Houston Methodist Orthopedics & Sports Medicine Annual Report 2013

LEADING ORTHOPEDICS & SPORTS MEDICINE CARE 20

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A PROUD TRADITION OF EXCELLENCE, WITH A NEW NAME.The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.

THAT’S THE DIFFERENCE BETWEEN PRACTICING MEDICINE AND LEADING IT.

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LEADING MEDICINE: AN OVERVIEW 2

PURSUING MEDICAL DISCOVERIES 6

BREAKING NEW GROUND 10

DELIVERING BETTER OUTCOMES 14

EDUCATING FOR TOMORROW 20

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CONTENTS

2 Orthopedics

Our patients range from professional athletes and performing artists to “weekend warriors” to student athletes — and everyone receives the same superior level of care from the moment they walk through our doors.

Houston Methodist Orthopedics & Sports Medicine exists

to provide our patients with outstanding, comprehensive

orthopedic care. We do this through unparalleled expertise

combined with innovative research, sophisticated technology

and a dedication to compassionate patient care. Our center

exemplifies orthopedic excellence and is recognized as a

hub of knowledge and progress where patients, educational

institutions, governing bodies and the medical research

community can turn for the best in current orthopedic

treatments and rehabilitation.

A NATIONAL LEADER IN ORTHOPEDIC EXCELLENCE

Ranked within the top 25 in the nation in 2013 by

U.S. News & World Report, Houston Methodist Orthopedics

& Sports Medicine is one of the largest, most active and

comprehensive orthopedic centers in the United States.

The center is comprised of a multidisciplinary team of

orthopedic surgeons, primary care sports medicine physicians,

rehabilitation therapists, occupational therapists and athletic

trainers who collaborate in the delivery of superlative care

to patients with musculoskeletal diseases and disorders. Our

expansive network of clinical programs is directed by renowned,

board-certified and fellowship-trained orthopedic specialists.

The center has emerged as a national leader due to

its high quality of clinical care, dedication to resident

and fellow education, and state-of-the-art clinical

and scientific research.

BLAZING THE PATH OF FUTURE ORTHOPEDIC MEDICINE

Houston Methodist Orthopedics & Sports Medicine has

developed or improved many orthopedic devices, procedures,

and therapies that have been translated into clinical practice

worldwide. Our ongoing commitment to orthopedic research,

through vigorous collaborations with numerous research

partners, helps to ensure our continuing leadership in the

diagnosis and treatment of orthopedic conditions.

THE LEADERS OF TOMORROW

Through our primary academic affiliation with Weill

Cornell Medical College and NewYork-Presbyterian Hospital,

Houston Methodist Orthopedics & Sports Medicine

provides fully accredited resident and fellowship programs.

Our curricula are designed to prepare the next generation

of orthopedic specialists through hands-on training and

extensive research programs.

ABOUT HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE

Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow

HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE2013 AT A GLANCE

TOTAL CASES

JOINT REPLACEMENT PROCEDURES

ACTIVE CLINICAL PROTOCOLS

43,7042,397

$1.4

9

5 ACADEMIC FELLOWSHIP AND RESIDENCY PROGRAMS

MILLION IN GRANT FUNDING

OVER

3Opthalmology


MESSAGE FROM THE CHAIR

Dear Colleagues, Expertise, compassion, innovation and patient focus are just a few of the reasons why patients seek treatment at Houston Methodist Orthopedics & Sports Medicine. I am extremely honored and proud to share our accomplishments and highlights over the past year.

In 2013, we used our close clinical association with elite athletes and performing artists to translate knowledge of repetitive and overuse injuries to our “weekend warriors.” In addition, we saw therapies that were originally reserved for professional athletes, such as platelet-enriched plasma procedures, cross over and benefit our orthopedic surgery patients.

At the Surgical Advanced Technology Laboratory, we are persisting in our work on a breakthrough technique that will significantly improve the way critical bone fractures are treated. Using a novel, regenerative approach to fractures that combines the mechanical advantages of biodegradable synthetic polymers with the biological function of natural biomaterial scaffolds, we are witnessing rapid healing in limbs that would previously have required amputation. We have been able to proceed with this research on bionanoscaffolds through a grant from the Defense Advanced Research Project Agency (DARPA).

We are helping to establish new surgical pathways for thumb joint replacements. We continue to stand at the leading edge in the advancement of sophisticated ankle implants through incorporation of a recently developed, three-component prosthetic that requires less bone resection and allows for greater joint rotation. In 2013, we also witnessed major advancement in cartilage replacement techniques for both the ankle and knee.

