Download Orthopaedic Surgery - NYU Langone Medical Center

2016 / YEAR IN REVIEW
Orthopaedic
Surgery
LARGEST
TOP 5
REDEFINING
RESIDENCY PROGRAM
IN THE COUNTRY
IN U.S. NEWS &
WORLD REPORT
QUALITY AND
PATIENT SAFETY
Contents
1
MESSAGE FROM THE CHAIR
2
FACTS & FIGURES
4
NEW & NOTEWORTHY
8
CLINICAL CARE & RESEARCH
9
Personalized Approach to Joint Replacement
11
Ultra-Low Dose CT Reduces Risk
13
Complex Case: Scheuermann’s Kyphosis
14
Regenerative Medicine
16
New Momentum For Wide-Awake Hand Surgery
18
Robot and Computer-Assisted Surgery
20
Quality and Safety Initiatives
22
Bone and Cartilage Regeneration Research
24
Complex Case: Pelvic Osteosarcoma
26
ACADEMIC ACTIVITIES
34
LOCATIONS
36
FACULTY & LEADERSHIP
Message from the Chair
Dear Colleagues and Friends:
From simple to complex cases, NYU Langone Medical Center’s
Department of Orthopaedic Surgery aims to provide each patient
we see with the very best in individualized care.
JOSEPH D. ZUCKERMAN, MD
Walter A.L. Thompson Professor of
Orthopaedic Surgery
Chair, Department of Orthopaedic Surgery
In 2016, I’m proud to report considerable headway toward that goal with exciting growth
in our educational, clinical, and research capabilities. Among the most significant steps
forward, the five-year Orthopaedic Surgery Residency Program’s expansion to 70 residents
now makes this program—one of the country’s most diverse—the largest of its kind.
Likewise, we expanded the department’s fellowship program to include 21 post-graduate
clinical fellows. As you’ll read in the pages of this update, our highly skilled surgeons
continue to blaze new trails and solve complex cases in collaboration with Neurosurgery,
Plastic Surgery, and other departments. An exciting partnership with the Department
of Radiology has demonstrated the mettle of low-dose CT scans in diagnosing joint
fractures, and we’ve presented promising results on using shockwave therapy to treat
refractory tendinitis.
Meanwhile, our bench-to-bedside approach is embodied in several additional clinical
care advances. We’re among the first medical centers in the United States to provide
dedicated space and resources for wide-awake hand surgery, and we’ve expanded our
same-day joint replacement options to include hip, knee, and shoulder arthroplasty.
After leading the way in robotic and sensor-assisted partial knee and total hip replacements,
our expanded suite of surgical options now includes total knee replacements. In the Joint
Preservation and Arthritis Center, an impressive roster of personalized options, including
less-invasive surgical alternatives, help patients retain their joints for as long as possible.
Our synovial fluid repository and new Joint Preservation Registry II also are providing
a rich vein of potential biomarkers that may help us measure osteoarthritis risk, disease
progression, and therapeutic response.
Finally, our vibrant research portfolio continues to pay big dividends. Multiple collaborative
projects are pointing the way toward promising bone and cartilage regeneration options that
may help patients recover from fractures, joint injuries, and other tissue-damaging conditions
more quickly. The new Center for Regenerative Medicine is rigorously testing the merits of
injectable biologics, such as stem cells derived from platelet-rich plasma to delay, or even avoid,
the need for knee replacement surgery.
Our safety and quality research projects are suggesting how to improve patient outcomes
while boosting efficiency—complementary goals as medicine moves toward bundled
payments. We are clarifying how to reduce the danger of pre- and post-surgical risk factors,
using simulations to improve how surgeons communicate with patients, and sharing
information with other medical centers to help reduce care disparities. Some of our studies
are underscoring how simple changes might significantly influence the operating room
turnover time for hand surgery, enable discharges to patients’ own homes, and enhance
tissue repair after shoulder surgery. Together, these insights will enable us to allocate our
resources where they can do the most good.
With this flurry of activity, we are laying the groundwork for an ever-stronger push toward
innovative explorations at the bench, interventions at the bedside, and improvements in the
daily lives of our patients.
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
1
Facts & Figures
Department
of Orthopaedic Surgery
TOP 5
Faculty and Students
in the country for
orthopedics in
U.S. News & World Report’s
“Best Hospitals” for
four consecutive years.
227
21
61
FACULTY
FELLOWS
RESIDENTS
Patient Volume: Top Procedures
1,901
1,725
4,263
TOTAL
HIP REPLACEMENTS
TOTAL KNEE
REPLACEMENTS
KNEE
ARTHROSCOPIES
Patient Volume: By Division
5,775
2,711
709
523
2,269
ADULT RECONSTRUCTIVE
HAND
FOOT AND ANKLE
PEDIATRICS
SPINE
797
2,269
4,343
797
142
SHOULDER AND ELBOW
SPINE
SPORTS
TRAUMA
TUMOR
Numbers represent FY16 (Sept 2015–Aug 2016)
2
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
NYU Langone
Medical Center
Adult Reconstructive:
Average Length of Stay
3.8
2013
3.5 3.0
2.7
2014
2015
Research
351
ARTICLES PUBLISHED
in academic journals
200,000+
2016
#10
#11
LEADER
IN THE NATION
BEST HOSPITALS
IN THE NATION
BEST MEDICAL SCHOOLS
FOR RESEARCH
IN QUALITY CARE
AND PATIENT SAFETY
and nationally ranked in
12 specialties, including top 10
rankings in Orthopaedics,
Geriatrics, Neurology &
Neurosurgery, Rheumatology,
Rehabilitation, Cardiology &
Heart Surgery, and Urology.
Nationally ranked in Cancer,
Diabetes & Endocrinology,
Ear, Nose, & Throat,
Gastroenterology & GI Surgery,
and Pulmonology
and an innovative leader in
medical education including
accelerated pathways to
the MD degree
and recognized for
superior performance as
measured by Vizient’s
nationwide 2016 Quality
and Accountability Study
PATIENTS ENROLLED
in patient-reported outcomes
database
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
3
New & Noteworthy
Transformation through
Growth and Innovation
Assessing the Impacts of Intra-Wound Antibiotics and Antiseptics on Wound and Tissue Healing
The application of intra-wound antibiotics
and dilute antiseptics in the surgical wound
is emerging as a clinical practice that may
decrease the postoperative infection rate.
“The efficacy of these strategies has been
shown clinically in nonrandomized clinical
studies,” says Mandeep S. Virk, MD, assistant
professor of orthopaedic surgery. “However,
the effect of these agents on host cells
participating in tissue repair is not known. It’s
possible that these agents might have a toxic
effect on cells participating in tissue healing—
including bone, tendon, ligament, and skin.”
To help understand the potential effects
of intra-wound application of these antibiotics
and antimicrobial agents on the host cells,
Dr. Virk and colleagues are studying the
process in vitro. The researchers apply
different concentrations of antibiotic and
antiseptic solutions to fibroblast, myoblast,
and osteoblast, assessing the impact on
proliferation, migration, and survival of
these cells.
“Our hope is to pick up a concentration
that would be least toxic to host cells, but
would still be efficacious against the bacteria,”
says Dr. Virk.
A Year of Expansion in Education and Training
LARGEST RESIDENCY IN THE NATION.
The department’s educational and training
programs experienced notable growth in
2016. Among the highlights: The ACGME
recognized the history of excellence in the
Orthopaedic Surgery Residency Program by
allowing it to expand from 60 to 70 residents
per year. The five-year program, already
highly ranked in the nation, is now also the
largest with 14 residents accepted every year.
NEW FELLOWSHIPS IN HAND SURGERY
AND ARTHROPLASTY. With expansions
in hand surgery and arthroplasty, the
department broadened its fellowship
programs to include 20 postgraduate clinical
fellows across six divisions. As leaders in
educational innovation, the residency and
fellowship programs both continued their
novel use of direct observation to evaluate
the clinical skills of trainees.
4
Orthopaedic Surgery residents
HEALTH POLICY CERTIFICATE
FOR RESIDENTS. In 2016, the department
also established a unique one-year certificate
program with the Robert F. Wagner Graduate
School of Public Service that allows one
resident per year to receive a health policy
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
certificate. Based on coursework and
involvement in both state and national
health lobbying organizations, the certificate
program offers special training in leadership
and policy development—skills increasingly
in demand among orthopaedic surgeons.
New Shockwave Therapy Unit Takes Aim at Intractable Tendinitis
Shockwave therapy has long been used as
an effective treatment to fragment kidney
stones and gallstones. Over the past few years,
evidence has mounted that the therapy’s
directed pulses of mechanical energy also
can help treat chronic tendinopathy cases
that haven’t responded well to other
therapeutic options. The therapy is showing
early promise in treating patients with
refractory tendinitis since debuting at
NYU Langone in September 2016.
“It’s a safe intervention with the potential
for excellent results,” says Dennis A. Cardone,
DO, associate professor of orthopaedic
surgery and chief of Primary Care Sports
Medicine. The division’s new shockwave
therapy unit is still a relative rarity at
academic medical centers in the United
States. With its arrival, however, Dr. Cardone
says the cutting-edge technique will help
him and his colleagues initiate new studies,
collect valuable long-term data, and
potentially expand its use to treat a range
of painful conditions, including rotator cuff
and hamstring injuries, frozen shoulder,
Achilles tendinitis, calcific tendinopathy,
and plantar fasciitis.
Insufficient blood flow, Dr. Cardone says,
may be a major reason why some chronic
tendinopathies are extremely difficult to heal.
Although the physiological mechanisms
underlying shockwave therapy aren’t fully
understood, studies have suggested that its
success may stem from its ability to promote
revascularization of the affected tendons.
Patients at NYU Langone typically receive
the treatment once a week for three weeks.
Data on long-term outcomes are still pending;
in the interim, however, Dr. Cardone is
encouraged by early signs that the repeated
treatments are bringing enduring relief.
Dennis Cardone, DO
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
5
New & Noteworthy
Claudette Lajam, MD
Improving Outcomes and Efficiency Through Better Blood Management
As part of an institution-wide initiative,
NYU Langone’s Value-Based Management
team partnered with the Department of
Orthopaedic Surgery to reduce the high rate
of blood transfusions performed beyond the
scope of medical indications. Unnecessary or
inappropriate blood transfusions have been
associated with higher inpatient mortality
and excess costs.
Thanks to a rigorous effort to change
practice, faculty members increased the
percentage of blood transfusion orders that
complied with national guidelines from 57
percent to more than 90 percent throughout
the institution, and the Department of
Orthopaedic Surgery improved more than any
other department. “We’re still doing well after
the initial push. That’s the real test of any major
change like this,” says Claudette M. Lajam, MD,
6
salvage a patient’s blood during surgery.
assistant professor of orthopaedic surgery,
After reviewing the frequency of use and
and departmental representative for the
examining the outcomes, the department
Medical Center-wide initiative.
adopted new guidelines about when the
From national guidelines based on
technique should and shouldn’t be used.
hemoglobin concentration and other medical
“We’ve brought our wasteful cell saver usage
factors, the team, led by hospitalist Frank M.
Volpicelli, MD, assistant professor of medicine, nearly down to zero,” Dr. Lajam says.
A third project, led by James D. Slover,
constructed a dashboard that linked each
MD, associate professor of orthopaedic
transfusion indication with the associated
surgery, has assessed the preoperative use
blood counts, and helped surgeons compare
of tranexamic acid, or TXA, to prevent major
their progress to that of their peers. A
bleeding associated with hip and knee
computerized order entry system also helped
arthroplasty. For institutions with baseline
the doctors think about a transfusion’s
transfusion rates below 25 percent, the
necessity while avoiding “alarm fatigue.” The
research suggested that TXA is not costsuccess also relied on regular communications
effective. The potential for savings, however,
with the physicians and reinforcement of
positive trends to help them change their habits. increases above the 25 percent threshold due
to TXA’s rising potential to help reduce
A similar approach has helped reduce the
transfusion rates.
unnecessary use of cell saver machines to
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
New Leadership and Growth in Pediatrics
NYU Langone added three new faculty
members to its Pediatric Orthopaedic
Division this year, including a new chief,
Pablo Castañeda, MD.
Dr. Castañeda comes to New York from
Mexico City, where he has specialized
in treating hip disorders in children and
adolescents. His practice focuses on
improving outcomes for children with
developmental dysplasia of the hip,
Legg-Calvé-Perthes disease, and slipped
capital femoral epiphysis. He currently
serves on the medical advisory board
of the International Hip Dysplasia
Institute and serves on the board of
the Mexican College of Orthopaedics
and Traumatology, and is past president
of the Mexican Society of Pediatric
Orthopaedics.
Also joining the Pediatric Orthopaedic
Division are Mara Karamitopoulos, MD,
clinical assistant professor of orthopaedic
surgery, who previously was the co-director
of pediatric orthopaedics at Maimonides
Medical Center, and Jody Litrenta, MD,
clinical assistant professor of orthopaedic
surgery, who joins NYU Langone following
a pediatric orthopaedic fellowship at
Children's National Medical Center.
Pablo Castañeda, MD
NYU LANGONE AFFILIATION WITH WINTHROP-UNIVERSITY HOSPITAL BRINGS EXPANDED
AND ENHANCED HEALTHCARE NETWORKS TO LONG ISLAND
NYU Langone Medical Center and WinthropUniversity Hospital on Long Island have
reached an agreement to affiliate the
institutions’ extensive healthcare networks.
NYU Langone, with more than 150 ambulatory
sites throughout the region, will complement
Winthrop-University Hospital’s main campus,
multiple ambulatory sites, and network of 66
faculty and community-based practices in more
than 140 locations extending from eastern
Long Island to Upper Manhattan.
The affiliation will further expand NYU
Langone’s presence on Long Island, while
enhancing Winthrop’s inpatient and outpatient
services with improved access to NYU
Langone’s wide range of medical and
surgical specialties.
“This agreement publicly confirms our
confidence that an affiliation will allow both
of our institutions to collaborate and share best
practices to better meet the healthcare needs
of the communities we serve,” says Robert I.
Grossman, MD, the Saul J. Farber Dean and CEO
of NYU Langone. Pending regulatory approval,
the institutions are aiming to complete their
affiliation in spring 2017.
