LSU Department of Orthopaedic Surgery - Fall 2019 Newsletter

Beyond the Bone

LSU Health Sciences Center Department of Orthopaedic Surgery 1542 Tulane Avenue, Box T6-7 New Orleans, LA 70112 Phone: (504) 568-4680 Fax: (504) 568-4466 https://www.medschool.lsuhsc.edu/orthopaedics/

Department of Orthopaedic Surgery

Fall 2019

Contents

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On the Cover: The 2019 Graduates: Drs. Jack McKay, Neuyan McLean, Thomas Lucak, and Vikas Patel).

Message from the Chair

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Focus on Faculty

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Faculty News

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Research News

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Awards & Accolades

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School Ties

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Resident Spotlight

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Resident News

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Research Day Photos

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Graduation Photos

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Tiger Bones Event Photos

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Tiger Bones Info & Calendar

Acknowledgements WRITERS Lori Green EDITOR Lisa Stang, BSN, RN, CCRP PHOTOGRAPHER Jeremy Schroth CONTRIBUTORS Vinod Dasa, MD Luis Marrero, PhD Linda Flot

Message from the Chair

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ne of the hallmarks of LSU Health Sciences Center and the Department of Orthopaedics is excellence in healthcare delivery for all patients. Our commitment means using our healthcare training, research, and knowledge to identify solutions that work for each patient. The support we have received over the years from the community and our philanthropic partners has ensured we can continue to explore ways to enhance education, expand our innovative research, and improve the health and well-being of all of Louisiana.

We have made great strides in our efforts to build on a legacy of training outstanding orthopaedic surgeons who provide quality care. In the last year, we have expanded staff, engaged in higher-level research, and graduated a wonderful group of residents who are our next generation of orthopaedic physicians, surgeons, and researchers.

Inside these pages, you will read about Dr. Michael Heffernan’s service project in Jamaica, learn how we are building opportunities for residents to develop strong skills outside of the clinic, and meet some of our faculty. Because our translational research is part of a strategic and intentional focus to build a strong care pathway for every patient we treat, irrespective of background, we also take a look at the work being done there.

We have just completed a rigorous review of our program by the Accreditation Council for Graduate Medical Education (ACGME), receiving accreditation for the next ten years. ACGME sets standards for effective training programs and monitors compliance for current and best practices in the field, evaluates efforts to cultivate a team-based learning environment and culture, and our ability to educate and train physicians dedicated to providing exceptional patient care. All of us are indebted to Dr. Michael Hartman and Residency Coordinator Linda Flot. Their organization and leadership saw us through this process and to such a successful outcome!

Our continued commitment to the advances and enhancements we make each day because of the philanthropic support we receive from alumni, grateful patients, and friends. We are grateful for their trust in our efforts to ensure equity and quality, and pledge to continue serving New Orleans, the state, and the world.

Robert Zura M.D. Robert D’Ambrosia Professor & Chair Department of Orthopaedic Surgery LSU Health Sciences Center New Orleans

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Focus on Faculty

Global Connections Promote Growth and Gratification By: Michael J. Heffernan, MD

T

he short trip to Kingston Public Hospital (KPH) was several years in the making.

Two years ago, I made it a priority to participate in a surgical mission volunteer opportunity.

After some research, multiple meetings, and various phone calls, my search led me to a meeting with Dr. Ken Paonessa at the Scoliosis Research Society Annual Meeting in Philadelphia. The passion and humility of Dr. Paonessa confirmed that I had found a good fit, and I made plans to join the Duncan Tree Foundation team on the next trip to Jamaica.

Our team, which included two surgeons, two neuromonitoring staff, two reps, and several foundation staff, stayed at a Kingston hotel close to the hospital. The group had been on numerous trips and had a strong partnership with physicians from Kingston Public Hospital (KPH).

Day 1 included a pre-op/indications clinic in combination with the surgeons and anesthesia team from KPH. I enjoyed meeting with my new patients and discussing the cases and interfacing with the Jamaican residents, medical students, surgeons, and the anesthesia team. After clinic, our visiting team worked with the local OR techs to get the sets ready for the next day.