Our commitment to leading medicine compels our motivation toward excellence in orthopedic research, innovation and education. Our compassion and dedication to our patients inspires our aspirations for excellence in care.

The accomplishments at Houston Methodist Orthopedics & Sports Medicine are made possible by the outstanding work of our physicians, nurses, administrators and staff. We invite you to browse inside these pages and explore the exciting developments in our realm of orthopedic care.

Warm regards,

Kevin Varner, MDInterim ChairHouston Methodist Orthopedics & Sports Medicine

JEFFREY KOZAK, MD Jeffrey Kozak, MD, joined the team of Houston Methodist Orthopedics & Sports Medicine after completing his fellowship in primary care sports medicine at Houston Methodist. He completed his orthopedic residency at the University of North Texas Health Science Center College of Osteopathic Medicine in Fort Worth, Texas and his primary care residency at Texas A&M University in College Station, Texas. During his fellowship, Dr. Kozak worked extensively with the Houston Dynamo, Houston Aeros, Rice University, RodeoHouston®, as well as community and high school athletic organizations.

4 Orthopedics


NEW HIRES

JOSHUA HARRIS, MD Joshua Harris, MD, joined Houston Methodist Orthopedics & Sports Medicine after completion of his medical and orthopedic residency at Ohio State University College of Medicine in Columbus, Ohio. He proceeded to complete his fellowship in sports medicine at Rush Medical Center in Chicago, where he was assistant team physician for the Chicago Bulls, White Sox, and DePaul University. Dr. Harris’ clinical and research interests include arthroscopic hip preservation, cartilage restoration techniques, stem cell therapy, the healing properties of platelet- rich plasma, endurance medicine and care of elite athletes. He has published over 60 articles in peer-reviewed journals, presented at various national and international symposia, and has been a journal reviewer for numerous publications including American Journal of Sports Medicine, The Physician and Sports Medicine and the Orthopedic Journal of Sports Medicine.

DANIEL LE, MD Daniel Le, MD, joined Houston Methodist in September of 2013 after completing his training at New England Baptist Hospital, in Boston, Massachusetts. During his residency, Dr. Le estimates he performed approximately 750 joint replacement surgeries. He is one of the few orthopedic surgeons in the country who currently performs minimally invasive hip replacement surgery known as the superior capsular or SUPERPATH approach. The superior capsular procedure preserves the integrity of the capsule and significantly limits postoperative hip restrictions. In collaboration with Brad Weiner, MD, vice chair (Academics) of the Department of Orthopedic Surgery, Dr. Le is developing a new total joint replacement rotation for residents in 2014.

SHARI LIBERMAN, MD Shari Liberman, MD, joined Houston Methodist Orthopedics & Sports Medicine after completing her orthopedic surgery residency at Baylor College of Medicine in Houston, Texas, and her hand and upper extremity fellowship at Stanford University School of Medicine in Stanford, California. Dr. Liberman’s clinical interests include Dupuytren’s disease, traumatic wrist injuries and peripheral nerve injuries of the upper extremity.


HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE MEDICAL STAFFKevin E. Varner, MD, Interim Chair

ORTHOPEDIC SPORTS MEDICINEWinfield Campbell, MDJoshua Harris, MDDavid Lintner, MD Mark W. Maffet, MD Patrick McCulloch, MD Bruce Moseley, MD John Seaberg, MDTimothy C. Sitter, MD

PRIMARY CARE SPORTS MEDICINEDavid A. Braunreiter, MD Vijay Jotwani, MD Jeffrey A. Kozak, DO Scott Rand, MD Kenneth M. Renney, MDChristian Schupp, MD Gregory M. Seelhoefer, MD

NECK & SPINEHoSun Hwang, MD Anthony J. Muffoletto, MD Bradley Weiner, MD Jeffrey B. Wood, MD

HAND & WRISTEvan Collins, MD D. Dean Dominy, III, MDKorsh Jafarnia, MD Shari Liberman, MD Vincent C. Phan, MD

JOINT REPLACEMENTWilliam J. “Bill” Bryan, MD Plinio Caldera, MD Mark Franklin, MDCarl A. Hicks, MD Stephen Incavo, MD Daniel Le, MD Ken Mathis, MD Eddie T. Matsu, MD James Pyle, MDChristopher K. Smith, MD Leland Winston, MD

FOOT & ANKLEPedro Cosculluela, MD Travis Hanson, MD Ray R. Valdez, MD Kevin E. Varner, MD

Physicians and scientists in the Houston Methodist Surgical Advanced Technology

Laboratory are at work on a breakthrough technique that will significantly improve

the way critical bone fractures are treated. In place of the traditional bone graft,

allograft, or artificial implant, orthopedic surgeons at Houston Methodist are using a

novel regenerative approach called BioNanoScaffolds.

