Orthopaedic Surgery at The Children’s Hospital Boston

James R Kasser, MD
Chairman of Orthopaedic Surgery
The Children’s Hospital, Boston, MA


While we provide clinical care, clinical and basic research and education from medical students through Continuing Graduate Medical Education, it is resident education that is central to our program. The clinical department has continued on a growth curve of approximately 4-5% per year increase in both surgical procedures and ambulatory patients seen. The combination of young staff, innovation and contracting has led to this clinical expansion. In this report I will cover our clinical department, research activity and teaching.

Clinical Department

We opened a North Shore satellite office in the new Children’s office building at the junction of 95 North and Route 128 known as 10 Centennial Drive. At the same time the North Shore was opening, the South Shore Children’s Hospital facility, the Stetson Building, affiliated with South Shore Hospital, opened. Neither site has operating rooms available at the present time but this will leave expansion capability in the future. Nearly all satellite surgeries are done at Waltham. The Waltham facility has six operating rooms and a small inpatient unit while the Lexington facility has 4 operating rooms and is purely ambulatory. With these expanded sites, we were able to provide an array of care for patients in a setting more convenient than travel into Boston. Longwood Avenue is a bit of a parking lot from 7:00 in the morning until about 7:00 in the evening every day. Without this satellite expansion program we would be unable to serve the present population under our care.

Last year our department of 26 orthopaedic surgeons provided greater than 87,000 ambulatory visits. The surgical procedures were 5,900 cases. Children’s Hospital including all services had a total number of ambulatory visits of roughly 500,000, giving Orthopaedics 20% of all ambulatory visits. The total number of cases in the operating room was nearly 26,000, placing us just shy of one-quarter of all cases at Children’s Hospital. Nearly all of our ten clinical programs have expanded over the past year with Sports leading the way. The Division of Sports Medicine, with Lyle Micheli continuing as director and Mininder Kocher as the associate director, has continued to expand and add new staff. The surgeons in the Sports Program include Min Kocher, Yi-Meng Yen, Dennis Kramer, and Martha Murray. Benjamin Heyworth who has just completed a fellowship with us will join the department as a full time staff member beginning in August of 2011.

The Spine Division is still directed by John Emans, M.D. John has continued to develop new surgical techniques as well as advancing conservative care. This outstanding group of spine surgeons includes Lawrence Karlin, Tim Hresko and Dan Hedequist. The addition of Michael Glotzbecker improves our ability to provide comprehensive care to Children’s patients. The Hand and Upper Extremity Program under the direction of Peter Waters is capably assisted by Don Bae. A new staff person, Apurva Shah, will be added this fall. The focus on brachial plexus will continue along with congenital deformity.

The Hip Program which evolved into a national resource as femoral acetabular impingement (FAI) has been recognized as a pathologic state in the adolescent and young adult hip. Our attempts to study this with consistent method of preoperative evaluation including questionnaires as well as imaging of articular cartilage followed by meticulous analysis under the direction of Young-Jo Kim will lead to answers to the question about the actual efficacy of many of the hip procedures being done with increasing frequency throughout the country. Dr. Kim will take over as Director of the Hip Program in August of 2011, with Dr. Millis continuing to operate and be very active within this program.

Another clinical program which we are very proud is the Cerebral Palsy program. This has continued under Brian Snyder’s guidance with the addition of a new faculty member, Benjamin Shore. Drs Zimbler, Melkonian and Rosenthal fill out the orthopaedic team. Dr. Shore completed his fellowship with us following a residency in Toronto and a fellowship in Melbourne, Australia prior to his pediatric fellowship with us. He is also attending the Harvard School of Public Health to obtain an MPH in epidemiology to complement his surgical skills and his devotion to patients with cerebral palsy and other neuromuscular problems.

The other programs including Trauma, Tumors, Myelomeningocele, Lower Extremity Abnormalities, General Orthopaedics and Bone Dysplasia and Growth continue to grow and develop.

Some facts about the clinical department which you might find interesting include the following:
1. We were again named the Number One pediatric orthopaedic department in the United States by US News & World Report.
2. Our spinal implants account for one-third of the total supply budget of the operating room including all services and all cases.
3. We now have 16 mid-level providers including both nurse practitioners and physician assistants in Orthopaedics and Sports Medicine.
4. We have over 120 non-physician employees in the department.
5. We have moved nearly 20% of our surgical volume from the Longwood operating site to the Waltham and Lexington satellites.