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
7
Clinical Care and Research
Research-driven
Innovations in Care
COMBINING EXPERTISE, NOVEL RESEARCH FINDINGS,
AND THE LATEST TECHNIQUES, TECHNOLOGY, AND FACILITIES,
THE ORTHOPAEDIC TEAM AT NYU LANGONE PROVIDES
INDIVIDUALIZED CARE FOR PATIENTS WITH COMMON CONDITIONS
OR THE MOST COMPLEX CLINICAL NEEDS.
James D. Slover, MD
8
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Personalized Solutions Preserve and
Replace Joints Based on Patient Profile
For some patients with joint-related problems, a total knee or hip replacement
may restore mobility and relieve pain, while others may achieve reduced
symptoms and restored function through less-invasive alternatives.
Stratifying these patients by risk and likelihood of improvement is a major
aim of NYU Langone.
“We want the right operation or intervention for the right
patient at the right time,” says Richard Iorio, MD, the Dr.
William and Susan Jaffe Professor of Orthopaedic Surgery
and chief of the department’s Adult Reconstructive Division.
Solutions may eventually need to be as individualized
as the “arthritis fingerprints” that determine a patient’s
risk, progression, and therapeutic response, Dr. Iorio
says. A host of recent departmental initiatives are
helping to make that personalized approach a reality.
The newly launched Joint Preservation Registry II
is supporting these efforts with an ambitious plan
to collect knee, hip, and shoulder joint synovial fluid
from 1,000 OA patients, as well as matched blood and
urine samples and patient-reported outcome scores.
Ultimately, Dr. Iorio says, validated biomarker profiles
may help doctors and patients determine whether
replacement surgery or joint preservation procedures
are likely to meet their needs. “It’s going to be an
important decision tool,” he says.
BIOMARKERS ENHANCE RISK PREDICTION
As they sort through the many factors that may
determine disease risk and therapeutic success,
the department’s researchers are increasingly looking
to biomarkers. “Part of our mission is to avoid joint
replacements and big surgeries in people who don’t
need them, and biomarkers may help us identify who
those patients are,” Dr. Iorio says.
The department’s well-curated synovial fluid
repository is already enabling researchers to test
biomarkers that may predict which young athletes who
sustain knee injuries are likely to subsequently develop
osteoarthritis (OA), and when older patients with OA are
likely to require a joint replacement. From roughly three
dozen potential biomarkers initially isolated from the
repository, researchers are extensively analyzing a set
of 10, according to Thorsten Kirsch, PhD, professor
of orthopaedic surgery and cell biology and vice chair
of research.
In addition, department faculty are partnering
with NYU Langone radiologists to develop new imaging
methods that can detect early OA changes and other
methods that could complement biomarkers in
predicting surgical outcomes and disease progression.
AVERTING HIP REPLACEMENTS FOR
AVASCULAR NECROSIS
Most patients diagnosed with avascular necrosis or
osteonecrosis of the hip are relatively young, which
means that any therapies doctors recommend to help
them avoid a hip replacement procedure—with a likely
later revision—carries considerable long-term benefits.
To that end, Thomas A. Einhorn, MD, professor of
orthopaedic surgery, director of clinical and translational
research and co-director of the Osteonecrosis Center, has
helped to formalize a program that uses mesenchymal
stem cells to treat early osteonecrosis.
“The idea is that in avascular necrosis of the hip,
or osteonecrosis, there’s dead bone in the head of the
femur,” Dr. Einhorn says, “and when that bone dies
it will eventually collapse and the patient would need
a hip replacement.” Bone marrow stem cells injected
directly into the femoral head through a minimally
invasive method can interrupt this process, helping
to regenerate, rejuvenate, and restore living bone to
prevent a collapse of the joint and subsequent OA.
The bone marrow aspirate concentrate (BMAC)
procedure has drawn patients to NYU Langone from
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
9
Clinical Care and Research
around the country. Dr. Einhorn estimates that it has
been successful in roughly two-thirds of cases so
far, with clinical success based on a diminution or
eradication of painful symptoms and an averted
hip replacement.
NEW PROGRAMS STRATIFY RISK IN ARTHRITIS
MANAGEMENT
NYU Langone also is personalizing treatment options
for total knee or hip arthroplasty with a new model that
stratifies candidates based on their preexisting surgical
risk factors and provides options to mitigate those factors,
which may lead to poor outcomes. Dubbed Perioperative
Orthopaedic Surgical Home, or POSH, the model is aimed
at identifying and reducing risk in eight main categories.
POSH, a collaboration with NYU Langone’s Rusk
Rehabilitation and Department of Population Health,
matches patients with the programs that will best meet
their risk-reduction needs. Those who smoke or are
morbidly obese, for example, can be enrolled in smoking
cessation or weight loss programs. “Patients could even
avoid a joint replacement if they modify these risk
factors sufficiently,” Dr. Iorio says.
The department also is incorporating the POSH
model into a broader commercial effort known as the
Lifetime Initiative for the Management of Arthritis,
or LIMA. This unique website provides comprehensive
information, peer support from other patients, advice
from an arthritis coach, and evidence-based selfevaluations to help patients determine their risk of
progression and the best course of action. If patients
find out they’re in a very low-risk category, for example,
conservative measures such as arthritis-friendly exercises
and over-the-counter pain medications might be enough
to help them manage their condition.
The same-day hip replacement program has
expanded to include knee and shoulder replacements;
a same-day discharge group with faculty from both the
Adult Reconstructive and Shoulder and Elbow divisions
collaborate to apply same-day hip replacement
protocols and best practices to the other procedures.
Surgeons decide which patients are good candidates
and how their pain and therapy needs will be safely and
efficiently met in the hours, days, and weeks after the
surgery. Regional nerve blocks and medication cocktails,
for example, can help provide smooth transitions
for patients in the first 24 postoperative hours. “Our
foremost priority is to ensure that this strategy is safe
and that patients will have adequate pain control at
home,” says Mandeep S. Virk, MD, assistant professor
of orthopaedic surgery. “They should have a responsible
adult with them, and all of the necessary resources
so that they can go home and sleep in their own bed
without being deprived of necessary, immediate
postsurgical care.”
SAME-DAY JOINT REPLACEMENT PROGRAM EXPANDS
For the right patients, same-day discharge following
joint replacement can lead to better outcomes and
higher satisfaction. Since Roy I. Davidovitch, MD,
assistant professor of orthopaedic surgery, performed
the first same-day hip replacement in New York City
in 2015, NYU Langone has worked to bring the benefits
of the approach to more patients.
10 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Roy I. Davidovitch, MD
Ultra-Low Dose CT Reduces Risk
in Joint Injury Diagnosis
Computed tomography scans, among the most common imaging methods in
medicine, have raised public health concerns over an increased cancer risk linked
to the scans’ ionizing radiation. A collaborative effort between NYU Langone’s
Orthopaedic Surgery and Radiology Departments has yielded an effective new
imaging method that may help to dramatically reduce that risk.
“We have been seeking ways to minimize radiation
exposure for both patients and physicians,” says
Kenneth A. Egol, MD, professor of orthopaedic
surgery and chief of the department’s Trauma and
Fracture Division.
A recent study by medical center researchers found
that CT scans that use computer-based enhancements
to preserve image quality and use only one-fourteenth
the standard radiation level can still accurately detect
joint fractures. Among a cohort of 50 patients,
researchers correctly identified a typical fracture
with 98 percent sensitivity and 89 percent specificity—
An ultra-low dose radiation CT scan
of a fracture of the tibial plateau
rates comparable to those achieved by a standard
CT scan. The technique lowered the average radiation
from 0.43 mSv to 0.03 mSv, akin to the dose of a routine
chest X-ray.
“We have taken a frequently used and necessary
imaging test and made it safer,” says the study’s lead
author Sanjit R. Konda, MD, assistant professor of
orthopaedic surgery. Dr. Konda’s team developed the
REDUCTION protocol (Reduced Effective Dose Using
Computed Tomography In Orthopaedic Injury)
in conjunction with radiologists led by Soterios
Gyftopoulos, MD, assistant professor of radiology.
A conventional dose CT scan
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
11
Clinical Care and Research
EARLY SIGNS OF IMAGING SUCCESS
The collaborative effort began when Dr. Konda
introduced the idea of using CT scans to diagnose
traumatic arthrotomies of the knee. The telltale
detection of air in the knee joint had previously relied
on the saline load test, which requires injections of
an intra-articular saline solution. “You could imagine
that it is likely an invasive, painful procedure for
a patient. It also takes time,” Dr. Egol says.
Dr. Konda, however, noticed that CT scans of open
fractures around the knee commonly revealed air
within the joint, and follow-up research confirmed that
the method could diagnose traumatic arthrotomies as
well. The promise of the approach, however, came with
a new challenge: how to reduce the patients’ radiation
exposure. “We worked with our radiology colleagues on
cadavers to see if we could develop an imaging protocol
that would help us detect the air in the joint and
minimize the radiation,” Dr. Egol says.
Based on their success in assessing open knee
wounds with the low-dose CT strategy, the researchers
asked whether the method also could help diagnose
extremity fractures. “We applied this low-dose
technology to all the different areas of the body that
would normally get CT scans, comparing it to standarddose radiation CT scans, and found that we really didn’t
lose any accuracy in diagnosis,” Dr. Egol says.
Subsequent research confirmed that the team’s
strategy didn’t adversely impact patient outcomes.
The results are now prompting a multidepartmental
collaboration between the Departments of Radiology
and Emergency Medicine to reduce radiation exposure
for patients with orthopaedic trauma and for the
physicians involved in their care. “Patients who undergo
a traumatic injury or suspected fracture have enough
to worry about,” Dr. Egol says. “Our research makes
radiation exposure among the least of their concerns.”
12 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
TAPPING NYU LUTHERAN’S DIVERSE PATIENT
POPULATION FOR RESEARCH INITIATIVES
Researchers are tapping NYU Lutheran’s diverse
patient population for two research projects. In one,
investigators are studying the incidence of lateral
compression type 1 pelvic ring fractures, which have a
mortality rate of 5.1% to 8.6%. In another, NYU Lutheran
has contributed more than 100 patients to a study about
a new geriatric trauma triage score developed by NYU
Langone researchers that has shown good ability to
predict inpatient mortality and complication. The Score
for Trauma Triage in the Geriatric and Middle-Aged
(STTGMA) distinguishes between high-energy and
low-energy injury patients. In early results, the STTGMA
has shown superior predictive value when the score
is calculated at initial patient presentation as opposed
to retrospective application. Researchers hope this
predictive score can be used to help guide efficient
and appropriate patient care in the future.
Complex Case: Scheuermann’s Kyphosis
Collaboration in Atypical Case of Scheuermann’s
Kyphosis and Spinal Cord Herniation
The strong collaboration between the orthopaedic surgeons and neurosurgeons
at NYU Langone’s Spine Center recently enabled a complex corrective spine
surgery following a rare diagnosis.
Postoperative X-ray
Traditionally, the realm of orthopaedic spine surgeons was
mainly bone issues, while spinal neurosurgeons dealt with
neural structures. “But over the last 20 years or so, these two
specialties have become less distinct and more collaborative,”
says Thomas J. Errico, MD, professor of orthopaedic surgery and
neurosurgery and co-director of NYU Langone’s Spine Center.
PRESENTATION
The benefits of such collaboration were in full view when Adam
White, 20, a former lineman on his Pennsylvania high school
football team, requested a surgical evaluation in May 2015
to address intense pain between his shoulder blades that had
worsened progressively over an eight-month period. In addition,
he experienced numbness and tingling that radiated from his
fingers to his biceps and from his toes to his knees. Sudden
movements, especially sneezing, caused severe and shooting
pain that was nearly unbearable, even with medication.
With an MRI, Noel I. Perin, MD, associate professor of
neurosurgery, discovered that White was suffering from a
rare T5 through T7 spinal cord herniation. It was an interesting
intersection with another uncommon diagnosis the young
man had received previously at NYU Langone: a pronounced
curvature of his thoracic spine due to Scheuermann’s kyphosis,
found by radiologists on scoliosis X-rays. “I’ve never before seen
both in a single patient,” Dr. Perin says.
SURGICAL PLAN
Dr. Perin developed a comprehensive surgical plan in
consultation with Dr. Errico. Each specialty “brings a little
extra to the table,” says Dr. Errico, and that additive effect
has been highly beneficial for complex cases such as White’s.
During the 13-hour surgery that followed, Dr. Perin first
addressed his patient’s spinal-cord hernia and myelopathy
with a laminectomy, laminoplasty, and cord decompression.
Following a durotomy, he explored the intradural spinal cord
with an operating microscope, released adhesions of the cord to
the anterior dura, and repositioned it in the center of the canal
by dividing the dentate ligaments.
Dr. Errico took over and performed radical facetectomies to
decompress the spinal nerves and harvest bone material for
subsequent grafting. He then corrected White’s spinal curvature
and stabilized the spine by fusing 12 of the patient’s vertebrae, from
T2 to L1, with 24 pedicle screws and two-foot-long titanium rods.
Finally, Dr. Perin completed the thoracic laminoplasty and
screwed miniplates to the vertebral laminae and adjacent lateral
mass to prevent a recurrence of the hernia. The surgeons then
carefully placed the allografts over the posterior elements of
White’s decorticated vertebrae, to aid bone regeneration.
RESULTS
Following the surgery, the patient felt immediate relief upon
waking in the post-anesthesia care unit. “No numbness, no
pain—just like that,” White recalls. After recovering from the
surgery, he remained pain-free, returning to golf and other
favorite activities.
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
13
Clinical Care and Research
Tailoring and Testing
New Treatment Options through
Regenerative Medicine
Over the past few years, sports medicine has benefitted enormously from the
use of injectable biologics to delay or even avoid the need for knee replacement
surgery. Among the growing list of promising therapeutic options, NYU
Langone is using growth factors derived from platelet-rich plasma and stem
cells from bone marrow aspirate to treat osteoarthritis (OA) and testing the
treatments on a range of other conditions.
“Biologics will certainly play a major role in the future
in the management of patients with musculoskeletal
disease,” says Laith M. Jazrawi, MD, associate professor
of orthopaedic surgery and chief of the Division of
Sports Medicine. Dr. Jazrawi is leading plans for the
department’s Center for Regenerative Medicine that
would include a dedicated procedure room for injectable
therapeutics.