Day 2 was our first day in the OR. I was paired with an intern, and this would be his first spine deformity surgery. We performed two AIS cases. Significantly limited instrumentation and unfamiliar staff helped me to accomplish one of my main goals for the trip: to get outside of my comfort zone. I was stretched past my pre-established limits and realized that they were not my actual limits. Interacting with a new team and establishing rapport, as well as achieving great outcomes with less “stuff � than I have in the US for my new patients, was rewarding. It was a great day. I slept well.

Day 3 I was in the other OR and had the opportunity to work with one of the attending surgeons from KPH. Dr. Bogle and I are close in age and share some similar interests. We took care of a severe congenital kyphoscoliosis case followed by an idiopathic patient. We lost signals during the congenital kyphoscoliosis

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Above: The physicians, residents, staff, and students from this medical mission trip pose for a picture at KPH. Below: Dr. Heffernan and Dr. Bogle performing surgery on a local patient.

case and worked through this as a team. The whole day was essentially like a mini-conference. We shared philosophies, surgical techniques, agreed, disagreed, and learned from each other.

Day 4 led to another chance to work with the intern on an 85 degree lumbar curve in a patient with Down Syndrome. After the cases wrapped up the day, we spent the afternoon in the mountains

Focus on Faculty

overlooking Kingston at a restaurant to unwind and share our experiences as a team. It was an excellent opportunity to reflect on the trip and spend time with each other.

Day 5 we rounded on the patients in the morning with the KPH residents and Dr. Bogle. The open-air ward was different than my hospital, but the early mobilization and recovery were quite similar.

The patients were in good spirits and very happy. After saying goodbye, our visiting team headed to the airport.

Things that I learned: • True growth only occurs outside of one’s comfort zone • Each day presents its own unique challenges • Resources do not dictate humanity • Relationships add richness to life The opportunity to work with and learn from people in different cultures is an overwhelmingly positive experience. The challenges made me a better surgeon. My interactions with staff and patients made me a better person, and the relationships built will hopefully be long-term. I can’t wait until the next trip.

Right: (top) Drs. Heffernan with Dr. Paonessa and Dr. Bogle. (bottom) Drs. Heffernan and Paonessa with the students and volunteers from the Duncan Tree Foundation mission trip.

Below: Drs. Heffernan, Paonessa, and Bogle.

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Focus on Faculty

Collegiality and Connectivity

By: Andrew G.S. King, MD, MB.ChB, FRACS, FACS

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lobalization may be a hot topic politically, but Orthopedic surgery has always been global, with the best ideas from many countries being incorporated into how we practice here in New Orleans. As a spine fellow in 1980, I was taken to Mexico City to check out a “crazy Mexican” called Eduardo Luque. A year later, we held the first Luque technique course here in New Orleans, and Dr. Luque became a friend and frequent visitor after. Some years later Moshe Solomonow and I spent a week in Paris France visiting spine surgeon Raymond Roy-Camille. The plan was to get his ideas and use them to make the New Orleans pedicle screw system. We never did, but instead had his team come to New Orleans for a pedicle screw course we hosted. Residents from the D’Ambrosia era will remember that the Boss was always jet setting around the world and many of the friends he made passed by New Orleans for presentations. I remember Professor Illizarov for one.

Earlier this year, I spent three months as a locum attending spine surgeon at Starship Children’s Hospital in Auckland, New Zealand.

After nearly 40 years of busy academic orthopedic practice in New Orleans, it was interesting to return back to New Zealand where I had done my medical and orthopedic training, and contrast medicine in New Zealand with practice in the United States.

I was working in Auckland at the time of the mass shooting in the mosque in Christchurch. Christchurch is in the South Island of New Zealand; Auckland is in the northern part of the North Island. I was sharing an office with Mr. Andrew Graydon, an Orthopedic Surgeon based at Starship Children’s Hospital (notice how surgeons in New Zealand are called Mr., not Dr.!). He asked me to look at a PowerPoint presentation of a patient under his care who had been flown up from Christchurch. It was a 4-yearold child hit by a bullet that had shattered his pelvis, injured his common iliac vessels on one side, and left a significant defect in the abdominal wall where the bullet had exited. He had been saved by heroic emergency vascular surgery in Christchurch, where there had been an international conference of vascular surgeons held in Christchurch at the time. An Ethiopian surgeon attending the conference who was experienced with gunshot wounds, went to the hospital and helped with the vascular repair). The child was then transferred to Starship in Auckland for the more long-term healing of his bones and abdominal defect. Andrew showed me a PowerPoint he had made of the child’s x-rays and asked if I had any comments, given that I practice in a city that has a reputation

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as being one of the gunshot capitals of my country. He had placed an external fixator on the pelvis but confessed that he had little experience with these kinds of injuries. However, most gunshot injuries I have experienced were in young adults, so I had minimal experience to advise Andrew Graydon’s 4-year-old patient.