This research has been made possible through a $7.9 million grant from the Defense

Advanced Research Project Agency (DARPA), an agency of the U.S. Department

of Defense responsible for the development of new military technologies.

“BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic

polymers with the biological functions of natural biomaterial scaffolds. This approach

achieves the correct strength requirements while enhancing the regeneration of

healthy bone tissue at the fracture site,” says Bradley K. Weiner, MD, professor and

vice chairman of the Department of Orthopedic Surgery and medical director of

the Surgical Advanced Technology Lab. BioNanoScaffolds provides rapid and

complete healing within four weeks of bony leg injuries that would normally result

in amputation.

“The polymer shell is made of a new material called polyether urethane, or PEU,

which is the most durable known material that can be safely reabsorbed in humans

over time. The shell holds the bone immobilized and works in concert with a novel

collagen-based scaffold that is loaded with bioactive nanoparticles. This will allow

accelerated bone healing,” says Weiner. The success of this research has resulted in

further funding. Currently, testing has been done using sheep as models. Increased

funding will provide for human clinical trials in both military and civilian patients.

6 Orthopedics

THE FUTURE OF MOBILITY: BIONANOSCAFFOLDS

“BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic

polymers with the biological functions of natural biomaterial scaffolds. This approach achieves the correct strength requirements while enhancing the regeneration of healthy bone tissue at the fracture site.”

Bradley K. Weiner, MD Vice Chair, Department of Orthopedic Surgery (Academics) Medical Director, Surgical Advanced Technology Lab



STEM CELLS: REVOLUTIONIZING SURGICAL REPAIR Houston Methodist Orthopedics & Sports Medicine physicians are using stem cells to help accelerate

healing and recovery after surgery. The ability of stem cells to differentiate into specialized cells and

divide continuously allows them to replenish damaged tissue and promote healing within the body.

A primary use of stem cells in orthopedics is in the treatment of rotator cuff injuries, which are

classically refractory to complete healing and rehabilitation.

“There is a lot of literature to indicate that stem cells have great potential to induce and accelerate healing,”

said David Lintner, MD, orthopedic surgeon and chief of sports medicine at Houston Methodist Hospital.

During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of

the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this

channel to induce healing through replacement of damaged cells and replenishment of injured tissue.

“Stem cells hold a great deal of promise in orthopedics,” says Mark Maffet, MD, orthopedic

surgeon at Houston Methodist Sugar Land Hospital. “Right now, their use is cutting-edge

but I believe they will ultimately play a huge role in the success of surgical repair.”

The efficacious combination of rotator cuff surgery and stem cell therapy has caused orthopedic

surgeons at Houston Methodist to broaden its application. Lintner says the surgery has been so

successful in shoulders that he has begun to use stem cells in anterior cruciate ligament (ACL) and

meniscus repair surgeries.

“For ACL repair, the graft is soaked in a concentrate full of stem cells and other growth factors prior to

fixation,” says Maffet. “In other cases, we can simply suture the torn ligament and inject the stem cell

concentrate into the affected area.”

“It seems advantageous to use stem cells when a muscle, tendon, or ligament might otherwise have a

limited ability to heal, which is often the case with rotator cuff repairs,” says Lintner.

During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this channel to induce healing through replacement of damaged cells and replenishment of injured tissue.

CARTILAGE RESEARCH: A BEND OF THE KNEE

Physicians at Houston Methodist Orthopedics & Sports Medicine are at the forefront of

orthopedic research in their ongoing studies of cartilage repair, resurfacing and regeneration.

Articular cartilage lines the bones within all joints and, due to its lack of blood supply, cannot heal

when torn or injured. In addition, articular cartilage consists of only one type of cell capable of

renewal - the chondrocyte - that becomes less active with age and injury. As a consequence, joint

repair that involves cartilage damage has been a longstanding challenge for orthopedic surgeons.

“We are currently involved in a multicenter study that is researching hystotechnologies and

tissue-engineered cartilage for articular defects. The research is focused on the meniscus — how it

behaves when it is torn and when it is repaired, how best to rest to restore it and how best to

rehabilitate it,” says Patrick McCulloch, MD, orthopedic surgeon.

Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to

study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting

small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different

angles. The x-rays are then combined to create 3-D images and measure the movement of the beads.

