Jupiter stepped down from his position as Chief of the Hand and Upper Extremity Service. We wish to thank Dr. Jupiter for his outstanding dedication, commitment, and contributions to the field of orthopaedic surgery and our Department. Dr. Jupiter has been an integral part of the Department of Orthopaedic Surgery for over three decades. He has been a member of Orthopaedic Surgery Residency Core Curriculum Committee and the Executive Committee, and is actively involved in many prestigious professional societies. Since 1994 he has been the Chairman of the Education Commission of the AO/ASIF Foundation. A prolific writer, Dr. Jupiter and has greatly contributed to the literature in the field. He has authored hundreds of articles, reviews, and chapters. In addition, he serves on numerous editorial boards and performs associate editor duties for the Journal of Orthopaedic Trauma, the Journal of Orthopaedic Techniques and the Journal of Reconstructive Microsurgery. Dr. Chaitanya Mudgal was asked to assume the position of Interim Chief of the Service. A national search is currently underway through HMS for a new Chief of the MGH Hand and Upper Extremity Service.

Drs. Jesse Jupiter, Chaitanya Mudgal, David C. Ring, and Sang-Gil Lee have been very busy utilizing the excellent outpatient surgery facilities at Mass General West. Drs. Jupiter and Mudgal also regularly see patients there as well. Increased collaborative efforts have led to Dr. Mudgal seeing patients and operating at the Brigham and Women’s/Mass General Health Care Center at Foxborough. These outreach efforts provide comprehensive patient care to individuals located far from the metro Boston area.

In August 2010, the Hand and Upper Extremity Service was pleased to add a new member to its faculty, Dr. David Ruchelsman. Dr. Ruchelsman was a fellow in the program and joined the staff after his graduation. He has also joined the Hand Fellowship faculty and participates in the training of our Hand fellows. Dr. Ruchelsman sees patients at both MGH and Newton-Wellesley Hospital where he is based.

Organizationally, the Hand and Upper Extremity Service has undergone substantial re-structuring over the last year. This was largely the result of efforts to improve both office efficiency and access. The overall result of these efforts was a better re-structuring of office personnel and the telephone system, as well as an increased emphasis on our mission statement to have a hand surgeon see each new patient presented to the offices. Expanding our service perimeter to Waltham and Foxborough has further enhanced the Service’s efficiency.

The Hand Surgery Fellowship is now in its third year as a combined fellowship with the Plastic Surgery Service. Dr. Mudgal has completed his first year as the Program Director. With their expertise in free tissue transfers as well as management of brachial plexus injuries, Drs. Jonathan Winograd, and Curtis L. Cetrulo Jr, from Plastic Surgery have greatly added to the fellows’ education. The Service continues to enhance educational and academic content regularly, with updates to the “Hand CD.” The fellows now have regular access to microsurgical laboratory facilities under the supervision of Mark Randolph from the Plastic Surgery Service. We are pleased with the continued collaboration of the Hand Service and Plastic Surgery, which further enhances the fellows’ experience and education during their time at the MGH.

The Service continues to have PhD candidates doing research under the guidance of Dr. Ring. Geert Buize and Kim Brouwer completed the research work on their doctoral degrees and will be defending their dissertations in the near future. The Service continues to regularly host several short-term research associates, who enhance our research efforts and productivity. The Service also enjoys a steady stream of international visitors for varying periods of time during the academic year, we are happy to have the AO fellows visit regularly for three months. This year we have a Swiss research fellow, Valentin Neuhaus, a practicing surgeon from Switzerland. He is spending time conducting clinical research in association with Sigrid Fostvedt another research associate. In an effort to increase our international collaboration, an association has also been established with Dr. Raja Sabapathy at the Ganga Hospital in Coimbatore, India. Dr. Sabapathy is an international authority in the management of complex mutilating hand trauma. It is anticipated that Dr. Alan Chambers, who graduated in 2010, will be our first fellow to visit the Ganga Hospital later this year.
Academic productivity continues to remain high. The Hand and Upper Extremity Service had nearly two dozen peer-reviewed publications, has produced over twenty clinical communications and review papers, and nearly a dozen book chapters. The faculty continues to be featured regularly in local, regional, national, and international symposia with roles varying from speakers to moderators to course chairmen.