However, I immediately forwarded the PowerPoint via email to Dr. Peter Krause who, after giving an orthopedic treatment opinion, in turn, sent it to Dr. John Hunt, (chief of trauma at University Medical Center) for an opinion on repair of the abdomen. Their replies to Andrew Graydon’s questions and advice on treatment came back in less than an hour, and their opinions were beneficial in this child’s care plan.

As I reflected on this story, I felt it underlines the connectedness of knowledge in the world today. If needed, we have ready access to world experts for the most demanding patients. Many of us regularly post on online forums where surgeons from around the world seek answers for difficult cases Doctor Graydon has a passion for orthopedic tumor surgery in children and adolescents and has many exciting new ideas on treatment. He will be coming to New Orleans in February of next year as the G Dean Macewen lecturer at Children’s hospital.

And the little 4-year-old boy who Andrew Graydon was caring for at Starship Hospital? Last I heard he is doing great!

“Orthopedic surgery has

always been global, with the best ideas from many countries being incorporated into how we practice here in New Orleans.”

Faculty News Clinical Staff Introductions Paul Phillips, IV, MD

Assistant Professor of Clinical Orthopaedics

Paul Phillips IV didn’t think he would follow in his father’s footsteps as an orthopaedic surgeon. However, after graduating from Texas State University and subsequent work in the healthcare field as an analyst and administrator at a California HMO, he knew he wanted to be a doctor. His natural interest in taking care of injuries and fixing broken bones led him to find his calling in orthopaedics.

Dr. Phillips grew up in Texas and California and looks forward to settling in New Orleans. “New Orleans is the perfect blend of my two homes,” he said. “New Orleans people are warm and genuine like Texans, and easy-going and fun-loving like Californians.” His wife, Alyce Richard, an anesthesiologist, is originally from the New Orleans area. They knew they’d move to the city eventually.

“I’m fortunate to find a place like LSU Health Sciences Center (LSUHSC) that really supports my goal of taking care of people,” he explained. “It involves three parts: collaboration, education, and community service.”

Dr. Phillips believes that quality healthcare takes collaboration by a network of people to ensure proper execution and delivery. “As a surgeon, you rely on colleagues and other team members to help get patients ready for surgery – or avoid it altogether,” he said. Creating that network requires excellent communication and trust to deliver quality patient care.

“I plan to network with physicians from every discipline and specialty,” Dr. Phillips said. “I want to create a strong team dedicated to helping people who need orthopaedic care.”

“I’m a strong believer in education and staying up to date with advances in medicine,” he explained. “LSU has access to the latest in orthopaedic care and is committed to sharing this with patients as well as medical students and trainees.” As a faculty member at the LSUHSC School of Medicine, Dr. Phillips will be one of those who ensure the next generation of orthopaedic surgeons develop the essential skills they need to deliver excellent healthcare.

“Education extends to patients as well,” Dr. Phillips explained.

“Helping people learn about their orthopaedic problems so they can take charge of their physical well-being is essential. People need to understand how their lifestyle can affect how they feel.”

“In the end, my job is all about community service,” said Dr. Phillips.

“Helping people feel better is at the core of what I do, and that’s how I serve my community.” Dr. Phillips described his job as fun and dynamic, with the best part helping patients ‘live their best life’ by treating any orthopaedic problems that may be a complicating factor.

Dr. Phillips completed college at Texas State University before engaging in graduate studies in pathology at the University of Southern California. He completed medical school at Boston University School of Medicine, and a surgical internship at Beth Israel Deaconess Medical Center. His orthopaedic surgery training included a residency at the State University of New York in Buffalo and specialty training in orthopaedic sports medicine at Houston Methodist Hospital.

Dr. Phillips has served as assistant team physician for the Houston Astros, Houston Rockets, Houston Texans and Houston Dynamo.