“In contrast to our original hypothesis, we found that meniscal repair sites did not gap when the knee

was taken through high flexion, or bent at a 90 degree or higher angle. We determined that it is not necessary

to restrict flexion after surgical meniscal repair,” says McCulloch. “We have subsequently performed several

studies using this new technique to look at the movement of the meniscus to evaluate the effects of weight

bearing, use of crutches, and different types of surgery, such as root repairs and the meniscus transplantation.”

8 Orthopedics

MAXIMIZING HUMAN PERFORMANCE


Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different angles. The x-rays are then combined to create 3-D images and measure the movement of the beads. m1


ORTHOPEDICS IN SPACE

Space travel can be extremely hard on the

human body. The collaboration between

Houston Methodist and NASA is addressing this

through supervision of a teaching program

that instructs astronauts how to do in-flight

musculoskeletal ultrasounds. The purpose of

the program is to identify soft tissue injuries that

might occur in space where the use of other

scanners or x-ray equipment is not possible.

“We also provide the decision-makers at NASA

with the highest level of orthopedic screening and

evaluation possible, applying the same techniques

we use with professional athletes to ensure a

healthy astronaut corps,” says McCulloch, serves

as the orthopedic surgical consultant for NASA.

PLATELET-RICH PLASMA: A HEALING ELIXIR

Houston Methodist continues to implement new

clinical breakthroughs in orthopedics such as

regenerative medical treatment with platelet-rich

plasma (PRP) injection therapies. The theoretical

use of PRP lies in the efficacy of certain growth factors

found in PRP that help in healing and tissue repair.

PRP can be used when cortisone shots and

viscosupplementation with hyaluronic acid injections

stop working. Results so far have been good.

“In fact, European two-year studies show PRP has

significant benefit over both of those therapies.

PRP is a promising, safe and effective treatment

that can help repair rotator cuff injuries, Achilles’

tendon injuries, arthritis and a number of other

diagnoses. Many surgeons are hesitant to use this

therapy because it is so new, but as leaders in

orthopedics, the surgeons here at Houston Methodist

are comfortable with implementing innovative

procedures,” says Josh Harris, MD, orthopedic surgeon.

THE SLAP TEAR

Researchers and physicians leveraged the

relationships with professional sports teams to

initiate research topics. Orthopedic surgeons at

Houston Methodist generated the first research

papers from this unique partnering, looking

specifically at injury outcomes in professional

athletes. “To evaluate the best way to treat a

common throwing injury known as the SLAP

tear, we merged the stats of players who were

treated surgically and those treated with non-

surgical rehabilitation,” says David Lintner, MD,

chief of sports medicine. “We found that players

perform much better with non-surgical treatment,

and the research confirmed what many team

physicians had suspected but not documented.”

m2

tibia beads

Orthopedics10

LEADING INNOVATIONS IN JOINT REPLACEMENT


Houston Methodist Orthopedics & Sports Medicine is a leader in the advancement of joint replacement, taking arthroplasty beyond the need for functionality into the desire to preserve and even optimize performance for a lifetime. Cutting-edge science and clinical research provide scientists and physicians the ability to accurately recreate normal function and motion of a joint, while continually pursuing the latest innovations in joint replacement technology.


THE NEWEST IDEAS IN KNEES

The population’s current health and longevity is steadily increasing the demand for joint

replacements as Baby Boomers seek to continue a robust and active lifestyle. Knee cartilage

is often the first to go. And, although surveys indicate that 85% of those who receive a knee

replacement are satisfied, this leaves 15% of this cohort unhappy.

“I believe that number is too high. We need to be asking important questions such as, ‘What are

the best methods to determine the proper implant for a given lifestyle? How can normal knee

function be maintained or recreated with implants that allow patients to run, jump, and climb –not

just walk? Should ACLs and PCLs be preserved?’” says Kenneth Mathis, MD, orthopedic surgeon and

joint replacement specialist.

Current models of implants are in the process of evaluation with more sophisticated tools of assessment.

“Using fluoroscopy, we can validate the computer-driven models to determine how accurately we

recreate function in a new implant. This has clear advantages over the evaluation of cadaver models

and guessing that implants will fit correctly in patients,” says Mathis.

In addition, the practice of severing the ACL and PCL is undergoing reevaluation. “In the past, we

only evaluated implants based on decreased pain and the duration of the implant,” says Mathis.

“Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential

to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may

lead to increased satisfaction.” Mathis has also contributed to the creation of a 120-question patient

survey that helps quantify the best implant match for each patient.

“In the past, we only evaluated implants based on decreased pain and the duration of the implant. Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may lead to increased satisfaction.”