NYU Langone researchers are conducting multiple
projects to help determine which biologics may have
the brightest future. For one multicenter randomized
controlled trial, investigators are comparing the
effectiveness of platelet-rich plasma to dry needling for
treating patellar tendinopathy. Other researchers are
pursuing a randomized controlled trial in collaboration
with Birmingham, Alabama-based NuTech Medical, Inc.,
to compare the effectiveness of the company’s ReNu™
amniotic stem cell allograft to a hyaluronic acid injection
or saline control for treating knee OA. A third study is
examining whether hyaluronic acid injections improve
the symptoms of patients with the earliest stages of OA,
compared with physical therapy alone.
Although preliminary, Dr. Jazrawi says the clinical
trials’ results have been encouraging so far. Pending FDA
approval, he and his colleagues also hope to investigate
the OA-treating potential of adipose tissue-derived stem
cells, which could be harvested from liposuctions in
collaboration with the Plastic Surgery Department.
The cells, Dr. Jazrawi says, might even help reestablish
cartilage in an OA-afflicted knee.
14 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
RESEARCH SYNERGY WITH SYNOVIAL
FLUID REGISTRY
The current and upcoming clinical research projects,
he says, fit well with the work of the department’s Joint
Preservation and Arthritis Center. Synovial fluid
samples collected as part of the Joint Preservation
Registry, for instance, are helping to match patients’
therapeutic responses to unique biomarkers. “We’re
beginning to tailor our medical care toward a specific
patient profile,” Dr. Jazrawi says. In this case, he notes,
the biomarker-based profile can help determine which
patients will respond best to which cellular therapy.
350
SYNOVIAL FLUID SAMPLES
COLLECTED FROM PATIENTS INDICATED
FOR ARTHROSCOPIC KNEE SURGERY.
“There may be a specific cohort of patients that has
better regenerative potential,” he says. Asking why they
improve with stem cell injections while others do not can
lead to a better alignment of treatments based on patients’
molecular characteristics identified via blood, urine or
joint fluid samples. “Getting that information, it will help
us determine if a patient will benefit more from an
Eric Strauss, MD
injection, from physical therapy, or by going right to total
knee replacement,” he says.
Departmental researchers led by Eric Strauss, MD,
associate professor of orthopaedic surgery, accurately
predicted OA severity based on levels of the synovial
fluid biomarkers MCP-1 and IL-6. A separate line of
collaborative research led by Philip Band, PhD, research
professor of orthopaedic surgery and biochemistry and
molecular pharmacology, found that higher levels of
a proprietary protein marker called TSG-6 may reflect
a more urgent need for knee replacement.
Finally, researchers are collecting fluid from patients
undergoing knee arthroscopy to likewise help determine
who is more likely to do well or poorly. The decisionaiding information, in turn, can prevent treatment delays
and streamline patient care. “They’re getting the best
treatment possible for them, not for all patients in general,”
Dr. Strauss says. “So we’re looking for this tailored, personal
medicine concept based on the data from this registry
to help us answer some of these questions.”
SUPERIOR RESULTS WITH SUPERIOR CAPSULAR
RECONSTRUCTION
NYU Langone’s expanding use of a new procedure called
superior capsular reconstruction is helping patients
with a deficient and non-repairable rotator cuff injury
avoid a traditional reverse shoulder replacement and
its complications.
“The concept of a superior capsular reconstruction—
using a dermal allograft, anchoring it into the glenoid
and then re-attaching it to the humeral head at the
rotator cuff insertion—has provided significant pain
relief to select patients with irreparable rotator cuff tears
and has improved shoulder function,” says Andrew S.
Rokito, MD, associate professor of orthopaedic surgery
and chief of the Shoulder and Elbow Division. This
procedure, which offers an alternative to shoulder
replacement, represents an “exciting” change in the field
of orthopaedics, especially within sports medicine.
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
15
Clinical Care and Research
A Dedicated Space and New Momentum
for Wide-Awake Hand Surgery
Hand surgery without tourniquets, sedation, or general anesthesia—once
unthinkable—is in the midst of a remarkable renaissance thanks to a burst of
recent research demonstrating the safety, efficacy, and benefits of a technique
once limited by misconceptions.
Wide-awake hand surgery with only local anesthesia—
first championed by Canadian surgeons—has been
implemented by a few U.S. institutions, and is becoming
a growing topic of discussion among hand surgeons.
NYU Langone will became one of the first centers in the
country to formalize a wide-awake hand surgery program,
with a dedicated check-in area and surgery room at its
Outpatient Surgery Center opening in January 2017. “One
key advantage of the technique is the ability to dispense
with general anesthesia and sedation that can lead to
negative side effects and complications for the patient,”
says S. Steven Yang, MD, MPH, clinical associate professor
of orthopaedic surgery, who led the launch of the center.
REMOVING THE EPINEPHRINE SAFETY BARRIER
Anesthesia is currently administered routinely
to counteract the intense discomfort of sustained
tourniquet pressure—up to 200 to 250 mm Hg—used to
provide a bloodless field for hand and arm surgery. As a
vasoconstrictor, epinephrine limits bleeding and prolongs
the anesthetic effect by delaying its dissipation through the
blood stream, but was thought to be hazardous. “We were
always taught that we shouldn’t use epinephrine,” Dr. Yang
says, based on the mistaken belief that an overwhelming
vasoconstrictive effect in the fingers’ small vessels could
lead to ischemia and necrosis. But recent studies now
suggest that the true culprit of epinephrine-related
complications was likely impurities in the anesthesia
formulations, lending the concept of wide-awake hand
surgery a major boost by eliminating the tourniquet.
Based on this new insight, doctors are using a large
dose of local anesthetic such as lidocaine, mixed with
epinephrine, to numb the surgical site and constrict the
blood vessels. The high volume of incoming medication
offers a secondary benefit by reducing bleeding via the
tamponade effect. “Almost like inflating a balloon inside
the arm or the hand, it pinches off the blood vessels,”
16 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Dr. Yang says. “The combination of those features
enables us to do the surgery without a tourniquet. And
if we don’t use the tourniquet, we don’t need to give the
sedation or general anesthesia drugs."
“If you don’t need to give the drugs, you don’t have to
have patients doing all of this preoperative testing, which
is costly and inconvenient for patients,” adds Dr. Yang.
CONFIRMING SURGICAL EFFICACY IN REAL TIME
Although a wide variety of surgeries may prove
amendable to the surgical technique, the department
is beginning by offering the approach for smaller
procedures, such as releases of carpal tunnel, trigger
finger, De Quervain’s, and wrist tendinitis, as well as
excisions of ganglions and cysts around the wrist.
Beyond improved safety, efficiency, and cost savings,
patients who remain awake during the procedures can
provide constructive feedback to their surgeons, Dr.
Yang says. After surgery to release a patient’s trigger
finger, for example, he can ask the patient to make
a fist and slowly straighten out the affected finger
to determine whether the tendon is still catching.
Likewise, for patients who have had tendon
lacerations repaired, surgeons can ask them to move
their hands and fingers to assess the strength and
quality of the repairs and determine whether more work
is required. “We can actually check patients’ movements
while they’re on the operating table, where the hand
is still open,” Dr. Yang adds. “There is obviously
a significant advantage there.”
In conjunction with the surgical program’s official
launch, Dr. Yang and colleagues are initiating several
prospective studies to assess patient satisfaction,
clinical outcomes, and potential cost savings of wideawake hand surgery. For patients, he says, the eventual
payoff could be a safe and effective procedure that makes
hand surgery akin to going to the dentist for a filling.
S. Steven Yang, MD, MPH
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
17
Clinical Care and Research
In Joint Replacement Surgeries, Robots
and Sensors Lend a Critical Hand
Recent advances in robotic and sensor technology have expanded their
application in joint replacement surgeries, from partial knee to total hip,
and NYU Langone is one of the first medical centers to offer a robot-assisted
surgical option for total knee replacements.
The evolution of such robot-assisted orthopaedic
surgeries has been spurred by a combination of
cutting-edge tools, technical expertise, evidence-based
pain management, and rapid recovery protocols. As
a result, surgeons can employ minimally invasive
techniques, reduce errors, prevent complications,
and increase their precision in ways that preserve more
bone and tissue. Indeed, the new option for total knee
replacement is poised to boost the accuracy, outcome,
and patient satisfaction of an increasingly in-demand
surgery that already accounts for about 85 percent of
all knee arthroplasties.
Patrick A. Meere, MD, clinical associate professor
of orthopaedic surgery, says the advances have actually
benefitted each of the main approaches for total knee
arthroplasty. “Within the last five years, two things have
happened: Robots have become the champions of the
measured resection-alignment school of thought, and
sensors have come into play in the balancing school,”
Dr. Meere says.
ROBOTICS MEET RESECTION
The measured resection approach, which places greater
emphasis on precise anatomical cutting of bone and
less on soft tissue alignment, has benefitted from
MAKOplasty®, a robot-assisted technique that uses
CT scans to create three-dimensional preoperative
templates. NYU Langone surgeons have successfully
used MAKOplasty for partial knee and unicompartmental
knee replacements over the past five years, and for total
hip replacements over the past three years.
With MAKOplasty, surgeons can match landmarks in
a patient’s body to those in the 3D model; a 1:1 registration
match then allows the robot to create a virtual space that
guides each surgical cut. “Once you have that, you can
achieve a level of accuracy that has been unsurpassed to
18 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
date, both for partial knee replacements and for hip
replacements,” Dr. Meere says.
The MAKO system, which offers preoperative imaging
capabilities and the highest levels of accuracy, is one of
two robotics-assisted systems used at NYU Langone. The
other is NAVIO, an image-less, handheld computer wand
that follows the contours of a patient’s bones and creates
accurate cut guides based on mathematical models.
“Because it doesn’t depend on a preoperative CT scan, the
NAVIO alternative is more nimble and less expensive, and
reduces the patient’s radiation exposure,” says Jonathan
Vigdorchik, MD, assistant professor of orthopaedic surgery.
In addition to his research using robotics in total
knee replacement, Dr. Vigdorchik is exploring how
robotic-assisted surgery can be used to help customize
the total hip replacement. By using the department’s
EOS full-body low-dose X-ray machine to take images of
patients in various functional positions, surgeons can
help guide a personalized and optimized position for
the components in a hip replacement to decrease the
risk of complications such as dislocation and improve
wear and longevity.
FINDING A BETTER BALANCE
The balancing approach to knee arthroplasty, which
places more emphasis on balancing the ligaments
and soft tissue of the knees, initially benefitted
from computer navigation tools that improved the
consistency in knee alignment when it came online
more than a decade ago. Yet patient satisfaction scores
following those surgeries still lagged behind those
of total hip replacement patients.
Now, newer sensors in the tibia liners, in regular use
at NYU Langone, offers greater balancing guidance by
measuring pressure rather than alignment. “They have
sensors embedded in the trial components, so surgeons
Jonathan Vigdorchik, MD
can verify the equal distribution of pressure on the
inside and outside of the knee,” says Dr. Meere. The
sensors also leave an imprint on the point of contact to
the tibia, to help surgeons see patterns associated with
excessive laxity or tightness.
EXPANDING APPLICATIONS, ENHANCING OUTCOMES
The Medical Center is concurrently focused on using
robotics to assist in surgeon training and to reduce
variability in outcomes—ultimately raising patient
satisfaction scores for knee replacement surgery.
Because the knee joint is so complex and subjected
to such unpredictable forces, Dr. Meere says, knee
arthroplasty was a challenging skill to teach in the
absence of technology. “It’s a fantastic learning tool for
the residents because it provides a live picture of your
action instead of a theoretical one—you do a surgical
correction and see the immediate results,” he says.
To further integrate the robotics technology with
balancing sensors in clinical practice, NYU Langone’s
Advanced Arthroplasty Research Lab is conducting both
bench-top and clinical research. “The integration and
NYU LANGONE IS
1 of 8
WORLDWIDE REFERENCE CLINICS THAT
ARE PART OF THE INTERNATIONAL SOCIETY
FOR COMPUTER-ASSISTED
ORTHOPAEDIC SURGERY FELLOWSHIP.
use of robotics will be tracked with our very efficient
tools of patient-reported outcomes before and after
surgery so we can clearly validate the superiority of
robotic surgery versus conventional surgery,” says Dr.
Vigdorchik. Although this type of research takes many
years to complete, early clinical results are already
showing promising success.
Likewise, patient-reported measures can help
demonstrate whether the robotics-sensor combination
offers the best possible outcome. “That’s the future,” he
says. “The natural evolution is to merge the two together.”
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
19
Clinical Care and Research
Quality and Safety Initiatives
Aid Outcomes While Boosting Value
Multiple studies examining orthopaedic quality and patient safety have
highlighted the many improvements that NYU Langone has made to clinical
practice. One major study, recently published in the Journal of the American
Academy of Orthopaedic Surgeons and based on data from more than 16,000
patients, found that a bacterial screening and prophylaxis eliminated much
of the post-surgical infection risk.
Before every joint or spine procedure over a nearly
10-year period, the department’s doctors swabbed
each patient’s nose for pathogens and applied topical
antibiotics to the nares to eradicate Staphylococcus
species. Roughly one-third of patients carry the bacterium
and an estimated two to three percent carry MRSA. “Our
research has shown that those patients are at increased
risk of developing infection after surgery, so we screen
and eradicate it,” says Joseph A. Bosco, MD, professor of
orthopaedic surgery and vice chair for clinical affairs.
The new study found that the preoperative procedure
decreased the infection rate in a cost-effective manner,
though it did not drive the risk to baseline levels. Now
the researchers are collaborating with infectious disease
and epidemiology experts at NYU Langone to identify
the remaining risk factors and eliminate them if possible.
In the meantime, Dr. Bosco says, surgeons can discuss
the infection risk with patients prior to surgery to help
them make a more informed decision about whether
to proceed with the surgery.
The department also is using physician-specific HCAPS
scores to identify opportunities for improvement, and is
developing a comprehensive educational program for
physicians who may need more help. One key element of
the program is a peer-to-peer simulation, developed in
conjunction with the New York Simulation Center for the
Health Sciences (NYSIM), which uses simulated patient
encounters to help physicians prepare for difficult situations.