He also was assistant team physician for Rice University Athletics, a consultant to the NASA Astronaut Corp in Houston and team physician for a Houston-based high school. Dr. Phillips specializes in arthroscopic procedures of the shoulder, hip, and knee, performs shoulder and knee replacements, and treatment of fractures throughout the body.

Matt Rubacha, MD

Assistant Professor of Clinical Orthopaedics

Matt Rubacha, MD, is brand new to the state – he just moved at the end of summer 2019. Already he and his family are settling into life in Lafayette. “We’re excited about the great music, food, and culture Louisiana has to offer,” he said.

A Toronto, Canada, native, Dr. Rubacha didn’t always see himself in medicine. “We had ‘Take your kid to work’ days,” he explained. Because his aunt is a nurse, he got to visit the hospital. “That really piqued my interest in medicine.”

He received his undergraduate degree from the University of Toronto, returning there for his residency. He received his medical degree from St. George’s University in the West Indies.

“I look forward to working with the team here in Lafayette,” Dr. Rubacha said. “They have a great program at here.”

He also is excited about building a practice in Lafayette. His wife is a family doctor with a focus on primary care in sports. They have one son just five months old.

In addition to building a practice, he is excited about engaging with the residents as a teacher and mentor. “Teaching is a two-way street,” he explained. “They teach me something with every encounter we have. I like to think my international experiences and training help bring different perspectives to their patient care.”

Dr. Rubacha is thrilled to work with LSU, where the emphasis is on quality patient care, and the residents have an opportunity to develop autonomous clinic skills. “It is really exciting to be part of such a strong collaborative team that fosters such diverse interactions for residents,” he said.

(continued on page 6)

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Faculty News (continued from page 5)

Ann-Elise Bertrand, PA-C

Colette Hilliard, MS, EMT, CCRC

The profession of physician assistants (PA) is still a growing healthcare career option. In the Department of Orthopaedics, Dr. Zura and the team are making great use of the skills of PA AnnElise Bertrand.

“Research is really about creating and thinking,” Colette Hilliard said. “It is fusing art and science to develop cutting edge science that advances the field and improves patient therapies and outcomes.”

Physician Assistant

A native of Lafayette, Ms. Bertrand received her undergraduate degree in kinesiology and biology from LSU, then her masters from the Physician Assistant Studies Program in the LSU Health Sciences Center New Orleans School of Allied Health Professions.

“PA seemed a natural choice to fulfill my desire to work in healthcare in a meaningful way,” she said. PAs help create consistency for patients, and, with the residents, help manage patients’ care to ensure quality.

The PA profession is trained in diagnostics, to problem solve in all clinical aspects, including prescribing medications and assisting in the operating room. “I work with the attendings and the residents, who are committed to providing the best care possible for our patients,” Ms. Bertrand said. “I enjoy working in this very positive team atmosphere.”

LSU was a great place to learn and train, and now pursue her career, Ms. Bertrand noted. “Faculty made sure I was trained well. I get to work with a group of physicians and residents who are dedicated to doing our best for every patient. It is a rewarding place to train and practice healthcare.”

Leaving Louisiana wasn’t a serious option for Ms. Bertrand. “I love Louisiana and the Saints!”

She knew New Orleans was the right place to settle because of her love of good food and live music. “The people in New Orleans are kind and good-spirited,” she said.

She highly recommends the Mid City area and City Park to every resident and visitor. “City Park is a beautiful place to walk around and relax,” she noted. “Mid City has a lot of great food!”

She and her fiancé, along with their two fluffy dogs, enjoy walking along Frenchmen Street, listening to the music. She noted, “It’s always a great time.”

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Research Staff Introductions Senior Clinical Research Coordinator

Returning to a role that fuses art and science proved too great a pull for her, and she opted to come out of retirement to return to LSU Health Sciences Center New Orleans and help residents, fellows and faculty conduct vital research to improve understanding, advance orthopaedic skills and enhance patient care.

A Plant City, Fla., native, Ms. Hilliard moved to New Orleans in 2017.

At one time she worked with the medical staff in Shreveport and has now moved here to work with the Department of Orthopaedics. “I found that I liked administrative work,” she explained. She pursued her masters in science in health services administration, graduating from California State University, Fresno; and is certified as a clinical research coordinator and an emergency medical technician. She has volunteered with the American Red Cross for nearly 36 years.

Some of her first research with animals helped develop her strong commitment to research ethics. “When you work with research supported by the FDA, you know they’re working hard to ensure compliance, patient safety, and the ethical reporting of results.”