Shoulder Service
The Harvard Shoulder Service under the direction of Dr. Jon JP Warner has continued its leadership in advancing the care of shoulder problems on regional, national, and international levels. Dr. Warner assumed position of President-Elect of the American Shoulder and Elbow Society and enters his second year as President of the New England Shoulder and Elbow Society.

Dr. Luke Oh continues to build a busy clinical practice and a successful academic career. He was the recipient of last year’s prestigious Mel Post Award from the American Shoulder and Elbow Society for his work on infection after total elbow replacement. This award is given semi-annually to the best research paper at the Shoulder and Elbow Meeting.

Dr. Thomas Holovacs continues to run a busy clinical shoulder practice at the MGH. In addition to his clinical responsibilities he has begun work on a novel shoulder prosthesis, which promises to improve shoulder replacement surgery by more accurately representing anatomy while respecting the available native bone. He is also working on innovative new technology to improve soft tissue healing to bony surfaces such as with rotator cuff repair.

The Shoulder Biomechanics Laboratory under the leadership of Daniel Massimini and Dr. Warner has been busy with an ongoing study of the three-dimensional anatomy and kinematics of the shoulder. This year two studies on three-dimensional nerve anatomy of the shoulder were completed and members of the laboratory are continuing their work on defining normal in-vivo shoulder kinematics and contact patterns.

This year’s four Shoulder fellows are anticipating the next stage of their careers. Dr. James T. Monica departed to start a practice at New Jersey Medical Center (with his practice principally based in Princeton, NJ). Dr. Umasuthan Srikumaran joined an academic practice at Johns Hopkins University. Dr. Tyler Fox has joined the staff at the University of Kansas as an Upper Extremity Surgeon. Dr. Paul Chung is still formulating his plans.

Orthopaedic Oncology Service
Members of the Orthopaedic Oncology Service are pioneers in the area of transplantation in limb sparing procedures and in complex pelvic and spine surgery for malignant bone and soft tissue tumors. The Orthopaedic Oncology Service is under the direction of Dr. Francis J. Hornicek, Service Chief.

Orthopaedic Oncology, Medical Oncology, Radiation Oncology Services, and the members of Pathology and Radiology form the Center of Sarcoma and Connective Tissue Oncology. As part of the MGH Cancer Center, it provides comprehensive care for children and adults with bone and soft tissue tumors. They are a regional, national, and international referral center for these complex tumors. Drs. Kevin Raskin, Dempsey Springfield, Joseph Schwab, and Francis Hornicek continue to divide their clinical service with additional passions including orthopaedic research and medical student and resident education. Drs. Francis Hornicek and Zhenfeng Duan run the Molecular Sarcoma Laboratory and have ongoing multiple collaborative efforts to study tumor agenesis and stem-cell research on tumor pathogenesis.

The Musculoskeletal Tumor Fellowship, one of the most sought after in the country, brings together members of Beth Israel Deaconess, Children’s Hospital Boston, and the MGH to develop an undisputed world-class fellowship program. The Orthopaedic Oncology group has a truly impressive past, a highly productive present, and a future that includes innovation in many areas!

Pediatric Orthopaedic Service
The Pediatric Orthopaedic Service has experienced another wonderful year under the direction of Service Chief, Dr. Brian Grottkau. Dr. Grottkau is joined on the Service by surgeons Drs. Maurice Albright, Saechin Kim, and Gleeson Rebello along with Advanced Practitioners Erin Hart and Alison Turner who assist in providing outstanding patient care. Dr. Grottkau reports that the Pediatric Orthopaedic Service “continues to meet and exceed the benchmarks we have set for ourselves in terms of outpatient visits, volume of surgical cases, patient satisfaction, and quality of care.” Dr. Grottkau and members of the Service enjoyed another productive year of research in conjunction with the Laboratory for Tissue Engineering and Organ Fabrication. Working in collaboration with colleagues in the Laboratory for Tissue Engineering, they are exploring a number of orthopaedic applications for the utility of patient-derived stem cells in treating Legg Calve Perthes disease, a major cause of premature arthritis in children and young adults. They are also investigating the utility of multi-detector CT scans in improving diagnostic capabilities in a host of injuries to the immature elbow. In addition they are continuing a tradition of research into the causes and prevention of injuries sustained by children as a result of trauma.