Ken Mathis, MD Orthopedic Surgeon

Orthopedics12


At Houston Methodist, hip replacement is accomplished through one of several minimally invasive techniques.

The mini-posterior approach splits rather than cuts the muscle and eliminates the need for numerous instruments.

Many believe the mini-posterior approach is the simplest and easiest approach to hip arthroplasty and provides

the greatest safety margin for the patient. The anterior approach also splits rather than cuts the muscles and

allows access to the hip joint from the front.

“In addition, we perform hip replacements via the anterolateral approach, which is also a less invasive procedure.

In this technique, a minimal amount of muscle-tendon insertion is detached from the front or the side of

the femur to provide safe access to the hip joint. Patients at a high risk for dislocation may benefit from the

anterolateral approach because there is no posterior disruption of the soft tissue,” says Stephen J. Incavo, MD,

orthopedic surgeon and section chief of adult reconstructive surgery.

Houston Methodist continues to provide high quality patient care in all aspects of reconstructive joint surgery.

“Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which

is expected to result in improved recovery and rehabilitation,” says Incavo.

Orthopedic surgeons here are also investigating methods to streamline operating room efficiency through the

use of dedicated surgical teams and disposable instruments. “Our equipment demands are enormous for

joint replacements. It’s manual labor to get them in the OR and working properly. The more we can streamline

this process, the better it will be for the patient,” says Incavo.

“Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which is expected to result in improved recovery and rehabilitation.”Stephen J. Incavo, MD Section Chief, Adult Reconstructive Surgery Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College Program Director, Adult Reconstructive Surgery Fellowship

MULTIPLE APPROACHES TO HIP REPLACEMENT

Houston Methodist is one of the nation’s busiest and most progressive centers for hip replacement and complex revisionist hip surgery. Here, dedicated orthopedic surgeons perform extensive hip replacement procedures that are based on state-of-the-art techniques and represent the best outcomes with an equal focus on perioperative pain management and rapid rehabilitation.


NEW SURGICAL TECHNIQUES

Arthritis of the first carpometacarpal (CMC)

joint of the hand is a fairly common and frequently

debilitating condition. Surgeons at Houston

Methodist are forging new operative techniques

to correct problems of the CMC joint when

surgical resection of the trapezium is required.

“We are augmenting the tendon repair with a

device called the Mini TightRope. This provides

a unique and less invasive way to suspend the

thumb metacarpal after partial or complete

trapezial resection. We use this technique for

treatment of CMC arthritis, thumb CMC

instability, and to correct proximal migration

after a failed tendon reconstruction,” says

Korsh Jafarnia, MD, orthopedic surgeon and

clinical assistant professor. “We look forward

to achieving outcomes beyond expectations

with minimally invasive and percutaneous

techniques that maximize function.

A new, less invasive technique that demonstrates

this philosophy is endoscopic correction of

radial nerve compression. “Rather than making

an open incision beginning at the elbow, an

endoscopic cannula is inserted proximal to

the radial nerve. We are then able to work on

the radial nerve from the inside, guided by

the endoscope,” says Jafarnia.

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NOVEL APPROACHES TO CARE IN HAND AND UPPER EXTREMITY

“We are augmenting the tendon repair with a device called the Mini TightRope. This provides a unique and less invasive way to suspend the thumb metacarpal after partial or complete trapezial resection. We use this technique for treatment of CMC arthritis, thumb CMC instability, and to correct proximal migration after a failed tendon reconstruction.” Korsh Jafarnia, MD Clinical Assistant Professor, Baylor College of Medicine


TREATING THE UNCONVENTIONAL ATHLETE

The Center for Performing Arts Medicine (CPAM) encompasses the expertise of

more than 100 physicians with specialized knowledge and skills who provide

integrated care to the particular needs of performing artists.

Working with a research-driven team to provide specialized care to professional

performing artists, Evan Collins, MD, orthopedic surgeon and vice chair of

CPAM, speaks nationally on the repetitive stress injuries and conditions

frequently experienced by musicians and the need for protocols specific to this

unique population. Dedicated to this effort, Collins and CPAM work in

collaboration with the Shepherd School of Music at Rice University on

an original research project. The study focuses on mechanical and biological

impact, the role of “capacity” in repetitive stress, and overuse injuries and

conditions musicians experience over the course of their long career.

The study is an extension of a recently completed paper Collins co-authored

with colleagues; Effective Hand & Upper Extremity Treatments for Performing

Artists and Musicians: Identifying Evidence Based Research. The goal of the

study is to establish evidence-based protocols and a “gold standard” level of care

for a unique type of “athlete” currently not represented in sports medicine protocols

developed for “traditional athletes.” This data will support development

of early training programs and preventive care integral for the lifelong careers of

musicians and broader performing artist population. It will also contribute

to a global database and translate into a higher standard of care and universal

protocol for non-musician patients experiencing similar tendinopathic

and repetitive stress conditions.