Richard Iorio, MD
20 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
NEW INSIGHTS ON MITIGATING SURGICAL RISK AND
IMPROVING ACCESS
In another quality and safety initiative, the department
is tapping large national databases to examine how
depression, substance abuse, smoking, and other risk
factors affect patient outcomes after joint arthroplasty.
One emerging point is that such risks are best addressed
preoperatively. Dr. Bosco and colleagues also have found
that patients with a lower socioeconomic status have
worse outcomes. “They tend to have fewer resources
available to them and less access to care,” he says. “And
they tend to come to the process later, so they’re sicker.”
Although high-volume medical centers like NYU
Langone yield better outcomes, Dr. Bosco says, poorer
individuals have reduced access to such centers. Even
relatively small increases in a patient’s distance to a
major center, he notes, can be prohibitive to those who
don’t own a car and whose lack of mobility makes public
transportation difficult.
The department’s research suggests that as joint
replacement surgeries have increased at high-volume
centers over the past decade, they have decreased at
low-volume centers. To address the growing gap in access,
the department is sharing lessons learned, clinical
pathways, and specific protocols—such as antibiotic
prophylaxis—with lower-volume medical centers. “We
have to be cognizant of the fact that high-volume centers
increase health care disparities by attracting greater
numbers of patients, and share our knowledge with lowvolume centers to decrease that disparity,” Dr. Bosco says.
BUNDLED PAYMENTS YIELD MULTIPLE BENEFITS
IN JOINT REPLACEMENT SURGERY
In January 2013, NYU Langone became an early entrant
in Medicare’s Bundled Payments for Care Improvement
initiative, which sets a fixed reimbursement price for
a hospitalization and the 90-day period after discharge,
known as an “episode of care.” Four years later, the
Medical Center is boosting patient outcomes after joint
replacement surgery at significant cost savings through
the bundled payments program, and developing
infrastructure and expertise that could similarly
aid a host of other procedures.
Upon their discharge, joint replacement patients
are typically transferred to relatively costly inpatient
facilities such as skilled nursing facilities or
BUNDLED PAYMENTS PROGRAM A SUCCESS
AT NYU LUTHERAN
The Bundled Payments for Improved Care initiative
also has been successful at NYU Lutheran, where
206 patients are enrolled, with 31% discharged home,
68% to NYU Lutheran Augustana Center, a subacute
rehabilitation facility, and just 1% to inpatient
rehabilitation.
rehabilitation centers. NYU Langone researchers found
that patients who were sent home instead, however,
fared better and at a lower average cost of care. “The
readmission rate was less, the infection rate was less,
and the patient satisfaction was greater,” says Dr. Bosco.
“Not only did discharge home save money, but it also
improved outcomes—and that came as a surprise.”
In a recent Journal of the American Academy of
Orthopaedic Surgeons study, Dr. Bosco and colleagues
documented 16 percent savings on bundled payments
for lower extremity joint replacement. Most of the
savings, they found, came in the post-acute phase. “It’s
all about making sure that there’s a smooth transition
between the hospital and home, that they have the
resources at home to be successful, and that we keep
a close eye on them,” he says.
Prior to all joint replacement surgeries, clinical care
coordinators help patients understand what to expect
following discharge. They also use a newly developed
tool called RRAT, or the Readmission Risk Assessment
Tool, to identify those at greatest risk for readmission or
discharge to a nursing home. The risk stratification, Dr.
Bosco says, helps the care team identify and allocate the
resources necessary to reduce readmissions.
After discharge, coordinators and other staff closely
monitor the patients, employing telemedicine, visiting
nurses, and therapists to smooth the transitions. Dr.
Bosco and colleagues are sharing their lessons learned
with other departments and institutions as the bundled
payment methodology becomes mandatory in multiple
areas of medicine. The added knowledge and tools are
driving efficiencies in non-bundled conditions as well.
“We were fortunate to develop an infrastructure and
expertise for our institution through our voluntary
participation, which will help us apply these practices
to other areas in the future,” Dr. Bosco says.
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
21
Clinical Care and Research
New Advances in Bone and
Cartilage Regeneration Research
NYU Langone’s musculoskeletal tissue regeneration research, led by Philipp
Leucht, MD, assistant professor of orthopaedic surgery and cell biology, and
Thorsten Kirsch, PhD, professor of orthopaedic surgery and cell biology and vice
chair of research, is simultaneously pursuing several major research projects to
enable more effective bone-healing treatments and strategies for cartilage repair.
ENHANCING BONE HEALING FUNCTION IN
OLDER PATIENTS
One line of NIH-funded research is focusing on the Wnt
signaling pathways, which induce the differentiation
of bone-forming cells from osteoprogenitor cells. The
number and potency of skeletal stem cells decreases
significantly with aging; boosting endogenous Wnt
signals, then, may be one way to reclaim the lost
function and help older patients more quickly recover
from bone fractures.
Dr. Leucht and colleagues are optimizing an
approach—tested in mice, rabbits, and human cells—
that delivers the Wnt 3A protein via liposomes to help
boost a patient’s bone-healing potential. “If we use it in
a young animal, we’re able to increase bone formation
by about 350 percent,” he says. In older animals or those
with major defects, the strategy can restore the osteogenic
potential back to that of a healthy young animal.
Periosteal chondrogenesis (top), Cortical bone (bottom)
22 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
RE-CODING SKELETAL STEM CELLS
A second study is examining whether removing an
embryonic signal called the Hox code can enable the
body’s skeletal stem cells to be more adaptable when
introduced to new locations. Bones above the neck’s hyoid
lack a Hox code, whereas all other bones include it. “The
code basically imprints a function onto the cell, and the
cells are limited by that,” Dr. Leucht says. “If you put them
into a different environment, they recognize that it’s not their
home, are confused by that and don’t do the right thing.”
As Dr. Leucht has found, the Hox code may have
critical clinical implications because stem cells derived
from code-lacking craniofacial bones are far better at
regenerating broken or injured bones in mice than are
cells from code-constrained bones such as the tibia.
Surgeons cannot use facial bones for bone grafts,
so Dr. Leucht and his team hope to introduce the same
plasticity into stem cells isolated from the pelvis or other
long bones. Based on RNA sequencing, his team has
Periosteal osteogenesis (top), Cortical bone (bottom)
found more than 2,000 gene expression differences
in Hox-positive versus Hox-negative cells. Follow-up
studies now underway may help identify the true drivers
of the latter cells’ regenerative powers.
Another project is looking at the role of chronic
low-level inflammation on skeletal stem cells. This
chronic inflammation slowly increases with age,
raising the risk of cancer and Alzheimer’s disease and
potentially interfering with bone healing due to its
negative impact on the number and osteogenic potential
of the remaining pool of bone marrow stem cells.
Dr. Leucht found that one-year-old mice—equivalent
to 55 to 65-year-old humans—showed elevated signs of
inflammation associated with aging, or “inflammaging.”
Remarkably, however, his team suppressed such
inflammation and restored the skeletal stem cells’
bone-healing potential with low doses of nonsteroidal
anti-inflammatory drugs. In essence, the treatment
seemed to reverse the aging process and restore the
cells’ osteogenic potential.
“By reducing the inflammation, these cells can recognize
and recover from a senescence pathway and turn back into
an active progenitor cell pool that can be used if there’s an
injury in these animals,” he says. Dr. Leucht and colleagues
are now trying to clarify the underlying pathway.
STUDYING THE ROLE OF ANTIDEPRESSANTS
IN FRACTURE HEALING
For a fourth project, the lab is conducting bench-tobedside research to better understand whether
commonly prescribed selective serotonin reuptake
inhibitor antidepressants such as fluoxetine might
interfere with fracture healing. The project began when
Dr. Leucht noticed that roughly 25 to 30 percent of his
patients with nonunions were on SSRIs, compared to
about 10 percent of the general population.
In mice, his team showed that chronic antidepressant
users were indeed impaired in their fracture healing:
their osteoblasts survived and proliferated normally, but
could not differentiate properly. The researchers are now
planning to look prospectively at patients with fractures,
document those who are taking SSRIs, and determine
which develop nonunions. “This may be something
that’s very clinically relevant and may be actually
translatable within a year or two if we can finish the
clinical trials,” Dr. Leucht says.
NEW PEPTIDE GREATLY ENHANCES CARTILAGE REPAIR
Other NYU Langone researchers led by Dr. Kirsch have
made strides in cartilage regeneration, including the
recent identification of a peptide that seems to stimulate
cartilage repair. The peptide, which binds to hyaluronan
in the cartilage matrix, has proven effective when
combined with high molecular weight hyaluronan.
Although the mechanism remains unclear, “it is
possible that the peptide together with high molecular
hyaluronan might provide a stem cell niche where the
cells can attach and build new cartilage,” says Dr. Kirsch.
The researchers have filed for a patent on their discovery
and are actively investigating the peptide’s potential role
in recruiting stem cells to repair musculoskeletal tissues.
COLLABORATION WITH ENGINEERS
The Department of Orthopaedic Surgery is expanding
its collaboration with the NYU Tandon School of
Engineering, moving two labs to the school’s facilities
with the aim of further stimulating interactions between
engineers and orthopaedic surgeons.
Philipp Leucht, MD
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
23
Complex Case: Pelvic Osteosarcoma
3D Imaging Finds New Application
in Resection of Complex Pelvic Osteosarcoma
Every year, doctors in the United States diagnose about 800 people with
osteosarcoma—many of them adolescents or young adults who contract
the cancer for unknown reasons during growth spurts.
PRESENTATION
In 2013, Sara Morales, 32, had been treated at NYU Langone
for an osteosarcoma above her right shin that had required
resection and a knee replacement. When she returned in 2014
with increasingly intense pain in her left hip, an MRI revealed a
new tumor growing in her pelvic bone near the sacroiliac joint.
Morales faced a new round of chemotherapy and removal
of the diseased bone, but the osteosarcoma’s hard-to-reach
location deep in the pelvis, along with the need to maintain
pelvic integrity to allow for weight-bearing, complicated the
procedure. Full excision might require removing up to half
of her pelvis and permanently confining her to a wheelchair.
SURGICAL PLAN
To preserve her ability to walk, the surgeons devised
an alternate strategy, employing sophisticated 3D tools more
commonly associated with head and neck surgery. Timothy
R. Rapp, MD, associate professor of orthopaedic surgery and
chief of the Division of Orthopaedic Oncology, had previously
removed Morales’s initial tumor above her shin. He developed
the new tumor resection plan in partnership with plastic
surgeon Pierre B. Saadeh, MD, associate professor and chief of
plastic surgery at Bellevue Hospital Center. Instead of reaching
the pelvis through her abdomen and performing an internal
amputation, the surgeons concluded that accessing and
resecting her tumor from the back would cause less damage
and allow for a more accurate resection. Equally important,
this approach also would provide the exposure needed for
reconstruction. To stabilize the pelvis after cutting out a nearly
three-inch segment of bone, they opted to use part of her left
fibula to bridge the gap. In order to keep the fibula alive during
and after surgery, the fibula’s blood supply was brought with
the bone and reconnected to local vessels in the pelvis using
an operating microscope.
The complex operation would have to be extensively planned,
and standard anatomy diagrams failed to provide the sufficient
24 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
resolution the team needed to map the surgical site. Dr. Rapp
and Dr. Saadeh turned to BioDigital Human®, an augmented
reality program, to create a highly detailed interactive map.
In collaboration with a 3D virtual surgery engineer at 3D
Systems in Colorado, the team created custom 3D-printed jigs
that they could temporarily secure to the pelvic and fibula
bones to precisely guide a surgical saw. “The pelvis is a curved
bone,” Dr. Rapp says, “so it’s much more difficult to anticipate
the angles of the cuts, even if you have the best anatomical
mind in the world.”
The virtual surgical plan converted CT scans into exact copies
of Morales’s bone anatomy, permitting the surgeons to practice
the surgical procedure beforehand. “This would be the first time
part of a fibula would be inserted into a pelvis with the aid of 3D
technology, but using the models, we felt confident that it could
work,” Dr. Rapp says.
The strategy sounded so futuristic, Morales recalls. “But these
men had saved my life before, and I’d seen what they were
capable of. I trusted them,” she says.
RESULTS
After a carefully devised chemotherapy regimen to shrink the
tumor, Dr. Rapp and Dr. Saadeh led a seven-hour surgery at
Tisch Hospital in February 2015. Dr. Rapp excised Morales’s
tumor while Dr. Saadeh removed the matched fibula fragment.
They slotted in the replacement bone, performed microsurgery
to attach the veins and arteries, and inserted titanium plates at
both sites to stabilize the bone while it healed.
Six months later, a cancer-free Morales was able to put weight
on her left leg and stand up unassisted. A year after the surgery,
she began walking on her own—and reclaiming her future.
“There’s so much I want to do now,” she says. “I want to get
my life started.”
Pierre Saadeh, MD, and Timothy Rapp, MD
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
25
Academic
Activities
SELECTED PUBLICATIONS
Agten CA, Kaplan DJ, Jazrawi LM, Burke CJ. Subchondroplasty: what the radiologist needs
to know. AJR Am J Roentgenol. 2016; 207: 1257–1262.
Arno S, Bell CP, Alaia MJ, Singh BC, Jazrawi LM, Walker PS, Bansal A, Garofolo G, Sherman
OH. Does anteromedial portal drilling improve footprint placement in anterior cruciate
ligament reconstruction? Clin Orthop Relat Res. 2016; 474: 1679–1689.
Ayalon O, Marcano A, Paksima N, Egol K. Concomitant ulnar styloid fracture and distal
radius fracture portend poorer outcome. Am J Orthop (Belle Mead NJ). 2016; 45: 34–37.
Behery OA, Kester BS, Williams J, Bosco JA, Slover JD, Iorio R, Schwarzkopf R. Patterns
of ninety-day readmissions following total joint replacement in a bundled payment
initiative. J Arthroplasty. 2016 Nov 1.
Buchalter DB, Mahure SA, Mollon B, Yu S, Kwon YW, Zuckerman JD. Two-stage revision
for infected shoulder arthroplasty. J Shoulder Elbow Surg. 2016 Nov 22.
Buza JA 3rd, Jancuska JM, Slover JD, Iorio R, Bosco JA 3rd. Variation in diagnoses for hip
arthroplasty among New York State hospitals: implications for the Comprehensive Care
for Joint Replacement Model. J Arthroplasty. 2016 Nov 15.