The Pediatric Orthopaedic Service also continues to have a competitive clinical fellowship. Dr. Niranjan Kavadi, who just graduated from the fellowship program, will be heading to the University of Alabama for a second fellowship in spine.

Congratulations to Dr. Grottkau and the Pediatric Orthopaedic Service on another wonderfully productive year.

Sports Medicine Service
The Sports Medicine Service under the direction of Service Chief, Dr. Thomas J. Gill IV, continues to experience exponential growth. A major development in the Sports Medicine Service has been the establishment of several programs in the Brigham and Women’s/Mass General Health Care Center at Foxborough. Drs. Eric M. Berkson, Luke S. Oh, and Kelly C. McInnis center their practices there. A major Performance Center for the evaluation of athletes at all levels of activity has opened in the Sports Medicine Service. The main focus will be the evaluation, study, and performance improvement of baseball throwing and golf swinging motions. Foxborough is also the trial site for the development of a Sports Medicine database, which began on July 1, 2010. A program to inform the local communities of the services offers in Foxborough has started.

Medical coverage for the Boston Red Sox, New England Patriots, Boston Bruins, New England Revolution, and a variety of local high schools and colleges has expanded. Plans are in place to extend the Service’s comprehensive athletic coverage by developing a Women’s Sports Medicine Program and with the collaboration of Dr. Ross Zafonte and the Spaulding Rehabilitation Hospital a Center for Concussion Treatment and Research (CCTR) has opened. Concussions in contact sports from the Pop Warner level to the professional level are serious problems that have yet to be addressed in a systematic way. The Primary Care Sports Medicine Clinic, under the direction of Laurence Ronan, MD, has also opened in the Sports Medicine Center, and its patient referrals are growing.

The Sports Medicine Fellowship program continues to attract outstanding candidates from around the country. The Service has a number of visiting fellows and visiting residents from the United States, Europe, and Japan. Broader teaching activities include the Sports Medicine 2010 Course given in collaboration with the Department of Radiology, and the 5th Annual New England Sports Medicine Fellows Course.

The Sports Medicine Research program remains very productive, and has grown due to its affiliation with the Bioengineering Laboratory under the direction of Dr. Guoan Li, the Laboratory for Musculoskeletal Tissue Engineering with Mark Randolph, Media Laboratory at MIT with Dr. Joseph Paradiso, Spaulding Rehabilitation Hospital in association with Dr. Ross Zafonte, and the Department of Human Evolution at Harvard College in collaboration with Dr. Daniel Lieberman. Recent grants from the NFL Charities (for Drs. Gill and Berkson) and the NIH (for Dr. Gill and Mr. Randolph) have added substantial support to these programs. A new initiative on the use of platelet-rich plasma (PRP) has been undertaken by Drs. McInnis and Berkson. Dr. Thomas J. Gill III, is involved with all aspects of the research program as Director of Research for the Sports Medicine Service. In the academic year 2009-2010, the faculty of the Sports Medicine Service published 23 papers, ten chapters, one review article, and one book on techniques of knee arthroscopy.

To enhance its teaching capabilities, the Sports Medicine Service established the Dinesh Patel, MD, Arthroscopy Learning Laboratory in which knee, shoulder, and ankle models are available for the fellows and residents to practice surgical techniques. Plans are underway to expand this educational opportunity even more broadly. Members of the Service also oversee training for the residents and fellows in local cadaver arthroscopy labs.

The Sports Medicine Service physicians have received a number of recent honors. Harvard University honored Dr. Arthur L. Boland with the establishment of the Arthur L. Boland Award for an outstanding graduating senior athlete who plans to attend medical school. Drs. Bonvaronit Chuckpaiwong, Eric Berkson, and George Theodore were awarded the Nicola’s Foundation Young Researchers Award of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine in Osaka, Japan.