For more than 30 years, Ms. Hilliard has been involved in clinical trials for treatment therapies and devices. The LSUHSC Department of Orthopaedic Surgery currently oversees some 70 research projects in the LSUHSC Department of Orthopaedic Surgery, with a current focus on patient recruitment for a knee pain trial.

She sees her work as critical to medicine, chiefly because today’s doctors are time-challenged to fit essential research into a schedule committed to seeing and caring for patients. “The orthopaedic scientist is nearly extinct,” she noted. The LSUHSC model of training excellent orthopaedic surgeons and fostering exceptional patient care provides the perfect forum for Ms. Hilliard. “I like working in an academic environment because the emphasis is on finding a solution,” she explained. The team in the Department of Orthopaedics offers a comprehensive framework for someone dedicated to utilizing research to uncover solutions. “I love working at LSU,” Ms. Hilliard shared.

Her role as coordinator means Ms. Hilliard is reviewing and assessing patient candidates; scheduling clinic visits for participants; recruiting companies; writing contracts, grants, and budgets; developing reports for publication and public relations; and serving as the conduit between patient/participant and the physician/ researcher. Hillard explained: “This is a challenging and dynamic field. You’re engaging with participants, developing protocols to ensure legal and ethical compliance, managing data gathering and entry, and assisting with the publication of results.”

She also helps reinforce to participants that they are the real heroes.

“Their willingness to participate is a gift to the future,” Hilliard noted. While she can never guarantee the outcome, “without patient participation, we would never be able to look for the answers.”

Faculty News

Visiting Professors

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n initiative begun by Dr. Zura remains a strong influence on and for residents.

“Leaving the Tiger’s Den” was created as a way to introduce residents to training options and opportunities outside of patient care.

“We have an opportunity to learn from financial and business experts,” said Dr. Neuyen Mclean, a 2019 graduate. “Dr. Zura wanted to make sure we knew there was more to medicine than seeing patients.”

Residents and medical students received a wealth of knowledge and insight from this year’s guest speakers. With a focus on everything from diversity to trauma, they heard from experts about the challenges and opportunities that lie ahead.

The year culminated with a visit from Dr. Eric George, noted New Orleans hand surgeon and renowned philanthropist. He is also regarded as a leading entrepreneur inside and outside the world of medicine.

“I was honored that residents asked me to speak,” said Dr. George.

“We wanted to hear from someone who is making a significant difference in the community,” said Dr. Mclean. “Dr. George not only has a thriving hand clinic, but he has invested in the health of the community by ensuring its arts, social, and educational programs thrive.”

However, Dr. George reminded residents that the number one priority was to give quality care to every patient. To do this, he said, “you must listen to your patients. Every patient knows what’s wrong with them even if they don’t know what it is. Your job as a physician is to figure what they’re trying to tell you.”

“Listening shows you care,” he added.Every physician has time constraints. The listening, he acknowledged, can be challenging because of the demands on his time. But he remains an admired and successful physician because of this second piece of advice: with the right help and the right questions, you can get to focus on the patient’s issue.

This ability to identify those experts has helped advance Dr. George’s work outside of the office, as well. “The secret is to accept that you are not an expert in everything and you can’t be everywhere,” he said. Find those experts, rely on good help. “Ditch the me mindset for the “we” mindset, and you can change the world.”

in an ambulatory care center, hospital, or instrument – an area or opportunity that is near to the everyday work and to which you can add (through your expertise). As you learn that world, move into the next level.

“If you have an interest in a program or initiative, volunteer for the Board,” he said. Once you have a concept on how the Board works, start moving among the Board offices until you are named chair.

“The others on the Board are noted for other areas of expertise,” he explained. “Listen to them and how they conduct business in order to start honing those skills in yourself.”

For Dr. George, moving into an entrepreneurial role started with one rule: take care of the family. “Save your money and always take care of your family,” he said. And, with the extra dollars, “invest in something you believe in.”

He gives the we mindset credit for his success here, as well.

“Make sure you understand that it is a group that will help you,” he said. “Work with people; learn from people.”

Doctors, and particularly surgeons, have spent a long time learning their skills, he explained. “This makes them great students,” said Dr. George. “Of course, anyone can learn something new. You just have to listen and be willing to learn from others.”