Capo J, Kaplan DJ, Fralinger DJ, Adler RS, Campbell KA, Jazrawi LM, Alaia MJ.
Ultrasonographic visualization and assessment of the anterolateral ligament. Knee Surg
Sports Traumatol Arthrosc. 2016 Jun 25.
Capo J, Kaplan DJ, Fralinger DJ, Gyftopolous S, Strauss EJ, Jazrawi LM, Alaia MJ. Femoral
screw divergence via the anteromedial portal using an outside-in retrograde drill in
bone-patella tendon-bone anterior cruciate ligament reconstruction: a cadaveric study.
Arthroscopy. 2016 Sep 10.
Capo J, Shamah SD, Jazrawi L, Strauss E. Clinical outcomes of ACL reconstruction
with tibialis anterior allograft using an anteromedial portal approach. Knee. 2016; 23:
1089–1092.
Capogna B, Ryan WE, McGee AW, Jazrawi LM. Coracoid fracture following Latarjet failure
a case report. Bull Hosp Jt Dis (2013). 2016; 74: 318–322.
Capogna B, Strauss E, Konda S, Dayan A, Alaia M. Distal patellar tendon avulsion in
association with high-energy knee trauma: a case series and review of the literature.
Knee. 2016 Dec 1.
Capogna BM, Egol KA. Treatment of nonunions after malleolar fractures. Foot Ankle Clin.
2016; 21: 49–62.
Capriccioso CE, Zuckerman JD, Egol KA. Initial varus displacement of proximal humerus
fractures results in similar function but higher complication rates. Injury. 2016; 47:
909–913.
Christiano AV, Pean CA, Konda SR, Egol KA. Predictors of patient reported pain after lower
extremity nonunion surgery: the nicotine effect. Iowa Orthop J. 2016; 36: 53–58.
Ding DY, Kanevsky R, Strauss EJ, Jazrawi LM. Anteromedialisation tibial tubercle
osteotomy for recurrent patellar instability in young active patients: a retrospective
case series. Injury. 2016; 47: 737–741.
Ding DY, Ryan WE, Strauss EJ, Jazrawi LM. Chronic distal biceps repair with an Achilles
allograft. Arthrosc Tech. 2016; 5: e525–529.
Dundon JM, Bosco J, Slover J, Yu S, Sayeed Y, Iorio R. Improvement in total joint
replacement quality metrics: year one versus year three of the Bundled Payments
for Care Improvement Initiative. J Bone Joint Surg Am. 2016; 98: 1949–1953.
Elbuluk A, Deshmukh A, Inneh I, Iorio R. The present and future of genomics in adult
reconstructive orthopaedic surgery. JBJS Rev. 2016; 4: e61–66.
Fralinger DJ, Kaplan DJ, Weinberg ME, Strauss EJ, Jazrawi LM. Biological treatments
for tendon and ligament abnormalities: a critical analysis review. JBJS Rev. 2016; 4(6).
Frankel VH, Kaplan DJ, Egol KA. Biomechanics of fractures. Orthop Trauma. 2016; 30
(Suppl 2): S2–56.
Galos DK, Konda SR, Kaplan DJ, Ryan WE, Alaia MJ. Transosseous-equivalent repair
for distal patellar tendon avulsion. Arthrosc Tech. 2016; 5: e385–389.
Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C. Association of depression with 90-day
hospital readmission after total joint arthroplasty. J Arthroplasty. 2016; 31: 2385–2388.
Gross SC, Galos DK, Taormina DP, Crespo A, Egol KA, Tejwani NC. Can tibial shaft
fractures bear weight after intramedullary nailing? A randomized controlled trial.
J Orthop Trauma. 2016; 30: 370–375.
Hinds RM, Gottschalk MB, Strauss EJ, Capo JT. Trends in arthroscopic procedures
performed during orthopaedic residency: an analysis of Accreditation Council for
Graduate Medical Education case log data. Arthroscopy. 2016; 32: 645–650.
Hinds RM, Phillips D, Egol KA, Capo JT. Variation in pediatric orthopedic case volume
among residents: an assessment of Accreditation Council for Graduate Medical Education
case logs. J Pediatr Orthop B. 2016 Oct 27.
Inneh IA, Clair AJ, Slover JD, Iorio R. Disparities in discharge destination after lower
extremity joint arthroplasty: analysis of 7924 patients in an urban setting. J Arthroplasty.
2016; 31: 2700–2704.
Iorio R. The future is here: bundled payments and International Statistical Classification
of Diseases, 10th Revision. J Arthroplasty. 2016; 31: 931.
Jones RB, Wright TW, Zuckerman JD. Reverse total shoulder arthroplasty with structural
bone grafting of large glenoid defects. J Shoulder Elbow Surg. 2016; 25: 1425–1432.
Kester BS, Williams J, Bosco JA, Slover JD, Iorio R, Schwarzkopf R. The association between
hospital length of stay and 90-day readmission risk for femoral neck fracture patients:
within a total joint arthroplasty bundled payment initiative. J Arthroplasty. 2016; 31:
2741–2745.
Clair AJ, Evangelista PJ, Lajam CM, Slover JD, Bosco JA, Iorio R. Cost analysis of total joint
arthroplasty readmissions in a bundled payment care improvement initiative. J
Arthroplasty. 2016; 31: 1862–1865.
Khurana S, Davidovitch RI, Kwon YK, Zuckerman JD, Egol KA. Similar function and
improved range of shoulder motion is achieved following repair of three- and four-part
proximal humerus fractures compared with hemiarthroplasty. Bull Hosp Jt Dis (2013).
2016; 74: 212–218.
Cuéllar VG, Cuéllar JM, Kirsch T, Strauss EJ. Correlation of synovial fluid biomarkers with
cartilage pathology and associated outcomes in knee arthroscopy. Arthroscopy. 2016; 32:
475–485.
Konda SR, Davidovitch RI, Egol KA. Initial surgical treatment of humeral shaft fracture
predicts difficulty healing when humeral shaft nonunion occurs. HSS J. 2016; 12: 13–17.
Davidovitch RI, DelSole EM, Vigdorchik JM. Subspine impingement: 2 case reports of
a previously unreported cause of instability in total hip arthroplasty. Hip Int. 2016; 26:
e24–29.
Konda SR, Goch AM, Leucht P, Christiano A, Gyftopoulos S, Yoeli G, Egol KA. The use of
ultra-low-dose CT scans for the evaluation of limb fractures: is the reduced effective dose
using ct in orthopaedic injury (REDUCTION) protocol effective? Bone Joint J. 2016; 98-B:
1668–1673.
DelSole EM, Egol KA, Tejwani NC. Construct choice for the treatment of displaced,
comminuted olecranon fractures: are locked plates cost effective? Iowa Orthop J. 2016;
36: 59–63.
26 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Mahure SA, Mollon B, Shamah SD, Zuckerman JD, Kwon YW, Rokito AS. The incidence
of subsequent surgery after outpatient arthroscopic rotator cuff repair. Arthroscopy. 2016;
32: 1531–1541.
AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS (AAOS)
ANNUAL MEETING 2016
Mahure SA, Mollon B, Yu S, Kwon YW, Zuckerman JD. Definitive treatment of infected
shoulder arthroplasty with a cement spacer. Orthopedics. 2016; 39: e924–930.
Podium Presentations, Instructional Course Lectures, and Symposia
Manoli A, Capriccioso CE, Konda SR, Egol KA. Total shoulder arthroplasty for proximal
humerus fracture is associated with increased hospital charges despite a shorter length
of stay. Orthop Traumatol Surg Res. 2016; 102: 19–24.
Mercuri JJ, Okey NE, Karia RJ, Gross RH, Zuckerman JD. Resident physician duty-hour
requirements: what does the public think? J Am Acad Orthop Surg. 2016; 24: 789–795.
Mollon B, Mahure SA, Ding DY, Zuckerman JD, Kwon YW. The influence of a history of
clinical depression on peri-operative outcomes in elective total shoulder arthroplasty:
a ten-year national analysis. Bone Joint J. 2016; 98-B: 818–824.
Mollon B, Mahure SA, Ensor KL, Zuckerman JD, Kwon YW, Rokito AS. Subsequent
shoulder surgery after isolated arthroscopic SLAP repair. Arthroscopy. 2016; 32:
1954–1962.
Mollon B, Mahure SA, Roche CP, Zuckerman JD. Impact of glenosphere size on clinical
outcomes after reverse total shoulder arthroplasty: an analysis of 297 shoulders. J
Shoulder Elbow Surg. 2016; 25: 763–771.
Naik AA, Hinds RM, Paksima N, Capo JT. Risk of injury to the dorsal sensory branch of the
ulnar nerve with percutaneous pinning of ulnar-sided structures. J Hand Surg Am. 2016;
41: e159–163.
Odeh K, Doran J, Yu S, Bolz N, Bosco J, Iorio R. Risk-stratified venous thromboembolism
prophylaxis after total joint arthroplasty: aspirin and sequential pneumatic compression
devices vs aggressive chemoprophylaxis. J Arthroplasty. 2016; 31 (9 Suppl): 78–82.
Phillips DP, Zuckerman JD, Kalet A, Egol KA. Direct observation: assessing orthopaedic
trainee competence in the ambulatory setting. J Am Acad Orthop Surg. 2016; 24: 591–599.
Ramme AJ, Gales J, Stevens N, Verma V, Egol K. Rumpel-Leede phenomenon in a patient
with laboratory markers positive for Sjögren disease. A A Case Rep. 2016; 6: 352–354.
Diabetes as a Predictor for Extended Hospital Stay and Complications in Surgical CSM
Patients—Nancy Worley, Cyrus Jalai, BA, Shaleen Vira, MD, Shenglin Wang, MD, Thomas
J. Errico, MD, Michael C. Gerling, MD, Peter G. Passias, MD
Focal and Dynamic Cervical Alignment Correlates with Health-Related Quality of Life
in Cervical Deformity Patients—Renaud Lafage,Virginie Lafage, PhD, Themistocles S.
Protopsaltis, MD, Robert A. Hart, MD, Eric O. Klineberg, MD, Justin S. Smith, MD, Brian J.
Neuman, MD, Christopher Ames, MD
A Novel Index for Quantifying the Surgical Risk for Patients with Cervical Spine
Disorders—Peter G. Passias, MD, Bryan J. Marascalchi, MD, Bassel Diebo, MD, Nancy
Worley, Cyrus Jalai, BA, Virginie Lafage, PhD
Prospective Multicenter Assessment of Early Complication Rates Associated with ACD
Surgery in 78 Patients—Justin S. Smith, MD, Virginie Lafage, PhD, Christopher I. Shaffrey,
MD, Themistocles S. Protopsaltis, MD, Peter G. Passias, MD, Eric O. Klineberg, MD, K D.
Riew, MD, Christopher Ames, MD
Length of Stay and 30-Day Readmission Predictors in CSM Patients: Analysis of 3,057
ACS-NSQIP Patients—Peter G. Passias, MD, Cyrus Jalai, BA, Nancy Worley, Shaleen Vira,
MD, Michael C. Gerling, MD, Virginie Lafage, PhD, Thomas J. Errico, MD
Predictors of Upper Body Post-Operative Pain/Disability in Surgical Cervical
Radiculopathic Patients—Peter G. Passias, MD, Kristen E. Radcliff, MD, Robert E. Isaacs,
MD, Kristina Bianco, Cyrus Jalai, BA, Paul M. Arnold, MD, Patrick C. Hsieh, MD, MSc,
Alexander Vaccaro, MD, PhD
How to Reverse Reversomania: Arthroscopic Repair of Massive Cuff Tears—
Laith Jazrawi, MD
How bundled payment works in my practice—Richard Iorio MD
Principles of Orthopaedic Leadership: Local, Regional, National—Joseph Zuckerman, MD
Ramme AJ, Iorio R, Smiaronksi J, Wronka A, Rodriguez G, Specht L, Chang G, Egol KA.
Organizational and technical considerations for the implementation of a digital
orthopaedic templating system. Bull Hosp Jt Dis (2013). 2016; 74: 254–261.
Cervical Spine Smackdown: Ask the Experts—Themistocles Protopsaltis MD
Regan DK, Gould S, Manoli A 3rd, Egol KA. Outcomes over a decade after surgery for
unstable ankle fracture: functional recovery seen 1 year postoperatively does not decay
with time. J Orthop Trauma. 2016; 30: e236–241.
Periarticular Fractures of the Tibia: The Case for Going Prone—Kenneth A. Egol, MD
Shue J, Karia RJ, Cardone D, Samuels J, Shah M, Slover JD. A randomized controlled trial
of two distinct shared decision-making aids for hip and knee osteoarthritis in an
ethnically diverse patient population. Value Health. 2016; 19: 487–493.
Shulman BS, Marcano AI, Davidovitch RI, Karia R, Egol KA. Nature's wrath-the effect
of weather on pain following orthopaedic trauma. Injury. 2016; 47: 1841–1846.
Slover JD, Mullaly KA, Payne A, Iorio R, Bosco J. What is the best strategy to minimize
after-care costs for total joint arthroplasty in a bundled payment environment? J
Arthroplasty. 2016; 31: 2710–2713.
Strauss EJ, Day MS, Ryan M, Jazrawi L. Evaluation, treatment, and outcomes of meniscal
root tears: a critical analysis review. JBJS Rev. 2016; 4(8).
Uquillas CA, Ward JP, Zuckerman JD. Total hip arthroplasty after proximal femoral
osteotomy: a technique that can be used to address presence of a retained intracortical
plate. Am J Orthop (Belle Mead NJ). 2016; 45: E224–226.
Wasserman BR, Singh BC, Kaplan DJ, Weinberg M, Meislin R, Jazrawi LM, Strauss EJ.
Braking reaction time after right-knee anterior cruciate ligament reconstruction: a
comparison of 3 grafts. Arthroscopy. 2016 Aug 25.
Williams J, Kester BS, Bosco JA, Slover JD, Iorio R, Schwarzkopf R. The association between
hospital length of stay and 90-day readmission risk within a total joint arthroplasty
bundled payment initiative. J Arthroplasty. 2016 Sep 28.