The Sports Medicine Service and the Spaulding Rehabilitation Hospital play a major role in the study of traumatic brain injury as part of the Home Base Program. The Home Base Program is a collaborative effort between the Red Sox Foundation and the MGH to provide diagnosis, treatment, and rehabilitation to veterans with traumatic brain injury and post-traumatic stress disorder.

A growing focus of the Sports Medicine Service is to treat athletic injuries, including concussions in young people, and to develop sound criteria for return-to-play (parallel to our work to develop return-to-combat criteria for the military).

Congratulations to the Sports Medicine Service on all these wonderful accomplishments!

Orthopaedic Spine Service
The Orthopaedic Spine Service at the MGH is under the direction of Dr. Kirkham B. Wood, and is now in its 12th year. All aspects of spine care, teaching, and research fall under the auspices of this Service. Our multidisciplinary Orthopaedic Spine Service includes surgeons: Drs. Kirkham Wood, Brian Grottkau, Joseph Schwab as well as Physiatrists: James Sarni, Leonid Shinchuk, and David Binder. Dr. James Rathmell, an anesthesiologist with the MGH Pain Center, works closely with this multidisciplinary program to provide a full breadth of services to our patients.

We are currently developing a “Comprehensive MGH Orthopaedic Spine Center.” Our goal is to create a Center that will be able to care for every aspect of a patient’s spinal condition: from surgery to physiatry, medicine, geriatric treatments, pharmacology, physical therapy, radiology, and orthotics as well as chiropractic and acupuncture consultations, alternative medicines, and patient education in both non-operative and operative care.

The Harvard Combined Spine Fellowship (along with Brigham and Women’s Hospital Attendings, Drs. Mitchell Harris and Christopher Bono) has three fellows (two at MGH, and one at BWH). The fellows are actively involved in teaching and research programs in addition to their clinical duties. Over the last year the Spine Fellowship has authored papers in the Journal of Biomechanics, Spine, Journal of Spine Disorders, European Spine Journal, Oncology, and a number of textbook chapters.

Drs. Kirkham Wood and Guoan Li continue to actively collaborate in the area of Spine Kinematics. Dr. Wood is using the dual-fluoroscopic kinematics system to better study the kinematics of the cervical and lumbar spine. The implication of this work is to provide kinematics data for our orthopaedic spine surgeons in the field of disc replacement surgery. In addition, Dr. Wood has developed a spine database along with Dr. Henrik Malchau, Co-Director of the Harris Orthopaedic Laboratory (HOL).

Research Updates

Bioengineering Laboratory

The Bioengineering Laboratory under the direction of Guoan Li, PhD, has entered its 11th year and is a leader in the field of musculoskeletal engineering and biomechanics. This year they made a significant contribution to several subspecialty areas including knee, arthroplasty, and spine biomechanics. They reported the first in vivo data on real-time tibiofemoral cartilage deformation and lumbar intervertebral disc deformation. Other investigations evaluated the in vitro biomechanical performance of various contemporary anterior cruciate ligament (ACL) reconstructions using the robotic testing system.

The laboratory has a fabulous team of outstanding graduate students from MIT, including Daniel Massimini and Shaobai Wang and postdoctoral fellows, including Drs. Samuel Van de Velde, Michal Kozanek, Zongmiao Wan, Ali Hosseini, and Kartik Varadarajan. In collaboration with Dr. Warner, Mr. Massimini continues to conduct research on shoulder biomechanics and is working towards his PhD. Mr. Hosseini, together with Drs. Kozanek and Van de Velde, has been working closely with Drs. Thomas Gill, Peter Asnis, and Luke Oh on a R01 grant evaluating knee biomechanics in vivo after ACL injury and reconstruction. Mr. Wang and Drs. Wan and Kozanek are actively studying intrinsic biomechanics of lumbar spine in collaboration with Drs. Kirkham Wood, Frederick Mansfield, and Brian Grottkau. Drs. Kozanek, Varadarajan, Hany Bedair, and I have also compiled a chapter on total knee arthroplasty biomechanics for the upcoming edition of Orthopaedic Knowledge Update. Drs. Van de Velde, Kozanek, and Thomas Gill IV, are actively publishing on in vivo ACL and PCL biomechanics. Dr. Van de Velde has also begun his studies at the Harvard School of Public Health and obtained his MPH degree in June 2011. Congratulations! The Laboratory also celebrated the fact that Dr. Kozanek will start his orthopaedic residency in 2011 in the Harvard Combined Orthopaedic Residency Program. Mr. Hemanth Gadikota is the Lab’s core bioengineer and has actively participated in a variety of clinical and robotic projects. Mr. Gadikota has been conducting a series of biomechanical testing of various ACL reconstruction techniques using the robotic system.