“Our research on repetitive and overuse syndromes with professional

musicians will easily translate to the general population. These initiatives

at Houston Methodist are just the beginning of a real shift in the paradigm

of how we care for patients,” says Collins.

“Our research on repetitive and overuse syndromes with professional musicians will easily translate to the general population. These initiatives at Houston Methodist are just the beginning of a real shift in the paradigm of how we care for patients.”

Evan Collins, MD, MBA Vice Chair, Center for Performing Arts Medicine


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NEW ALTERNATIVES TO OLD TECHNIQUES: OPTIONS FOR PATIENTS

Specialists at Houston Methodist Orthopedics & Sports Medicine are leading the way in the advancement of

sophisticated ankle implants and cartilage replacement techniques. Here, the orthopedic surgeons and dedicated

surgical team treat a variety of ankle injuries, from acute trauma to chronic problems that result from old

injuries or surgeries performed elsewhere that have failed.

The ankle has historically been a difficult joint to replace, primarily due to the large amount of bone

resection required and the lack of excess tissue necessary for adequate healing and recovery. Working with a

recently developed three-component implant that requires less bone resection, known as the Scandinavian

Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion in

the ankle compared to traditional fusion.

Cartilage replacement is a new technique in use at Houston Methodist when arthroscopy of the ankle fails.

“The problem with an ankle sprain is the cartilage is often damaged which can cause chronic, long-term

consequences such as arthritis. The articular cartilage can be bruised when too much pressure is exerted on it but

the injury to the cartilage doesn't manifest until months later,” says Pedro Cosculluela, MD, orthopedic surgeon.

“The damaged cartilage or exposed bone can be replaced by small cylinders of cartilage and bone that are

obtained from areas that are not weight-bearing, or from allografts or cadaveric tissue. A second option is

to use cadaver grafts and remove a plug to cover the hole that’s in the patient’s ankle,” says Kevin Varner, MD,

interim chair of the Department of Orthopedic Surgery. “Both ankle replacement with the STAR prosthesis

and cartilage replacement are new, viable alternatives to standard ankle repair that consisted primarily

of joint fusion,” says Varner.

TACKLING THE DAMAGED ANKLE


Working w ith a recent ly developed three-component implant that requires less bone resect ion, know n as the Scandinavian Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion in the ankle compared to traditional joint fusion.

Based on its reputation of excellence in sports

medicine, Houston Methodist is the destination

of choice for Houston’s premier sports teams and

fine arts organizations. “We’re extremely proud

to be the official health care provider for the

Houston Texans, Houston Astros, Houston Dynamo,

Rice Athletics, and RodeoHouston,” says David

Lintner, MD, chief of sports medicine at Houston

Methodist Hospital. “Performers can suffer from

injuries as well – not just athletes. And so we

are also the official health care provider for the

Houston Symphony, Houston Ballet and the Houston

Grand Opera. We are able to provide them with the

best care available, but we learn from them as well.

Performers and athletes give us unique insights into

the extremes of human performance.”

Houston Methodist’s commitment to excellence in

sports medicine at all levels is evident in its support

of the Houston community student athletic programs.

Physicians serve as team doctors and consultants

to many of the areas middle and high school teams.

During the fall sports season, the physicians host

Saturday morning clinics to help student athletes quickly

get treatment for, and recover from, injuries incurred

during a week of practice and games. The clinics provide

easy access to specialists and physical therapists as

well as on-site imaging and rehabilitative services.

CARING FOR THE UNIQUE NEEDS OF ATHLETES, FROM ELITE PROFESSIONALS TO STUDENT ATHLETES


Orthopedics18

The specialists at Houston Methodist Orthopedics & Sports Medicine aspire to maximize all aspects of human performance through the multidisciplinary collaboration of leading orthopedic surgeons, primary care sports medicine specialists, athletic trainers and physical therapists.

Houston Methodist is the destination of choice for Houston's premier sports teams and fine arts organizations.

ATHLETIC TRAINING PROGRAM: REGIONAL HEALTH CARE EXTENDERS


The Houston Methodist Athletic Training Program has 19 full-time

trainers that serve over 500 schools across the region. “Our program

is unique because of its purpose and execution,” says Jace Duke,

ATC, LAT, operations coordinator of Athletic Training Services.