Yu S, Mahure SA, Branch N, Mollon B, Zuckerman JD. Impact of race and gender
on utilization rate of total shoulder arthroplasty. Orthopedics. 2016; 39: e538–544.
Yu SW, Szulc AL, Walton SL, Davidovitch RI, Bosco JA, Iorio R. Liposomal bupivacaine as
an adjunct to postoperative pain control in total hip arthroplasty. J Arthroplasty. 2016;
31: 1510–1515.
Elbow Arthritis in the Young Athlete—Laith Jazrawi, MD, Mandeep Virk, MD
Dynamometer Strength Testing Following Subpectoral Proximal Biceps Tenodesis with
Cortical Button Fixation—Adam Lipman, MD, Steven Shamah, Alan W. McGee, MD,
Maxwell Weinberg, MD, Eric J. Strauss, MD, Orrin H. Sherman, MD, Andrew J. Feldman,
MD, Laith M. Jazrawi, MD
Fractures of the Proximal Femur: A Case-based Approach—Kenneth A. Egol, Roy
Davidovitch, MD, Sanjit Konda, MD, Phillip Leucht, MD
Tibial Plateau Functional Outcome Score Identifies Patients at Risk of Diminished
Functional Outcome—Sanjit R. Konda, MD, Arthur Manoli III, MD, Roy Davidovitch, MD ,
Kenneth A. Egol, MD
Low Intensity Pulsed Ultrasound in Acute Tibial Shaft Fractures Treated with IM Nails:
The Results of the TRUST Trial—Thomas A. Einhorn, MD
The Effect of Knee Flexion Contracture on Outcomes of Distal Femur Fractures—Kenneth
A. Egol, MD
Differences in Cost and Length of Stay for Hip, Distal Femoral, and Pelvic Fractures—
Kenneth A. Egol, MD, Sanjit Konda, MD
Relationship Status Affects the Discharge Location for Trauma Patients—Kenneth A. Egol,
MD, Sanjit Konda, MD
The Relationship Between Hospital Payer Mix and Volume Growth in Total Joint
Arthroplasty—Anthony A. Catanzano, MD, Raj Karia, MPH, Joseph A. Bosco III, MD
Pitfalls in the Operative Management of Common Shoulder Problems: How to Avoid
and What To Do When They Occur—Joseph Zuckerman, MD, Andrew Rokito, MD
Preventing Hospital Readmissions and Limiting the Complications Associated with
Total Hip Arthroplasty--Optimizing Patient Health Perioperatively and Preventing
Readmission—Richard Iorio, MD
Practical Tips for Implementing Bundled Payments in Your Practice-- Strategies
and Tactics for Successful Implementation of Bundled Payments Richard Iorio, MD
From the Glenoid to the Radial Tuberosity - Management of Biceps Pathology—
To understand open and arthroscopic approaches to long head of the biceps tendon
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
27
tenodesis, with an emphasis on outcomes, value, and complications in 2016—Eric Strauss,
MD, Laith Jazrawi MD
Reverse Total Shoulder Arthroplasty Outcomes With and Without Repair of the
Subscapularis—Richard J. Friedman, MD, Pierre-Henri Flurin, MD, Thomas W.
Wright, MD, Joseph D. Zuckerman, MD, Christopher Roche, MBA
Comparison of Outcomes with Reverse Total Shoulder Arthroplasty in Patients With
and Without Scapular Notching—Joseph D. Zuckerman, MD, Lynn A. Crosby, MD,
Pierre-Henri Flurin, MD, Thomas W. Wright, MD, Christopher Roche, MS, MBA
Reverse Shoulder Outcomes with Scapular Deformities: Augmented Glenoid Baseplates
vs. Bone Grafting—Thomas W. Wright, MD, Richard B. Jones, MD, Pierre-Henri Flurin,
MD, Joseph D. Zuckerman, MD, Christopher Roche, MD
Incidence of Unplanned Admission from an Outpatient Orthopaedic Surgery Center—
Michael S. Day, MD, Germaine Cuff, PhD, RN, Hersh Shroff, MD, Lorraine Hutzler, BA,
Samir Kendale, MD, Jeanna D. Blitz, MD
Comparison of Perioperative Times at an Ambulatory Surgery Center and an Outpatient
Facility Andrew D. Rosenberg, MD, Joseph A. Bosco III, MD
Improvement in TJA Quality Metrics: Year One vs. Year Three of the Bundled Payment for
Care Initiative—Richard Iorio, MD, Joseph D. Zuckerman, MD, Joseph A. Bosco III, MD,
James D. Slover, MD, Stephen Yu, MD, John M. Dundon, MD, Yousuf Sayeed SR, MS
Joint Replacement Surgical Home: Impact of Patient Characteristics and Comorbidities
on Length of Stay—Ran Schwarzkopf, MD, Kyle S. Ahn, MD, Joseph B. Rinehart, MD,
Maxime Cannesson, Zeev Kain, MD, MBA
Ultra Low Dose Computed Tomography Scanning: A Reliable Modality with an Improved
Patient Safety Profile—Sanjit R. Konda, Abraham M. Goch, Philipp Leucht, MD, Anthony
V. Christiano, Soterios Gyftopoulos, Kenneth A. Egol, MD
Inpatient Rehabilitation Following Hip Fracture: Recent Trends and Implications for
Post-Acute Care Reform—Arthur Manoli III, MD, Sanjit R. Konda, MD, Christian A. Pean,
MS, Kenneth A. Egol, MD
Total Shoulder Arthroplasty for Proximal Humerus Fracture is Associated with Increased
Hospital Charges—Arthur Manoli III, MD, Sanjit R. Konda, MD, Christina Capriccioso, BS,
Kenneth A. Egol, MD
Development of a Preoperative ASD Frailty Index that Correlates to Common Quality
and Value Metrics—Amit Jain, MD, Daniel Sciubba, MD, Baltimore, Maryland, Khaled
Kebaish, MD, Brian J. Neuman, MD, Robert S. Bess, MD, Christopher Ames, MD
When Does Compensation for Lumbar Stenosis Become a Clinical Sagittal Plane
Deformity?—Aaron Buckland, FRACS, MD, Shaleen Vira, MD, Jonathan H. Oren, MD,
Renaud Lafage, Bassel Diebo, MD, Themistocles S. Protopsaltis, MD, Frank J. Schwab, MD,
Virginie Lafage, PhD, John A. Bendo, MD
Center Variability in Surgical Technique and Outcomes in Adult Spinal Deformity—
Thomas Cheriyan, Munish C. Gupta, MD, Renaud Lafage, Justin S. Smith, MD, Robert S.
Bess, MD, Robert A. Hart, MD, Richard A. Hostin, MD, Virginie Lafage, PhD
Clinical Outcomes of Hip Arthroscopy in Patients Over 60—Brian Capogna, MD, John
Begly, MD, Michael Ryan, MD, Kristofer E. Chenard, MD, Rajkishen Narayanan, MS,
Thomas Youm, MD
Adult Lumbar Scoliosis: State-of-the-Art Treatment (Operative and Nonoperative) —
Themistocles Protopsaltis
The Management of Meniscal Pathology: From Partial Meniscectomy to
Transplantation—Eric Strauss, MD, Laith Jazrawi, MD
Adult Lumbar Disc Herniation: Treatment, Complications, Outcomes, and EvidenceBased Data for Patient and Health Professional Counseling—Peter Passias MD
Realignment Planning in Adult Spinal Deformity: The Newest Tools, Formulas, and
Techniques to Get it Right—Robert S. Bess, MD, Themistocles Protopsaltis, MD
Preoperative Optimization of Total Joint Arthroplasty Surgical Risk—Richard Iorio, MD,
Moderator
Cardiovascular Disease and Stroke Prevention—James D. Slover, MD
The Effect of Severity of Illness on Spine Surgery Costs Across New York State Hospitals—
Ian Kaye, MD, Lorraine Hutzler, BA, Joseph A. Bosco III, MD
Joint Preservation Techniques for the Knee in 2016--Technical pearls for performing
combined cartilage restoration, meniscus transplantation, ligament reconstruction,
and/or realigning osteotomies—Eric Strauss, MD
Risk Factors for Subsequent Surgery after ACL Reconstruction: A Population-Based
Study—Siddharth A. Mahure, MD, Brian Capogna, MD, Brent Mollon, MD, FRCSC,
Orillia, Ontario, Canada, Andrew S. Rokito, MD
Is it the Back or the Hip? Differentiating Lumbar Spine from Hip Pathologies: Key Points
of Evaluation and Treatment—Afshin Razi, MD, Moderator
Discrepancies in Planned Sagittal Alignment and Age-Adjusted Ideals: Implications of
Over- or Under-Correction—Jensen Henry, BA, Matthew A. Spiegel, BA, Jonathan H. Oren,
MD, Isaac Gammal, BA, Cyrus Jalai, BA, Themistocles S. Protopsaltis, MD, Thomas J.
Errico, MD, Virginie Lafage, PhD
Chain of Relaxation: How Sagittal Correction Affects Spino-Pelvic, Lower Limb, and
Global Alignment—Jonathan H. Oren, MD, Shaleen Vira, MD, Barthelemy Liabaud,
MD, Bassel Diebo, MD, Matthew A. Spiegel, BA, Renaud Lafage, Thomas J. Errico, MD,
Frank J. Schwab, MD, Virginie Lafage, PhD
Age-Adjusted Alignment Goals Have the Potential to Reduce Proximal Junction
Kyphosis—Frank J. Schwab, MD, Renaud Lafage, Steven D. Glassman, MD, Robert S. Bess, MD,
Robert A. Hart, MD, Douglas C. Burton, MD, Han Jo Kim, MD, Virginie Lafage, PhD
Degenerative hip disorders or painful total hip replacement with back pain—
James D. Slover, MD
Challenges in spinal deformity and hip arthritis—Aaron Buckland, FRACS
Ask An Expert: Shoulder and Elbow—Joseph Zuckerman, MD
Fitness Tracking Devices: Applications in Orthopaedics—Dalibel M. Bravo, MD,
Stephanie Swensen, MD, Claudette M. Lajam, MD
Knee Society/AAHKS: Minimizing TKA Complications—Richard Iorio, MD
Hip Society/AAHKS: Complex Primary THA: Case-Based Discussion on the State
of the Art—Richard Iorio, MD
Defining the Role of Lower Limbs in Compensating for Sagittal Malalignment—Renaud
Lafage, Barthelemy Liabaud, MD, Bassel Diebo, MD, Jonathan H. Oren, MD, Shaleen Vira,
MD, Themistocles S. Protopsaltis, MD, Thomas J. Errico, MD, Frank J. Schwab, MD,
Virginie Lafage, PhD
International Society for the Advancement of Spine Surgery: Hype and Marketing—
Jeffrey Goldstein, MD
Unlocking T1 Pelvic Angle’s Clinical and Sagittal Significance by Analyzing Its Relation
to Pelvic Tilt— Barthelemy Liabaud, MD, Renaud Lafage, Jonathan H. Oren, MD, Shaleen
Vira, MD, Bassel Diebo, MD, Themistocles S. Protopsaltis, MD, Thomas J. Errico, MD,
Frank J. Schwab, MD, Virginie Lafage, PhD
Posters/Video/ Multimedia Presentations
Reliability of Intraoperative Prone Lateral Radiographs in Predicting Postoperative
Standing Sagittal Alignment—Wesley Bronson, MD, Themistocles S. Protopsaltis, MD,
Barthelemy Liabaud, MD, Gregory M. Mundis, MD, Jeffrey Gum, MD, Douglas C. Burton,
MD, Frank J. Schwab, MD, Virginie Lafage, PhD
Brushing Up on Your Test-Taking Skills—Joseph Bosco
Adult Spinal Deformity: Surgical Planning and Complications—Thomas Errico, MD,
Themistocles Protopsaltis, MD, Robert Bess, MD
Hospital Specific Hip Arthroplasty Surgical Site Infection Rates do Not Correlate with
Other Procedure SSI Rates—Ravi Vaswani, BS, Raj Karia, MPH, Lorraine Hutzler, BA,
Joseph A. Bosco III, MD
Regional Anesthesia Only for Clavicle Fracture Open Reduction Internal Fixation is Safe
and Effective—Devon J. Ryan, BA, Kenneth A. Egol, MD
28 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Knee Society/AAHKS Session V: Highlights—W.N. Scott, MD
3D-MRI versus 3D-CT in the Evaluation of Osseous Anatomy in Femoroacetabular
Impingement and Hip Dysplasia—Jonathan Vigdorchik, MD, Nima Eftekhary, MD,
Avner Yemin, MD, Roy Davidovitch, MD, Michael C. Bloom, MD, Soterios Gyftopoulos, MD
Establishing a Pragmatic Knee Preservation Registry to Follow Patients with Degenerative
Joint Disease—Stephen Yu, MD, Alessandra Szulc, MA, Elisha Lee, Xiang Zhou, PhD, Raj
Karia, MPH, Eric J. Strauss, MD, Laith M. Jazrawi, MD, Richard Iorio, MD, Philip Band, PhD
Knee Arthroscopy in the Setting of Degenerative Arthritis—Jason P. Hochfelder, MD,
Jiho Han, W N. Scott, MD, William J. Long, MD
Biomechanical Evaluation of Four Internal Fixation Constructs for Scaphoid Fractures—
Bryan Beutel, MD, Eitan Melamed, MD, Richard M. Hinds, MD, Michael B. Gottschalk,
MD, John T. Capo, MD
End Tidal Carbon Dioxide (ETCO2) Predicts Pulmonary Embolism in Postoperative
Orthopaedic Patients—Austin Ramme, MD, PhD, Alana E. Sigmund, MD, Eduardo Iturrate,
MD, Lorraine Hutzler, BA, Ezra E. Dweck, David J. Steiger, MD, Joseph A. Bosco III, MD
Psychiatric Conditions Impact 90-Day Hospital Readmission Rates Following Total Joint
Replacement—Heather Gold, James D. Slover, MD, Lijin Joo, MA,Joseph A. Bosco III, MD,
Richard Iorio, MD, Cheongeun Oh, PhD
to Protect Ourselves—Rachel S. Rohde, MD, Claudette M. Lajam, MD, Julie E. Adams, MD,
Jennifer M. Wolf, MD
Socioeconomic Status Independently Affects HCAHPS Scores—Brandon Shulman, MD,
Brooks Crowe, BA, Lorraine Hutzler, BA, Joseph A. Bosco III, MD
Total Disc Arthroplasty: The Current and Future Use of an Evolving Technology in Spine
Surgery—Saqib Hasan, MD, Karan S. Patel, MD, Wesley Bronson, MD, William Ryan, BS,
Themistocles S. Protopsaltis, MD, Jeffrey A. Goldstein, MD, Thomas J. Errico, MD
Predictors for Hospital Readmission Within Two Years Following Adult Spinal Deformity
Surgery—Peter G. Passias, MD, Eric O. Klineberg, MD, Cyrus Jalai, BA, Nancy Worley, MS,
Alexandra Soroceanu, MD, Themistocles S. Protopsaltis, MD, Virginie Lafage, PhD
Unilateral versus Bilateral Instrumentation in Transforaminal Lumbar Interbody Fusion:
A Meta-Analysis—Thomas Cheriyan, Virginie Lafage, PhD, Sonali Narang, BA, Steven
Samrock, BA, Bradley Y. Harris, JD, Jeffrey A. Goldstein, MD, John A. Bendo, MD,
Frank J. Schwab, MD, Thomas J. Errico, MD
Predicting Extended Length of Hospital Stay in an Adult Spinal Deformity Surgical
Population—Eric O. Klineberg, MD, Peter G. Passias, MD, Cyrus Jalai, BA, Nancy Worley,
MS, Robert A. Hart, MD, Daniel Sciubba, MD, Douglas C. Burton, MD
Development of New Onset Cervical Deformity in Non-Operative ASD Patients With
Three-Year Follow Up—Peter G. Passias, MD, Cyrus Jalai, BA, Nancy Worley, MS, Renaud
Lafage, Virginie Lafage, PhD, Christopher Ames, MD, Eric O. Klineberg, MD
CSM Surgery Complication Rates, Predictors of Their Development, and Effect on
Outcomes at Two Years—Michael C. Gerling, MD, Peter G. Passias, MD, Shaleen Vira, MD,
Kristina Bianco, Nancy Worley, MS, Cyrus Jalai, BA, Cheongeun Oh, PhD, Alexander
Vaccaro, MD, PhD
Chronic Conditions Associated with Reoperation After Adult Lumbar Fusion Surgery—
Justin Paul, MD
Predicting Cervical Curvature Required for Horizontal Gaze; Implication for Cervical and
Thoracolumbar Surgeons—Bassel Diebo, MD, Shaleen Vira, MD, Jonathan H. Oren, MD,
Barthelemy Liabaud, MD, Renaud Lafage,Themistocles S. Protopsaltis, MD, Thomas J.