He complimented the residents and students at LSU Health Sciences Department of Orthopaedics.

“This is really a great program that has selected tremendous, high-quality residents who want to learn,” he said. “The faculty is a talented group of people who have the right attitude and are committed to helping the students learn.”

Dr. Mclean appreciated the perspective offered by Dr. George. “He learned how to navigate the patient waters and be a successful physician and community leader,” he said. “He inspired all of us by explaining how to practice and practice better.”

“This is really a great program that

has selected tremendous, highquality residents who want to learn.

The faculty is a talented group of people who have the right attitude and are committed to helping the students learn.”

“Start with what you know,” Dr. George encouraged. “When you first start out, stay in your lane or area of expertise.” Early on, invest

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Faculty News (continued from page 7)

Last Year’s Visting Professors September

Paul Khanuja, MD Adult Reconstruction

October Dante Leven, MD Spine November Edward Perez, MD Trauma

J.A. “Tony” Herring, MD

G. Dean MacEwan Lectureship (CHNOLA) Pediatric

December Robin McGoey, MD Chief Administrative Officer, University Medical Center January Robert Maupin, MD Diversity February Heather Vallier, MD Trauma March Wael Barsoum, MD Adult Reconstruction April

Keith Wapner, MD Foot & Ankle

May

Louis Catalano, MD Dr. Rekant and former LSU Orthopaedics Residents, Dr. Bliss and Dr. Fugarino Hand

June

Eric George, MD Founder and CEO, Omega Hospital Career advice Douglas Letson, MD Tumor Research

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Research News Testing the Influence of Race on Severity and Global Pathology of Osteoarthritis Dr. Luis Marrero, PhD, Assistant Professor of Orthopedics, is leading a project entitled “Testing the Influence of Race on the Severity and Global Pathology of Osteoarthritis” co-submitted with Dr. Martin Ronis (Professor of Pharmacology) under the R21 mechanism to the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH). Preliminary data for this proposal was supported in part by U54 GM104940 from the National Institute of General Medical Sciences of the NIH, which funds the Louisiana Clinical and Translational Science Center.

during OA progression. We propose to classify patient subgroups by race (black vs. white) or OA stage (early vs. late) while ensuring equal distributions of sex, disease stage, mean age, and body mass index within each subgroup and 1) profile SF and various cell types from diseased and healthy knees by multiplex and quantitative PCR; 2) test the differential capacity of SF profiles by race to alter the behavior of normal joint cell types to promote disease severity and thus the incidence of disease hallmarks; and 3) correlate the molecular profile and influence of the SF from each OA patient with corresponding clinical measures of joint problems.

Project Abstract. Osteoarthritis (OA), a chronic health problem primarily associated with age, obesity, and mechanical stress, is a major cause of pain and disability and is associated with an extremely high economic burden. OA is a disease of the whole joint; in addition to causing cartilage degradation, OA promotes inflammation and fibrosis of the synovium, formation of osteophytes, microfractures of the subchondral bone, and meniscal tears. Retrospective analyses of prospectively collected patient-reported outcomes in our clinic show significant disparities in the pre-operative severity of knee OA pain, symptoms, and function by race. Black patients consistently report worse knee OA problems than white patients, regardless of disease stage and after controlling for insurance type, access to healthcare resources, and socioeconomic status. To evaluate biological factors that may help explain these racial disparities, we developed a repository to bank joint tissues and cell lines, synovial fluid (SF), and blood from consented knee replacement candidates and healthy organ donors. Scoring by histopathology of femoral condyles and synovium from 75% of banked sample sets shows an even distribution of OA progression in the condyles and inflammation of the synovium in black and white patients. We have validated these scores by correlation with secreted proteins relevant to OA symptomology and severity. For example, synovitis scores show a significant correlation (R=0.61; p=0.0002) with proinflammatory interleukin-6 in the SF from both black and white patients, suggesting that SF can serve as a local vehicle for predictors of disease state.