There have also been several new additions to the Laboratory. Mr. Zhonglin Zhu came from Tsinghua University in Beijing to help members of the Laboratory improve computer algorithms for automated model matching. Dr. Jun Miao, an attending spine surgeon from Tianjin, China joined the spine research team to help Drs. Wood and Grottkau in their study of biomechanics of spinal scoliosis. Dr. Koichi Kobayashi from Nigatta University and Dr. Takashi Suzuki from Nehon University Medical School of Japan joined the Laboratory to study patellofemoral joint biomechanics. Dr. Jing-Sheng Li came from Taiwan to investigate biomechanics of ACL reconstruction in vivo. Drs. Jae-Ang Sim and Won-Man Park, from South Korea, expanded the ranks of postdoctoral fellows in the Lab, taking part in several projects involving the prediction of in vivo spinal forces in humans. Another great addition to the team is Ms. Genevra Stone, a third year medical student form Tufts University, is working in the Laboratory on several sports medicine related projects while also preparing to help the US National Rowing Team secure a medal in the 2012 Olympics. One more athlete to join the Laboratory is Mr. Thomas Zumbrunn, who came aboard after obtaining his master’s degrees from the University of Utah and the Swiss Federal Institute of Technology (ETH Zurich). Next year, Mr. Zumbrunn will conclude his professional skiing career representing the Swiss National Ski Team in Turkey. His work will focus on improving arthroplasty implant designs. Finally, former fellow, Dr. Sang Eun Park, was promoted to the chairman’s position at the Department of Orthopaedic Surgery, Dongguk University International Hospital in Seoul, South Korea.

Furthermore, this year at the ORS/AAOS meeting, the team presented over 30 abstracts, including podium and presentations. They published over a dozen articles in prestigious peer-reviewed journals in the areas of arthroplasty, sports medicine, spine, foot and ankle, and biomechanics. In addition, the team secured several competitive grants from the NIH to study the biomechanical intricacies of ACL reconstruction and degenerative disc disease. Another fabulous year!

Shoulder Research Laboratory
The Shoulder Research Laboratory, under the direction of Dr. Jon JP Warner and Daniel Massimini, MS, had a great year with the adoption of a dedicated research space. Since then, progress within the Laboratory has occurred at an exponential rate. This year they reported the first data on in vivo glenohumeral contact kinematics after total shoulder arthroplasty in the Journal of Bone and Joint Surgery. It was found that contact kinematics are not centered on the glenoid as traditionally thought, but in fact are mostly superior posterior. These data have huge implications for the next generation design of shoulder arthroplasty. The Laboratory also developed a technique for nerve tagging for analysis by dual plane fluoroscopy in a cadaver model. The suprascapular nerve was tracked under simulated rotator cuff forces. It was found that a tear of the supraspinatus and infraspinatus caused a retraction of the nerve towards the spinoglenoid notch and may be responsible for neuropathy which is common in many rotator cuff patients.

Dr. Luke S. Oh won an AEF grant to investigate the in vivo kinematics of the shoulder in patients with anterior instability treated with the Latarjet technique. Daniel Massimini supervises all research activities within the Laboratory and focuses his research efforts on in vivo shoulder biomechanics. Mr. Massimini just began a new study to quantify the coupled scapular and humeral contributions to dynamic shoulder motion in healthy individuals during the activities of daily living. These data will serve as a benchmark for all future studies of the kinematics of rthe shoulder. Dr. Warner is passionate about shoulder research and has an endless amount of questions to answer. The Shoulder Research Laboratory is looking forward to another productive year. Plans are in the works to add a full time research engineer and postdoctoral fellow. Congratulations to Dr. Warner and Mr. Massimini on these wonderful achievements.