Errico, MD, Frank J. Schwab, MD, Virginie Lafage, PhD, Lonner, MD, Thomas J. Errico, MD
MRI Physics: What Every Orthopaedic Surgeon Should Know—Stephanie Swensen, MD,
Michael S. Day, MD, Maxwell Weinberg, MD, Michael J. Alaia, MD, Gregory Chang, MD,
Michael Recht, MD, Eric J. Strauss, MD, Laith M Jazrawi, MD
The Weak Link in ACL Reconstruction: A Guide to Graft Fixation Device Selection.
—Maxwell Weinberg, MD, Christopher Looze, MD, Steven Shamah, Michael J. Alaia, MD,
Guillem Gonzalez-Lomas, Eric J. Strauss, MD, Laith M. Jazrawi, MD
Update on Fracture Nonunion: State of the Art 2016—Anthony V. Christiano, Abraham
M. Goch, Philipp Leucht, MD, Sanjit R. Konda, MD, Kenneth A. Egol, MD
Scapular Fractures: From Bankart to Body—Michael S. Day, MD, William Ryan, BS,
Maxwell Weinberg, MD, Michael J. Alaia, MD, Eric J. Strauss, MD, Kenneth A. Egol, MD,
Laith M. Jazrawi, MD
Evaluation and Management of Pediatric Bone Lesions—Alan T. Blank, MD, MS, Daniel
M. Lerman, Norman Y. Otsuka, MD, Timothy Rapp, MD
Rectus Femoris Repair with Anterior-Inferior Iliac Spine Debridement—Guillem
Gonzalez-Lomas, MD, Daniel J. Kaplan, BA, Natalie Danna, MD, David Fralinger, MD,
Michael J. Alaia, MD, Roy Davidovitch, MD, Laith M. Jazrawi, MD
Chronic Quadriceps Tendon Reconstruction—Michael J. Alaia, MD, Daniel J. Kaplan, BA,
William Ryan, BS, Maxwell Weinberg, MD, Guillem Gonzalez-Lomas, MD, Eric J. Strauss,
MD, Robert J. Meislin, MD, Laith M. Jazrawi, MD
Chronic Patellar Tendon Reconstruction—Michael J. Alaia, MD, Jason Capo, MD, Brian
Capogna, MD, Daniel J. Kaplan, BA, William Ryan, BS, David Fralinger, MD, Eric J. Strauss,
MD, Laith M. Jazrawi, MD
Predictive Model for Cervical Alignment Following Surgical Correction of Adult Spinal
Deformity—Peter G. Passias, MD, Cheongeun Oh, PhD, Cyrus Jalai, BA, Nancy Worley,
MS, Renaud LafageVirginie Lafage, PhD, Christopher Ames, MD
Repair of a Patellar Chondral Lesion in the Setting of an Increased TT-TG—Jason Capo,
MD, Daniel J. Kaplan, BA, William Ryan, BS, David Fralinger, MD, Thomas Youm, MD
Adult Spinal Deformity: National Trends in the Treatment and Perioperative Outcomes
from 2003-2010—Peter G. Passias, Cyrus Jalai, BA, Nancy Worley, MS, Shaleen Vira, MD,
Bryan J. Marascalchi, MD, Virginie Lafage, PhD, Thomas J. Errico, MD
Chronic Patellar Instability with Large Chondral Defect—Guillem Gonzalez-Lomas, MD,
Daniel J. Kaplan, BA, Sergio A. Glait, MD, William Ryan, BS, David Fralinger, MD, Robert J.
Meislin, MD, Eric J. Strauss, MD, Laith M. Jazrawi, MD
Novel Index to Quantify the Surgical Risk in Adult Spinal Deformity: 10,912 Patients from
National Inpatient Sample—Bassel Diebo, MD, Vincent Challier, MD, Bryan J. Marascalchi,
MD, Cyrus Jalai, BA, Nancy Worley, MS, Virginie Lafage, PhD,Peter G. Passias, MD
Extra-Articular Augmentation for the Failed ACL:ALL Reconstruction Sergio A. Glait, MD,
Daniel J. Kaplan, BA, William Ryan, BS, Amy Kaplan, BS, Michael J. Alaia, MD, Eric J.
Strauss, MD, Laith M. Jazrawi, MD
Performance Outcomes After Metacarpal Fractures in National Basketball Association
Players—Michael S. Guss, MD, John Begly, MD, Austin Ramme, MD, Richard M. Hinds,
MD, Raj Karia, MPH, John T. Capo, MD
Lateral Collateral Ligament Reconstruction Using Docking Technique—Sergio A. Glait,
MD, Daniel J. Kaplan, BA, William Ryan, BS, David Fralinger, MD, Guillem GonzalezLomas, MD, Eric J. Strauss, MD Laith M. Jazrawi, MD
Fracture Repair in Hemodialysis Patients is Associated with Higher Complication Rate
and Worse Quality Measures—Ravi Vaswani, BS, Arthur Manoli III, MD, Kenneth A.
Egol, MD
Biomechanics of Fractures—Victor H. Frankel, MD, Daniel J. Kaplan, BA, Kenneth A.
Egol, MD
Microdialysis Detects Ischemic Change Early in the Evolution of Acute Compartment
Syndrome—Alexander Crespo, MD, Sanjit R. Konda, MD, Abraham M. Goch, Kenneth
A. Egol, MD
Pectoralis Major Tendon Repair: Brief Review and Surgical Technique—Jason Capo, MD,
Brent Mollon, MD, Sergio A. Glait, MD, Daniel J. Kaplan, BA, William Ryan, BS, Andrew S.
Rokito, MD
Hip Fracture Treatment at Orthopaedic Teaching Hospitals: Better Care at a Lower Cost—
Sanjit R. Konda, MD, Arthur Manoli III, MD, Karan S. Patel, Kenneth A. Egol, MD
Arthroscopically Assisted Acromioclavicular/Coracoclavicular Joint Reconstruction of
the Shoulder—Jason Capo, MD, John Begly, MD, Daniel J. Kaplan, BA, William Ryan, BS,
Amy Kaplan, BS, Laith M. Jazrawi, MD, Robert J. Meislin, MD
Advanced Arthroplasty Techniques for Acetabular Component Placement in Dysplastic
Hips—Amy Wasterlain, MD, Nicole Wake, MS, Maxwell Weinberg, MD, Jonathan
Vigdorchik, MD
Rotator Cuff Repair Using Collagen Based Bioinductive Implant—Jason Capo, MD, John
Begly, MD, Daniel J. Kaplan, BA,William Ryan, BS, David Fralinger, MD, Eric J. Strauss,
MD, Robert J. Meislin, MD,
LIMA: Lifetime Initiative for the Management of Arthritis (LIMA): Understanding
Arthritis as a Disease State—Richard Iorio, MD, Alessandra Szulc, MD, Philip Band, PhD,
Thomas A. Einhorn, MD, Joseph A. Bosco III, MD, Laith M. Jazrawi, MD, James D. Slover,
MD, Raj Karia, Joseph D. Zuckerman, MD
Ulnar Collateral Ligament Reconstruction - Modified Jobe Approach using Docking
Technique—Sergio A. Glait, MD, Daniel J. Kaplan, BA, William Ryan, BS, Maxwell
Weinberg, MD, Michael J. Alaia, MD, Guillem Gonzalez-Lomas, MD, Laith M. Jazrawi, MD
Distal Radius Fractures: Tips to Prevent Complications and Management if They
Occur—Christopher Klifto, MD, Michael S. Guss, MD, Anthony Sapienza, MD,
Syngil S. Yang, MD, John T. Capo, MD, Nader Paksima, DO, Kevin M. Klifto, MD
3D Printing: The Latest Innovations and Applications in Orthopaedic Surgery—Stephen
Yu, MD, Hamadi Murphy, Austin Ramme, MD, PhD, Richard Iorio, MD, Peter S. Walker,
PhD, Jonathan Vigdorchik, MD
Osteoporosis and the Orthopaedic Surgeon's Role—Arthur Manoli III, MD, Roy
Davidovitch, MD, Nirmal C. Tejwani, MD, Frank A. Liporace, MD, Sanjit R. Konda, MD,
Kenneth A. Egol, MD
Management of Glenoid Bone Loss in Shoulder Arthroplasty—Michael S. Guss, MD,
William Ryan, BS, Daniel J. Kaplan, BA, Brent Mollon, MD, Kirk A. Campbell, MD,
Young W. Kwon, MD, PhD, Joseph D. Zuckerman, MD
Open Shoulder Stabilization using Humeral and Distal Tibial Allografts—Jason Capo, MD
Michael Ryan, MD, Daniel J. Kaplan, BA, William Ryan, BS, David Fralinger, MD, Andrew
S. Rokito, MD
French-Door (Double-Door) Laminoplasty—Daniel J. Kaplan, BA, Christine Choi, BS, MS,
Themistocles S. Protopsaltis, MD
Occupational Hazards of Orthopaedic Surgery: What's Known, What's Not, and How
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
29
Patrick A. Meere, MD
Awards & Recognition
Edward M. Adler, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Roy I. Davidovitch, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Salil Gupta, MD
New York Metro Area’s Top Doctors,
Castle Connolly
O. Alton Barron, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Kenneth A. Egol, MD
New York Metro Area’s Top Doctors,
Castle Connolly
John A. Bendo, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Thomas J. Errico, MD
America’s Top Doctors, Castle Connolly
Richard Iorio, MD
Frank Stinchfield Research Award,
The Hip Society •
Richard Kilfoyle Award, Winning Manuscript,
New England Orthopaedic Society •
Chairman, Advanced APM Development
Committee, American Association of Hip
and Knee Surgeons •
Chairman, Advocacy Committee, American
Association of Hip and Knee Surgeons •
New York Metro Area’s Top Doctors,
Castle Connolly
Joseph A. Bosco, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Louis W. Catalano, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Steven Z. Glickel, MD
America’s Top Doctors, Castle Connolly
David H. Godfried, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Jeffrey A. Goldstein, MD
America’s Top Doctors, Castle Connolly
Cary B. Chapman, MD
New York Metro Area’s Top Doctors,
Castle Connolly
30
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Laith M. Jazrawi, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Yong H. Kim, MD
New York Metro Area’s Top Doctors,
Castle Connolly
William L. King, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Vijay John Mani, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Patrick A. Meere, MD
America’s Top Doctors, Castle Connolly •
Best Podium Presentation, Conference
for Computer Assisted Orthopaedic
Surgery International
Thomas Errico, MD, and Anthony Frempong-Boadu, MD
Robert J. Meislin, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Nader Paksima, DO, MPH
New York Metro Area’s Top Doctors,
Castle Connolly
Anthony Sapienza , MD
Member, ER Committee, American
Society for Surgery of the Hand (ASSH)
Martin Posner, MD
Lifetime Achievement Award, New York
Society for Surgery of the Hand (NYSSH)
Ran Schwarzkopf, MD
The Lawrence D. Dorr Surgical Techniques
& Technologies Award, American
Association of Hip and
Knee Surgeons
Andrew E. Price, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Craig S. Radnay, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Timothy B. Rapp , MD
New York Metro Area’s Top Doctors,
Castle Connolly
Keith B. Raskin, MD
America’s Top Doctors, Castle Connolly
Michael E. Rettig, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Donald J. Rose, MD
New York Metro Area’s Top Doctors,
Castle Connolly
W. Norman Scott, MD
Lifetime Achievement Award,
Arthritis Foundation
Steve Sheskier, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Jeffrey M. Spivak, MD
Leon L. Wiltse Research Award,
International Society for the Advancement
of Spine Surgery • America’s Top Doctors,
Castle Connolly
Jonathan R. Stieber, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Steven A. Stuchin, MD
America’s Top Doctors, Castle Connolly
Nirmal C. Tejwani, MD
Board member, Orthopaedic Trauma
Association (OTA)
Jonathan Vigdorchik, MD
Insall Knee Traveling Fellowship
Peter S. Walker, PhD
Best Podium Presentation, Conference
for Computer Assisted Orthopaedic
Surgery International
S. Steven Yang, MD, MPH
New York Metro Area’s Top Doctors,
Castle Connolly
Thomas Youm, MD
New York Metro Area’s Top Doctors,
Castle Connolly
Joseph D. Zuckerman, MD
America’s Top Doctors, Castle Connolly
Most Impactful Chairs of Last 20 Years,
Academic Orthopaedic Consortium
Eric J. Strauss, MD
Traveling Fellow, American Orthopaedic
Association’s American-BritishCanadian (ABC)
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
31
Locations
As of December 2016
Located in the heart of Manhattan, with
additional facilities throughout the New
York City area, NYU Langone Medical
Center consists of five hospitals and a
growing outpatient network that brings
our world-class medical services directly
to the communities where our patients
live and work.