Moreover, we found that black OA patients had significantly exacerbated deposition of collagen in the synovial subintima and higher levels of TGFβ1, a major driver of fibrosis, in both the synovium and SF compared with white OA patients regardless of disease stage. High collagen deposition (Figure 1) and TGFβ1 were significantly associated with worse knee symptoms assessed using a widely used, validated patient questionnaire. We believe that the macromolecular content of the SF can directly influence various tissue components of the knee during OA. Further, we predict that racial differences in response to OA stem in part from how each patient’s unique assembly of proteins and tissue components differentially collaborate to affect OA severity. Accordingly, we aim to test the hypothesis that the SF in black OA patients maintains a more potent pro-fibrotic profile regardless of disease stage compared with white OA patients, and this difference drives disparities and more severe joint defects (e.g., fibrosis and osteophyte incidence)

Figure 1: Microscopic analysis of picrosirius staining (green) of collagen fiber deposition in the synovial membrane of a patient with (A) low and (B) high fibrosis.

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Awards & Accolades Faculty Promotions

Residents Michael Heffernan, MD Promoted to Associate Professor

Awards

Thomas Lucak, MD Andrew G.S. King Resident Teaching Award Highest Orthopaedic In-Training Award

Peter Krause, MD Promoted to Professor

Awards

Neuyan McLean, MD Jack Winter Award for Research

Stuart Schexnayder, MD Vinod Dasa, MD LinkedIn’s Top 10 Healthcare Voices in 2018

LSU School of Medicine/UMCNO Intern of the Year

Tyler White, MD Christopher Marrero, MD 2019 UMC Physician Champion of Health Equity Award Ronald J. Rooney Teaching Award For Excellence in Resident Education

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LSU School of Medicine/UMCNO Resident of the Year Nominee

School Ties

Tiger Cubs 1 2

Welcome to the LSU Orthopaedics Family!

1. Kaya Mili Patel, daughter of Rucha and Vikas Patel (2019 Graduate), born 4/4/19

2. Veronica Wolph Cable, daughter of Katherine and Matthew Cable (Assistant Professor), born 3/19/19

3 4 3. Paul Charles Roubion, son of Rebecca and Ryan Roubion (PGY3), born 4/29/19

4. Thomas Hayes Shelton, son of Courtney and Luke Shelton (PGY5), born 11/16/18

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5. Eva Theodora, daughter of Anna CohenRosenblum (Assistant Professor) and Michael Cohen, born 12/30/2018

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Resident Spotlight

Thomas Stang, DO

O

ver the last 20 years, Dr. Stang has uniquely experienced extreme situations and traumatic injuries.

As a Special Forces Medical Sergeant, aka Green Beret 18 Delta, he witnessed, stabilized and helped treat a variety of injuries that could have been careerending or life-altering.

The care and treatment provided to these military soldiers and citizens by orthopaedic surgeons helped shape his passion for continuing his medical career.

A Midwest native originally from Osceola, Wisconsin, Dr. Stang enlisted in the Army Reserves after high school and continued serving during his undergraduate years at the University of Wisconsin, where he pursued his Bachelor of Science degree in Biology. After September 11th, 2001, Dr. Stang enlisted into the active duty Army, declining his commission to the rank of officer, to pursue the career path that would take him to the tip of the spear, a Special Forces Medical Sergeant, the best of the best.

His responsibility as a Special Forces Medical Sergeant (SFMS) through five deployments meant overseeing the work at three clinics in both Afghanistan and Iraq which were built de novo for the local citizens. At capacity, they could treat some 150 patients a day. “I was able to mentor the local physicians to become self-sustaining, allowing the clinics to remain open and successful after we left,” he explained.

While much of the care provided while deployed was routine, Dr. Stang was challenged continuously with more challenging and complex medical problems like gunshot wounds, motor vehicle accidents and blast injuries. He remembers, “As the only medical provider for 100’s of miles there were a lot of sleepless nights.” When he wasn’t busy caring for the injured, as the senior medical sergeant, he was responsible for planning, organizing, implementing, and execution of MEDEVAC procedures and platforms for more than 1500 combat operations.

“I am also proud of the work I did as a liaison between the US Embassy and Yemen, in particular, the work I was able to do to help improve medical treatments and facilities located in that country’s capital and the surrounding areas, along with my efforts to help improve the countries emergency response system,” he said.

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The experiences he gained during this time helped solidify his career goal in his mind.

“I want to translate my diversified life experience into innovation, to improve efficacy and efficiency, building on the strong legacy of revolutionary care and treatment within orthopaedics,” Dr. Stang explained.