Teaching Program

Our teaching program includes medical students, residents and fellows primarily. With respect to residents, we still have two 6-month rotations each year for the Harvard Combined Orthopaedic Residents with 6 residents each rotation. There is one Dartmouth resident and one Lenox Hill resident here at all times. It is interesting that the trend of approximately one resident per year going into pediatric orthopaedics continues and we remain excited about this continuous career choice by some of our “enlightened” residents. Gertrude “Ying” Li , Ben Heyworth and Brian Haus complete the pediatric orthopaedic fellowship program in July, with Ying taking a faculty position at the University of Michigan, Ben staying on with us at Children’s and Brian pursuing a second fellowship in Sports Medicine here at Children’s.

Peter Waters has taken over running of the clinical program in pediatric orthopaedics. It has been a welcome addition to the HCORP Executive Committee, having him included in the management of the program. While Peter and I are both involved in the orthopaedic executive committee, we maintain a single vote between us. We both have a continued interest in the growth of all orthopaedic education but have a focus on the continued improvement of pediatric orthopaedic education.

This year we welcomed our 24th Grice Visiting Professor, Alain Dimeglio. He came for a week in late October 2010 and participated in a fellow reunion as well as several teaching days for the residents and alumni. In addition to this, he participated in a course on Cerebral Palsy for physicians and therapists. Dr. Dimeglio is from Montpellier, France. He is a talented man of many interests, giving lectures on spinal growth, clubfeet, general pediatric orthopaedics and the art of Degas. Residents did case presentations on two days and the combination of new insights and frank discussion yielded an outstanding educational experience for all. Dr. DiMeglio has now become an honorary member of our orthopaedic faculty following this outstanding experience.

Research

A component of education is dependent upon a research program. Our clinical research program is supported by the Clinical Effectiveness Unit, which now is comprised of an MPH leader, a statistician, a quality coordinator, and eight research assistants. This clinical research group supports our plans to measure outcome in 80% of everything we do. Our goal is to make this transition over the next 5 years, and we are on track to achieve this. When residents and fellows want to become involved in clinical research, support staff is available to help with IRB approval, data coordination and analysis as well as project planning which yields a high probability of successful completion of the project. We published over 50 papers last year from this group.

The basic science research lab under the direction of Matt Warman, MD has continued to grow. Over the four years since Matt arrived on the scene in the Enders Building, we have transitioned the lab from a physical chemistry and structure lab to a genetics and molecular biology lab. Funding has been outstanding, taking us from nearly last place in the Enders environment to third place in overall funding of research, based on dollars per square foot or indirect cost recovery. By any measure including publications, post-docs as well as funding, Matt’s success has been applauded by all.

Matt Harris came to the lab last year as a dual appointment in Genetics and Orthopaedics, focused on the genetic basis of structural defects using the zebra fish as a model. We are actively seeking a stem cell scientist to complement the lab and help us to take it to a new level of performance.

It is of note that for the first time in many years, we have had two residents do research projects within the lab as part of their HCORP resident research requirement. We hope that as the lab continues to grow and flourish, such opportunities will continue to increase

Martha Murray is continuing to work 80% of her time in the research lab, focused on her quest to be able to heal anterior cruciate ligaments with primary repair rather than with replacement. Her lab has continued to grow with broad collaborations and the addition of post-docs and junior investigators. Martha’s work has the potential to change care of the injured athlete.

Faculty

The number of faculty in our program has continued to grow. A listing of all faculty and present academic rank is listed at the end of this piece. It is of note that Peter Waters is presently serving as President of the Pediatric Orthopaedic Society of North America. Mininder Kocher is serving on the Board of Directors of the American Academy of Orthopaedic Surgeons. Lyle Micheli won the award of Mr Sports Medicine from the American Orthopaedic Society for Sports Medicine. I will complete my stint as President of the American Board of Orthopaedic Surgery in September 2011.

Over this past year, our department underwent an outside review conducted by Harvard Medical School. The outside reviewers included Tony Herring, Dennis Wenger, and Stuart Weinstein. This external review recognized areas where we can continue to grow and improve and will help us to focus our efforts to achieve excellence. Some of the coming changes which are in the works include an improvement of the resident rotation schedule to try to adjust to the changes in work hours, as well as moving another 20% of our cases to satellite surgical locations. We are adapting to changes in work hours, which is no small feat as all of you are aware. The need for training using surgical simulation as well as the operating room environment is a continued area on which I am focusing. In addition to simulation training in the technical aspects of surgery, team training has now come into residency as well as orthopaedic staff within the Children’s Hospital environment. The complexity of our large department, combined with changing work rules and a challenging environment present threats to the educational mission. We are responding to these threats with continued evolution of our program, focus on the need to educate the next generation of orthopaedic surgeons while we continue to evolve and innovate.