Harris Orthopaedic Laboratory (HOL)
The Harris Orthopaedic Laboratory (HOL) is under the co-direction of Drs. Orhun K. Muratoglu and Henrik Malchau. Members of the HOL have contributed to the field of adult reconstructive surgery for over four decades. A variety of different topics have been studied and major contributions have been made in the areas of implant stability, implant fixation, bearing-surface applications, and first, second, and now third generations of highly cross-linked polyethylenes. Currently, there are a number of outstanding clinical projects underway at the HOL.

Dr. Charles R. Bragdon who has been a member of the laboratory for over three decades is leading several studies to evaluate the clinical performance of first and second generations of highly cross-linked and melted polyethylene as well as the Vitamin-E doped irradiated polyethylenes for use in hip and knee arthroplasties. It may be hard to believe, but Dr. Bragdon and I did the first uncemented titanium fiber metal canine hip replacement in the early eighties. The combination of clinical outcomes studies and specialized RSA studies have determined that the wear behavior of cross-linked polyethylene in conjunction with traditional, as well as large femoral heads, has been dramatically decreased with the use of this new material. These studies have shown marked reduction in wear and femoral head penetration out to ten years of clinical use. I presented these findings in February at the 2011 Hip Society Meeting. Dr. Malchau and co-investigators, who are quite pleased with these results report, “so far the first generation highly cross-linked polyethylene performs as predicted by the pre-clinical experiments and seems to be the bearing of choice in the active patient.”

The HOL is also focusing on materials including cross-linked polyethylene with low-wear and high strength for applications in hip, knee, and other joint arthroplasties. This section of the HOL is under the direction of Dr. Muratoglu, an innovator in this field for over 15 years. The newest technology utilizes Vitamin-E to stabilize the residual free radicals and protects the base polymer against oxidation. The FDA cleared the use of this material in total hips in 2007 and for total knees in 2008. Dr. Ebru Oral and a group of scientists along with Dr. Muratoglu are leading the way in this important area of investigation.

Another innovation is in the area of load bearing materials for use in total joint reconstruction. This new technology minimizes the loss of mechanical properties and limits the cross-linking of the polyethylene to the articular surface layer, where it is needed to improve wear resistance. The investigators at the HOL think this new technology will be suitable for younger and more active patients.

Drs. Muratoglu, Malchau, Li and I are also continuing to tackle the difficult and perplexing problem of knee wear. This project will provide groundbreaking information, with the ultimate goal of detecting in vivo wear as it relates to implant longevity.

Another uncharted area of collaboration for the HOL is spine kinematics and spine reconstruction. The team is working on technology using hydrogels as materials for intervertebral disc replacement along with biodegradable polymer technology. These studies could benefit many of our patients with degenerative axial-skeleton disease, as well as spinal deformity. Ongoing studies in the Biomechanics Laboratory include projects studying the three-dimensional analysis of intervertebral disc motion using a combined MRI-fluoroscopic technique, the effects of disc degeneration on in vivo disc deformation, and the effect of spinal deformity surgery on adjacent segment vertebral kinematics using non-invasive techniques.

The HOL is a source of enormous activity and energy in the area of translational and basic scientific research. The skillful scientists in this laboratory had another incredible year at the ORS and the AAOS with over 20 abstracts presented. Once again the members of this outstanding laboratory have added a tremendous amount of new knowledge to our field. The first generation highly cross-linked UHMWPE developed in this laboratory has now been implanted in over two million hip and knee patients worldwide. I know these important contributions will continue in the future. Here’s to another fabulous year!