“As regional extenders, our trainers take Houston Methodist’s

world-class medical services beyond the walls of the hospital and into

communities where top-notch sports medicine care is often unavailable.”

In 2013, Houston Methodist expanded its outreach to east and

north Texas by partnering with several large school systems

to provide athletic trainers to support their athletic programs.

COMPREHENSIVE PHYSICALS THROUGH PRE-PARTICIPATION STUDENT PHYSICALS EVENTS

5001,500

19 FULL TIME LICENSED ATHLETIC TRAINERS

OVER

OVER

SCHOOLS SUPPORTED THROUGH THE ATHLETIC OUTREACH TRAINING PROGRAM

HOUSTON MITIE AT A GLANCE

26SURGICAL SPECIALTIES FROM ACROSS THE WORLD

SQUARE FEET OF EDUCATION AND RESEARCH SPACE

40,000

20,000MORE THAN

LEARNERS SINCE INCEPTION

6,300MORE THAN

LEARNERS IN 2013

HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION (MITIESM)

MITIE offers multidisciplinary, hands-on learning opportunities using advanced imaging systems and robotics.

Surgeons and other health professionals are able to continually refine and acquire new skills that allow them to

perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools,

our research programs are focused on the development and assessment of emerging technologies and technical skills

to improve the care of patients through less-invasive therapies. At MITIE, the finest researchers and clinicians are

building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.

LEADING MEDICINE

One of the largest and most comprehensive education and research facilities in the world, MITIE is leading the practice of medicine for physicians and health care providers.

For more information, visit mitietexas.com


Orthopedics20

20,000


ORTHOPEDIC SURGERY RESIDENCY PROGRAM

For over 50 years, Houston Methodist has served as a teaching hospital for Orthopedic surgery residents.

Today, the Houston Methodist Orthopedic Surgery Residency Program is accredited by the Accreditation

Council for Graduate Medical Education (ACGME) and is under the directorship of Bradley Weiner, MD,

vice chair (Academics) of the Department of Orthopedic Surgery. The residency program provides a

unique structure designed on a foundation of evidence-based care, surgical mentorship and academics.

Our residency program accommodates three residents per year for a total of 15 residents. Our teaching faculty

integrates attending physicians in all subspecialties including joint reconstruction, spine, sports medicine, hand

and upper extremity, foot and ankle, trauma, pediatrics, oncology and general orthopedics. All attending

physicians are fellowship-trained, and their average duration of resident teaching experience exceeds eight years.

Orthopedic surgery residents experience hands-on surgical training with subspecialty rotations,

mentorship style. Within the Methodist Institute for Technology Innovation and Education (MITIE),

considered by many as the top surgical simulation center in the world, cadavers are used to teach anatomy

and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical

techniques. Residents work exclusively with one or two attending on the service – in clinic, on the floors,

in the ORs and in personalized didactic and case sessions. This immersion-style of subspecialty training

provides the best possible educational setting for our residents.

Our residents are actively engaged in research from their first year of residency, and are required to dedicate

four months to Orthopedic research carried out in the Surgical Advanced Technology Laboratory (SATL)

with a focus on nanotechnology and tissue engineering.

ADULT RECONSTRUCTIVE SURGERY FELLOWSHIP

A one-year fellowship in Adult Reconstructive Surgery is designed to provide clinical and research experience in

total knee and hip replacement, with an emphasis on muscle-sparing reconstructive surgical approaches.

“Our fellows get a broad exposure to a high volume of diverse patients. They will see straightforward and

complex hip and knee replacement cases and will learn a variety of state-of-the- art techniques and procedures,”

says Stephen J. Incavo, MD, orthopedic surgeon and hip and knee replacement specialist.

Research is a highlight of the fellowship program, and the Houston Methodist research facilities are

available to each fellow to help facilitate investigation that is performed in direct collaboration

with teaching faculty and the dedicated staff of engineers, clinical research specialists and computer scientists.

PREPARING FOR TOMORROW: ORTHOPEDIC SURGERY ACADEMIC PROGRAMS

Within MITIE cadavers are used to teach anatomy and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical techniques.

TRAINING THE NEXT GENERATION OF SPORTS MEDICINE SPECIALISTS


Orthopedics22

Houston Methodist provides comprehensive residency and fellowship programs aimed at training the next generation of sports medicine specialists.

ORTHOPEDIC SPORTS MEDICINE FELLOWSHIP

The Orthopedic Sports Medicine Fellowship at Houston

Methodist is unique based on its high clinical volume

and “hands-on” teaching experience in the clinic and

on the field.