Clinical Faculty

James R. Kasser, MD
Catharina Ormandy Professor of Orthopaedic Surgery
Harvard Medical School

Megan Anderson, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Donald S. Bae, MD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Gianmichel Corrado, MD
Clinical Instructor in Orthopaedic Surgery
Harvard Medical School

John B. Emans, MD
Professor of Orthopaedic Surgery
Harvard Medical School

Pierre D’Hemecourt, MD
Lecturer on Orthopaedic Surgery
Harvard Medical School

Mark C. Gebhardt, MD
Ilfeld Professor of Orthopaedic Surgery
Harvard Medical School

Ellen Geminiani, MD
Lecturer on Orthopaedic Surgery
Harvard Medical School

Michael P. Glotzbecker, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

John E. Hall, MD
Professor of Orthopaedic Surgery
Harvard Medical School

Daniel J. Hedequist, MD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

M. Timothy Hresko, MD
Associate Professor of Orthopaedic Surgery
Harvard Medical School

Lawrence I. Karlin, MD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Young-Jo Kim, MD, PhD
Associate Professor of Orthopaedic Surgery
Harvard Medical School

Mininder S. Kocher, MD, MPH
Associate Professor of Orthopaedic Surgery
Harvard Medical School

Dennis E. Kramer, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Susan T. Mahan, MD, MPH
Instructor in Orthopaedic Surgery
Harvard Medical School

Travis H. Matheney, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Gregory J. Melkonian, DVM, MD
Instructor of Orthopaedic Surgery
Harvard Medical School

Lyle J. Micheli, MD
Clinical Professor of Orthopaedic Surgery
Harvard Medical School

Michael B. Millis, MD
Professor of Orthopaedic Surgery
Harvard Medical School

Martha M. Murray, MD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Michael J. O’Brien, MD
Clinical Instructor in Orthopaedic Surgery
Harvard Medical School

Bridget Quinn, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Leela Rangaswamy, MD
Lecturer on Orthopaedic Surgery
Harvard Medical School

Robert K. Rosenthal, MD
Assistant Clinical Professor of Orthopaedic Surgery
Harvard Medical School

Frederic D. Shapiro, MD
Associate Professor of Orthopaedic Surgery
Harvard Medical School

Brian D. Snyder, MD, PhD
Associate Professor of Orthopaedic Surgery
Harvard Medical School

Samantha A. Spencer, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Benjamin J. Shore, MD
Instructor of Orthopaedic Surgery

Cynthia Stein, MD
Clinical Instructor of Orthopaedic Surgery
Harvard Medical School

Peter M. Waters, MD
John E. Hall Professor of Orthopaedic Surgery
Harvard Medical School

Yi-Meng Yen, MD, PhD
Instructor of Orthopaedic Surgery
Harvard Medical School

Seymour Zimbler, MD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Basic Science Faculty

Melvin J. Glimcher, MD
Harriet M. Peabody Professor of Orthopaedic Surgery (Emeritus)
Harvard Medical School

Matthew Warman, MD
Harriet M. Peabody Professor of Orthopaedic Surgery
Harvard Medical School

Peter V. Hauschka, PhD
Associate Professor of Oral and Developmental Biology
Harvard Medical School, Harvard Dental School

Matthew Harris, PhD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Keith R. Solomon, PhD
Assistant Professor of Orthopaedic Surgery
Harvard Medical School

Justin Allen, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Eric Boyden, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Steven Hann, PhD
Research Fellow in Developmental Biology
Harvard Medical School

Carla Haslauer, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Katrin Henke, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Adele Hill, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Christina Jacobsen, MD, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

May Jacobson, PhD
Research Associate in Orthopaedic Surgery
Harvard Medical School

Chunmei Li, PhD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Benedikt Proffen, MD
Research Fellow in Orthopaedic Surgery
Harvard Medical School

Patrick Smits, PhD
Instructor of Orthopaedic Surgery
Harvard Medical School

Patrick Vavken, MD
Instructor in Orthopaedic Surgery
Harvard Medical School

Minjie Zhang, PhD
Research Fellow in Developmental Biology
Harvard Medical School

Advertisements

About Arun Shanbhag

Tinkerer, Thinker, Innovator, Engineer, Scientist, Photographer, Marathoner, Indian, Writer, Editor, Publisher, Citizen Journalist, Manager, Bostonian, American

Posted on December 21, 2011, in Chief's Reports and tagged . Bookmark the permalink. Comments Off on Orthopaedic Surgery at The Children’s Hospital Boston.

Comments are closed.