Laboratory of Musculoskeletal Engineering
The Laboratory for Musculoskeletal Tissue Engineering, under the direction of Mr. Mark Randolph and Dr. Thomas J. Gill IV, focuses on cartilage repair and regeneration in the knee. The group focuses on developing new hydrogels for articular cartilage repair and regeneration. Working with Drs. Robert Redmond and Irene Kochevar from the Wellman Center of Photomedicine, the group has developed a novel means to photo cross-link collagen gel for use as an encapsulation gel for chondrocytes and neocartilage formation. Initial work on cell survival following photopolymerization was published in Tissue Engineering in 2007 (Ibusuki S et al, 13(8):1995-2001). Follow up studies on the capacity of these photopolymerized collagen gels to form neocartilage was published in the Journal of Knee Surgery in January 2009 (Ibusuki S et al, 22(1):72-81). A grant from the AO Foundation allows them to continue this work with Dr. Redmond with the focus on improving the biomechanics of the gel and improving cell survival. A grant has recently been received from the Department of Defense to test the use of cophondrocytes encapsulated in photopolymerized collagen and PEG gels in swine to restore the articular joint surface. Parallel work on the cartilage formation capacity of human articular chondrocytes placed in hydrogels has been funded by a grant to Dr. Gill from the NFL Charities. The collaboration will also include Dr. Seemantini Nadkarni from the Wellman Center for Photomedicine who will focus on using laser speckle imaging as a non-invasive means for measuring the modulus of native and engineered cartilage.

New studies in collaboration with Dr. Muratoglu and the HOL are exploring a hybrid scaffold composed of non-degradable poly (vinyl alcohol) scaffolds combined with chondrocytes for joint cartilage replacement. Several types of PVA hydrogels have been tested for cell compatibility and cartilage formation in mice with support through an Academic Enrichment Fund (AEF) Grant from the Department of Orthopedic Surgery. To date, several candidate gels have been identified that support new cartilage formation; one recent publication describes the use of this PVA gel for craniofacial purposes (Bichara DA, et al, J Surg Res. 2010, Apr 24).

Previous work funded by the AO Foundation focused on tissue engineering strategies to repair lesions in the avascular regions of the meniscus. The results demonstrated an efficient means to seed chondrocytes onto polygalactin (PLGA) scaffolds, and the capacity of this cell-scaffold constructs to heal bucket handle lesions made in swine menisci. One study published in the American Journal of Sports Medicine in November 2006 (Weinand C, et al, 2006, 11:34) presented preliminary data on using allogeneic chondrocytes for meniscal repair. Recent work funded by the Musculoskeletal Transplant Foundation has allowed us to test the utility of allogeneic chondrocytes for healing lesions in the swine meniscus. This work is nearing completion and will demonstrate the contribution of the allogeneic cells to the repair as well as document the host’s immune response to the allogeneic cells.

Sarcoma and Molecular Biology Laboratory (SMBL)
The Sarcoma Molecular Biology Laboratory (SMBL), under the direction of Drs. Zhenfeng Duan and Francis J. Hornicek, is working on understanding the mechanisms of multidrug resistance, identification of small molecules and targets to reverse drug resistance, and characterization of molecular mechanisms governing the growth and proliferation of human sarcoma cells.
One of the overall objectives of the Laboratory is to explore biological mechanisms of tumors arising in bone and other tissues. Another major focus of the Laboratory is to elucidate the mechanisms of the development of drug resistance in cancer. Previously, it was found that multidrug resistance could be partially reversed by siRNA targeting of ABCB1 (MDR1) or by a combination of nanoparticles with chemotherapy drugs. Recently, two small molecules were identified that can overcome drug resistance in vitro. A significant aim of the research is to define the essential kinases that are responsible for the proliferation and survival of human sarcoma cells. In addition, translational research into new treatment options for sarcoma patients has been undertaken. Continued collaboration with other institutions and pharmaceutical companies has provided the foundation for an evaluation of new drug development. The SMBL has published articles on the kinase in sarcoma and multiple drug resistance in human cancer. Research projects on sarcoma biology have received funding from a variety of sources including NIH, foundations, corporate sponsors, and benefactors.

The sarcoma research group at the MGH includes investigators from multiple disciplines, as does the clinical group. I look forward to their continuing research expansion and further collaborations within the Harvard community.

Laboratory for Musculoskeletal Research and Innovation (LMRI)
I was pleased to introduce Dr. Adam Hacking, PhD, in my 2010 Report. Dr. Hacking, who has broad research interests related to improving orthopaedic treatment and patient care, joined our Department as the Director of the newly created Laboratory for Musculoskeletal Research and Innovation (LMRI). The focus of the Laboratory is to provide innovative solutions for unmet clinical needs in orthopaedics.