CT
8 additional
locations in
Westchester
NYU Langone’s Department of
Orthopaedic Surgery cares for patients
throughout the NYU Langone campus,
including five flagship facilities:
WESTCHESTER
Hospital for Joint Diseases,
New York, NY
This 190-bed hospital is the premier inpatient
facility of the Department of Orthopaedic Surgery
and the cornerstone of its patient safety and
quality initiatives.
NYU Langone Medical Center,
New York, NY
NJ
2 additional
locations in
New Jersey
BRONX
MANHATTAN
A variety of inpatient and outpatient orthopaedic
services are provided at NYU Langone’s 705-bed,
flagship acute care hospital, including emergency
orthopaedic services in the Ronald O. Perelman
Center for Emergency Services.
QUEENS
Center for Musculoskeletal Care,
New York, NY
With 110,000 square feet of state-of-the-art space,
NYU Langone’s premier facility for outpatient
musculoskeletal care encompasses orthopaedics,
rheumatology, rehabilitation, musculoskeletal
radiology, and pain management.
Outpatient Surgery Center,
New York, NY
NYU Langone’s 22,000-square-foot cuttingedge facility focuses on ambulatory orthopaedic
procedures, including shoulder, elbow, wrist, and
hand surgeries, knee and ankle arthroscopies, ACL
reconstruction, rotator cuff repair, and fracture
fixation, among others.
NYU Lutheran Medical Center,
Brooklyn, NY
BROOKLYN
STATEN
ISLAND
6 additional
locations in
Staten Island
Department of Orthopaedic Surgery
NYU Langone Medical Center
Affiliated with NYU Langone since April 2015
and merged as of January 2016, NYU Lutheran
offers Brooklyn residents convenient access
to high-quality healthcare.
32 8 additional
locations in
Long Island
NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
For more information about our locations,
visit, nyulangone.org/locations
Faculty & Leadership
Department Leadership
Joseph D. Zuckerman, MD
Dennis A. Cardone, DO
Nader Paksima, DO, MPH
Walter A.L. Thompson Professor of
Orthopaedic Surgery; Chair of the
Department of Orthopaedic Surgery
Chief, Primary Care Sports
Medicine Division
Clinical Site Chief, Jamaica Hospital
Medical Center
Pablo Castañeda, MD
Martin Posner, MD
Chief, Pediatric Orthopaedic Division
Chief, Hand Division
Thomas J. Errico, MD
Timothy B. Rapp, MD
Chief, Spine Division
Chief, Oncology Division
Phone: 646.501.7042
Richard Iorio, MD
Andrew S. Rokito, MD
Email: [email protected]
Chief, Joint Replacement and
Adult Reconstructive Division
Chief, Shoulder and Elbow Division
Vice Chair for Professional Practice
Laith M. Jazrawi, MD
Director, Center for Musculoskeletal Care;
Director, Hospital for Joint Diseases
Ambulatory Care Services
Chief, Sports Medicine Division
Clinical Site Chief, Hospital for Joint
Diseases
Toni M. Mclaurin, MD
Nirmal C. Tejwani, MD
Clinical Site Chief, Bellevue Hospital Center
Clinical Site Chief, Tisch Hospital
Phone: 212.598.6674
Email: [email protected]
Joseph A. Bosco, MD
Vice Chair of Clinical Affairs
Gail S. Chorney, MD
Phone: 646.501.7171
Email: [email protected]
Kenneth A. Egol, MD
Vice Chair of Education and Chief
of the Division of Trauma & Fracture
Phone: 212.598.3889
James D. Slover, MD
Kenneth J. Mroczek, MD
Chief, Foot and Ankle Division
Paul J. Ort, MD
Clinical Site Chief, Manhattan Veterans
Affairs (VA) Medical Center
Email: [email protected]
William L. Jaffe, MD
Vice Chair
Phone: 212.598.6796
Email: [email protected]
Thorsten Kirsch, PhD
Vice Chair of Research
Phone: 212.598.6589
Email: [email protected]
Thomas R. Lyon, MD
Vice Chair, NYU Lutheran
Phone: 718.630.7000
Email: [email protected]
Joseph A. Bosco, MD, and Joseph D. Zuckerman, MD
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
33
Full Faculty List
Adult Reconstructive
Richard Iorio Chief
Edward Adler
Alan J. Dayan
Ajit J. Deshmukh
Thomas A. Einhorn
Joseph Feliccia
Ivan Fernandez-Madrid
Philip A. Fontanetta
Robert S. Goldstein
James Gurtowski
William L. Jaffe
Michael N. Kang
Claudette M. Lajam
Justin G. Lamont
Peter R. Langan
Nachum Levin
John C. L’insalata
William J. Long
Vijay J. Mani
Scott E. Marwin
Patrick A. Meere
Robert L. Michaels
Gregory Montalbano
Paul J. Ort
Mukund R. Patel
Parthiv Rathod
Steven J. Ravich
Hank Ross
Ran Schwarzkopf
W. Norman Scott
Ernesto D. Seldman
Jeffrey Shapiro
James D. Sloverthaddeus Spak
Steven Struhl
Steven A. Stuchin
Vladimir Tress
Jonathan Vigdorchik
Raymond B. Walsh
Oskar Weg
Lori G. Weiser
Arnold B. Wilson
Thomas Youm
Joseph D. Zuckerman
Vivek Natarajan
Donna P. Phillips
Andrew E. Price
Joshua Strassberg
Spine
Thomas J. Errico Chief
Roger Antoine
John A. Bendo
Aaron J. Buckland
Alexandre B. De Moura
Joseph W. Dryer
Leon K. Eisen
Jason M. Gallina
Michael C. Gerling
Jeffrey A. Goldstein
Yong H. Kim
Jeffrey D. Klein
Angel E. Macagno
Ronald Moskovich
Jonathan H. Oren
Peter G. Passias
Carl B. Paulino
Jeffrey Perry
Anthony M. Petrizzo
Themistocles Protopsaltis
Joseph S. Pyun
Martin Quirno
Afshin E. Razi
Mark A. Rieger
Jeffrey M. Spivak
Jonathan R. Stieber
Sports Medicine
Laith M. Jazrawi Chief
Michael J. Alaia
Joseph A. Bosco
Kirk A. Campbell
Craig M. Capeci
Adam B. Cohen
Andrew J. Feldman
Joshua B. Frank
Calogero Gambino
Ramesh H. Gidumal
Guillem Gonzalez-Lomas
Stuart J. Hershon
James M. Kipnis
Jerry Lubliner
Robert J. Meislin
David S. Menche
David S. Pereira
Andrew S. Rokito
Donald J. Rose
Mehul R. Shah
Orrin H. Sherman
Jonathan J. Silver
Marc Silverman
Stuart Springer
Drew A. Stein
Eric J. Strauss
Bradley R. Wasserman
David S. Weiss
Pediatric Orthopaedic Surgery
Pablo Castañeda Chief
David H. Godfried Director,
Center for Children
Gail S. Chorney
Alice Chu
David S. Feldman
Jenny M. Frances
Samara Friedman
Mara Karamitopoulis
David Y. Lin
34 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
Alice Chu, MD
Primary Care Sports Medicine
Hand
Dennis A. Cardone Chief
Bret C. Jacobs
Warren K. Young
Martin Posner Chief
Steven Green Assoc. Chief
Nader Paksima Assoc. Chief
Omri B. Ayalon
Alton O. Barron
John T. Capo
Louis W. Catalano
Stuart Elkowitz
Steven Z. Glickel
Steven M. Green
Salil Gupta
Jacques H. Hacquebord
William L. King
Salvatore Lenzo
Eitan Melamed
Mukund R. Patel
Vipul P. Patel
Francis R. Pelham
Keith B. Raskin
Michael E. Rettig
Anthony Sapienza
Steven A. Stuchin
S. Steven Yang
Shoulder And Elbow
Andrew S. Rokito Chief
Laith M. Jazrawi
Young W. Kwon
Robert J. Meislin
Timothy G. Reish
Mandeep S. Virk
Jean S. Yun
Joseph D. Zuckerman
Trauma And Fracture
Kenneth A. Egol Chief
Roy I. Davidovitch
Sanjit R. Konda
Philipp Leucht
Frank A. Liporace
Thomas R. Lyon
Toni M. Mclaurin
Nirmal C. Tejwani
Aldo Vitale
Orthopaedic Oncology
Timothy B. Rapp Chief
Foot And Ankle
Kenneth J. Mroczek Chief
Cary Chapman
Craig S. Radnay
Steven Sheskier
Research
Thorsten Kirsch Chief
Philip Band
Marco Campello
Alesha Castillo
Mary Cowman
Sally R. Frenkel
Manny Halpern
Raj J. Karia
Oran Kennedy
Philipp Leucht
Chuanju Liu
Smita Rao
Ali Sheikhzadeh
Peter S. Walker
Shira Weiner
Sherri Weiser-Horwitz
Xiang Zhou
Emeritus
Academic Appointments
Marc H. Appel
Dan Atar
Andrew N. Bazos
Adam Bernstein
Alvin M. Bregman
Joel S. Buchalter
William Burman
Winshih Chang
Jack Choueka
Douglas J. Fauser
Colleen M. Fay
Lawrence G. Foster
Alfred Garofalo
Mark A. Gurland
James Gurtowski
Ronald H. Israelski
Kevin Kaplan
Victor Khabie
Steven Klein
Frank J. Liggio
Raphael S.f. Longobardi
Stephen G. Maurer
Morteza Meftah
Seth Miller
Roy M. Nuzzo
Andrew M. Peretz
Jeffrey Richmond
Philip Robbins
Jeffrey E. Rosen
Roy W. Sanders
Victor Sasson
Philip Schrank
Susan C. Scott
Jordan A. Simon
Michael G. Soojian
Adam D. Soyer
Stuart T. Styles
Bradley D. Wiener
Jamie Wisser
John Zeller
Arnold T. Berman
L. Paul Brief
Enrique Ergas
Victor Frankel
Vladimir Golyakhovsky
Alfred D. Greisman
John E. Handelsman
Wallace B. Lehman
Lester Lieberman
Margareta C. Nordin
Jacques Serge Parisien
Mark Pitman
Paul Post
Lawrence Schulman
Kenneth E. Seslowe
Joseph A. Suarez
N. Noel Testa
ORTHOPAEDIC SURGERY / NYU LANGONE MEDICAL CENTER
35
Leadership
New York University
William R. Berkley
Chair, Board of Trustees
Andrew Hamilton, PhD
President
Robert Berne, MBA, PhD
Executive Vice President for Health
Michael T. Burke
Senior Vice President and
Vice Dean, Corporate Chief Financial Officer
Joseph Lhota
Senior Vice President and
Vice Dean, Chief of Staff
Richard Donoghue
Senior Vice President
for Strategy, Planning,
and Business Development
Vicki Match Suna, AIA
Senior Vice President and Vice Dean
for Real Estate Development and Facilities
NYU Langone Medical Center
Kenneth G. Langone
Chair, Board of Trustees
Robert I. Grossman, MD
Saul J. Farber Dean and
Chief Executive Officer
Steven B. Abramson, MD
Senior Vice President and
Vice Dean for Education, Faculty,
and Academic Affairs
Dafna Bar-Sagi, PhD
Senior Vice President and
Vice Dean for Science, Chief Scientific Officer
Andrew W. Brotman, MD
Senior Vice President and
Vice Dean for Clinical Affairs and Strategy,
Chief Clinical Officer
Nader Mherabi
Senior Vice President and Vice Dean,
Chief Information Officer
Annette Johnson, JD, PhD
Senior Vice President and Vice Dean,
General Counsel
Robert A. Press, MD, PhD
Senior Vice President and Vice Dean,
Chief of Hospital Operations
Grace Y. Ko
Senior Vice President for
Development and Alumni Affairs
Nancy Sanchez
Senior Vice President and Vice Dean
for Human Resources and Organizational
Development and Learning
Kathy Lewis
Senior Vice President for
Communications and Marketing
NYU Langone By the Numbers*
1,519
100
145,907
68,602
3,850,000
9,649
Beds
Operating
Rooms
Emergency
Room Visits
Patient
Discharges
Outpatient
Faculty Practice
Visits
Births
3,584
4,899
574
80
233
397
1,472
Physicians
Nurses
MD Candidates
MD/PhD
Candidates
PhD Candidates
Postdoctoral
Fellows
Residents and
Fellows
4,381
550,500
$334M
$328M
Original
Research
Papers**
Square Feet of
Research Space
NIH Funding
Total Grant
Revenue
36 NYU LANGONE MEDICAL CENTER / ORTHOPAEDIC SURGERY
*Numbers represent FY16 (Sept 2015–Aug 2016) and include NYU Lutheran
**Calendar year 2015
Produced by the Office of Communications and Marketing,
NYU Langone Medical Center
Photography: Karsten Moran
Writer: Bryn Nelson
Creative Direction: Ideas on Purpose, www.ideasonpurpose.com
Design: Craig Williams, www.thecraigwilliams.com
On the cover: Human bone, osteoporosis
NYU LANGONE MEDICAL CENTER
550 First Avenue, New York, NY 10016
NYULANGONE.ORG