“We believe that sports medicine is about more than just

arthroscopic surgery,” says David Lintner, MD, chief of

sports medicine at Houston Methodist Hospital. “Our fellows

have huge clinical and surgical volumes. They also cover

games and practices for professional and college teams, and

spend almost as much time in the training room and on the

field as they do in surgery and clinic. Sports medicine is about

helping athletes realize their full potential on the field.”

PRIMARY CARE SPORTS MEDICINE FELLOWSHIP

This one-year fellowship provides fellows in certain

specialties, such as internal medicine, family medicine,

pediatrics, emergency medicine and physical medicine/

rehabilitation, with a broader understanding of the

unique needs of the athletic population – setting a

precedent in sports medicine training. The fellowship

operates out of two hospitals in the Houston Methodist

system – Houston Methodist Sugar Land Hospital and

Houston Methodist Willowbrook Hospital – and is

academically attached to the Houston Methodist Family

Medicine Residency Program.

“Although the primary care sports medicine physicians

are under the Department of Orthopedics, our fellowship

emphasizes care of the whole athlete,” says Scott Rand,

MD, FAAFP, CAQSM, director of the Primary Care

Sports Medicine Fellowship at Willowbrook Hospital.

More than half of the fellowship training focuses on

non-musculoskeletal medical problems in athletes

such as metabolic issues, heart screenings, asthma,

concussion management, altitude medicine and medical

problems in endurance athletes.

Primary care sports medicine is about providing the

right care at the right time from the right provider for

athletes of all sports. One such example is concussion

management which requires more study in the field of

neurology than a orthopedist would normally pursue.

“We see between three and six concussion patients a day,

so we develop the expertise to appropriately treat

concussion given this volume. This includes treating the

initial injury and understanding sport-specific issues

that can influence crucial return-to-play decisions,” says

David A. Braunreiter, MD, CAQSM, director of the

Primary Care Sports Medicine Fellowship at Houston

Methodist Sugar Land Hospital.

“This specialty and our fellowship specialize in a

population of people, not a specific disease process,” says

Dr. Rand. “Athletes typically don’t like to go to the doctor,

because they are generally healthy and know a lot about

their own body. So we seek the appropriate treatment,

which doesn’t always mean surgery. Athletes just want to get

fixed when they are broken and become better athletes,

and that’s what we help them do.”

PHYSICAL THERAPY RESIDENCY

The physical therapy residency is an APTA-credentialed

post-professional residency for physical therapists who want

to become a board certified sports physical therapist.

“In addition to caring for patients in the clinic, our

PT residents also participate in structured learning

with the orthopedic surgeons and fellows. We have

weekly hands-on training on specific topics, including

the cadaver lab at MITIE ®. However, they are also

covering sporting events out in the fields and on the

courts, which are integrated with the athletic trainers and

physicians,” says Matt Holland, PT, CSCS, director of the

Physical Therapy Residency Program.


The primary care sports medicine fellowship provides a broader understanding of the unique needs of the athletic population – setting a precedent in sports medicine training.

Dr. David Braunreiter, MD, CAQSM Director, Primary Care Sports Medicine Fellowship at Houston Methodist Sugar Land Hospital

At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list. For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list. Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.

FAST FACTS*

132Operating Rooms

2,157Licensed Beds(1,721 operating beds)

4,471Affiliated Physicians

8,150International Patient Encounters (from 90 foreign countries)

15,791Employees

85,042Inpatients in 2013

234,944Emergency Room Visits in 2013

616,317Outpatient Visits in 2013

*Houston Methodist data includes five hospitals in Greater Houston

HOUSTON METHODIST LEADING MEDICINE YESTERDAY, TODAY, AND TOMORROW

FORTUNE is a registered trademark of Time Inc. and is used under license. From FORTUNE Magazine, February 3, 2014 ©2014 Time Inc. FORTUNE and Time Inc. are not affiliated with, and do not endorse products or services of, Licensee.

See all the ways we’re leading medicine at hmleadingmedicine.com

Accelerating discovery and delivery to patientsAt Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.

LEADERS IN RESEARCH

More than 840 active clinical protocols$55m TOTAL RESEARCH FUNDING IN 2013

Photo courtesy of WHR Architects, Inc. © Aker/Zvonkovic Photography, Houston, Texas

Houston Methodist Hospital6565 Fannin Street Houston Texas 77030 houstonmethodist.org/orthopedics

LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW.At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.

Houston Methodist Orthopedics & Sports Medicine Annual Report 2013

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Transcript of Houston Methodist Orthopedics & Sports Medicine Annual Report 2013