Dr. Hacking received his PhD in Biomedical Engineering from McGill University in 2006. Dr. Hacking was the recipient of the Hip Society’s prestigious Otto Aufranc Award in 2002 for his PhD work implicating the role of the surface morphology of plasma sprayed HA coatings in osseointegration. While working on his PhD, he co-authored a number of pre-clinical studies validating and optimizing the properties of Trabecular Metal for hard and soft tissue fixation. Dr. Hacking completed two postdoctoral fellowships, the first in the Department of Orthopaedics at McGill University and the second with Dr. Ali Khademhosseini at the Harvard-MIT Division of Health Sciences and Technology. He has authored four book chapters, and 28 journal publications, generated four patents, presented at more than 50 conferences, and has delivered numerous invited lectures.

Dr. Hacking has actively recruited students and research fellows to the Laboratory. In the last year, Dr. Wang, MD, PhD; Dr Jun Xiao, MD, PhD; Dr. Jue Wang MD, PhD; have begun work on various projects. Dr. Ari Salmi, PhD, and Dr. Martin Rottman, MD, PhD, (visiting professor) will be joining the Laboratory in the fall. Five summer students and one medical student joined the Laboratory to develop research skills and laboratory exposure. Ongoing Laboratory projects encompass trauma, arthroplasty, tissue engineering, and biomaterials. Specifically, these include bone and vascular tissue engineering, enhancement of fracture healing and implant fixation, the development of novel surfaces to reduce implant infection, the use of non-invasive techniques to quantify implant stability, techniques to improve the evaluation of biomaterials, and to improve trauma care.

Dr. Hacking is beginning to work closely with the surgical staff to develop and refine new technology. The Laboratory is equipped with large and small animal models, techniques for undecalcified histology, testing instrumentation, micro-CT imaging, design and fabrication and mechanical testing. Collaborations exist locally with Harvard and MIT and internationally with the University of Helsinki, McGill University, and the University of Versailles. These collaborations broaden and complement the capabilities of the Laboratory. To visit the lab, please stop by GRJ 1120 or email ahacking@partners.org.

Congratulations to the 2010 Department of Orthopaedic Surgery Academic Enrichment Fund (AEF) Grant Award Recipients:

Mark Vrahas, MD, Olivia Pate, MD, and Kanu Okike, MD, MPH – “Outcomes of Displaced Proximal Humerus Fractures in the Elderly.”

Kirkham Wood, MD, and Joseph Schwab, MD – “The Use of Gene Single Nucleotide Polymorphism (SNP) Analysis as a Prognostic Indicator of Chronic Pain Risk in Patients Who Undergo Single Level Anterior Lumbar Interbody Fusions.”

John Kwon, MD – “Syndesmotic Reduction: Are We Malreducing the Syndesmosis With Our Current Technique?”

Young-Min Kwon, MD, PhD – “In Vivo Evaluation of Hip Biomechanics During Functional Activities.”

S. Adam Hacking, PhD and Thomas Holovacs, MD – “Engineered Bone Surfaces for Improved Soft Tissue Anchorage.”

Department Holiday Party

This past December we celebrated our 7th Annual Orthopaedic Department Holiday Party. This enormously popular event, held at the beautiful Seaport Hotel in South Boston, was a resounding success. We had over 600 guests who were treated to an outstanding dinner buffet, holiday themed décor and wonderful music. Fortunately, we were able to avoid the annual snow fall that inevitably arrives in conjunction with our festivities. All of us had a wonderful time.

It is my pleasure and distinct honor to work with all of you. The Department is now 112 years old and was once again recognized U.S. News and World Reports as one of the top in the nation out of 1600 hospitals. I would like to thank each of you for your outstanding contributions and skilled efforts for our patients and our profession.


About Arun Shanbhag

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Posted on December 17, 2011, in Chief's Reports. Bookmark the permalink. Comments Off on Orthopaedic Surgery at the Massachusetts General Hospital.

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