He somberly remembered one time while on foot patrol in Iraq, a blast from a 105mm Mortar improvised explosive device (IED) was detonated just 10 feet from him by a fellow soldier who also was a close friend. “I was the only medic on the ground,” he remembered.

“I did my best to get to him as quickly as possible, but I was only able to support and comfort my friend during his last moments, but for three others, I was able to stabilize and transport them to a higher level of care.”

He also sustained injuries from this blast that required surgery.

Because of postoperative complications, he spent nine months in and out of the hospital undergoing treatment and enduring pain beyond what chronic pain specialists could treat. Later that year, Dr. Stang was not only awarded his second Bronze Star for valor in the face of danger but also the Purple Heart for injuries sustained during combat.

“This was a very turbulent and seemingly unrelenting period for my family and me,” he said. “But in many ways, it was also a blessing because I now can completely appreciate what it means to be on the receiving end of the scalpel, the potential complications and related pain one can experience and the frustration of the recovery process.”

Dr. Stang completed his time in the military in 2012 and later went on to receive his medical degree from Lincoln Memorial University, DeBusk College of Osteopathic Medicine in Harrogate, Tennessee.

He is currently completing his fourth year of orthopaedic residency at LSU Health Sciences Center New Orleans, and is looking forward to interviewing for a Trauma fellowship position and eventually the next chapter of his life.

Resident Spotlight

Dr. Stang and his wife, Lisa, have been married for almost fifteen years. “She is my rock and my everything - without her, I would have never made it through the challenging times that I have gone through,” he explained. They have two children together, Nathan, 10, and Sophia, 8. “Balancing work and family can be difficult as a resident,” he explained, “But having such an amazing and understanding wife as well as a such a close-knit family of coresidents makes it manageable.”

When asked about why he chose LSU for his orthopaedic residency, he explained: “The faculty provide an individualized, unique and exceptional educational experience for each resident. They pay close attention to your operative skills and are very focused on helping you grow and learn so that you can be the best surgeon and doctor possible,” he explained. “The LSU Orthopaedic residency program offers an early, hands-on and immersive operative experience exactly what I was looking for in a program,” he added.

“Taking a shattered bone and putting it back together, making something work again – that’s where you make a difference in a patient’s life,” Dr. Stang explained. “You’re able to do something positive.” Dr. Stang recognizes that the vast life experiences he gained in the military and the opportunities he has had in New Orleans will all help shape him into the skilled, caring orthopaedic trauma surgeon that he hopes to one day be.

“I know what I want to do,” he said. “In many ways, I’ve already lived it. Given the training, guidance, and opportunity, I plan to perfect my skill set and expand my knowledge to provide exceptional care and quality educational experiences, as well as deliver innovative ideas and options into the field of orthopaedic surgery.”

Opposite page: (left) Dr. Stang in Baghdad, Iraq in 2007; (right) in the mountains of Yemen in 2005.

Left: Dr. Stang with his wife and kids last summer.

Above: (top) Dr. Stang treating a local animal in Afghanistan, 2005; (bottom) Treating a wounded Iraqi soldier who sustained multiple gunshot wounds during a combat operation in the back of a moving vehicle in Iraq, 2006.

“But in many ways, it was

also a blessing because I now can completely appreciate what it means to be on the receiving end of the scalpel, the potential complications and related pain one can experience and the frustration of the recovery process.”

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Resident News Congratulations, Graduates!

Dr. Jack McKay – Sports Medicine Fellowship at Andrews Institute in Gulf Breeze, FL Dr. Neuyan McLean – Hand and Microvascular Surgery Fellowship at The Hand Center of San Antonio, in San Antonio, TX Dr. Thomas Lucak – Hand Fellowship at University of Texas Southwestern in Dallas, TX Dr. Vikas Patel – Adult Shoulder and Elbow Reconstruction Fellowship at Cedars-Sinai Kerlan-Jobe Institute in Los Angeles, CA

Welcome, New Residents!

Matthew Darlow – McGovern Medical School @ University of Texas HSC - Houston Charles Hansen – Louisiana State University HSC – New Orleans Marc Schatz – University of Miami Jestin Williams – Meharry Medical College

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Research Day

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Graduation

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Graduation

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Tiger Bones

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Tiger Bones

We are grateful for those who have supported Tiger Bones, the Resident Educational LSU Orthopedic Resident Fund. Your generosity benefits the the LSU Orthopedic Residency Training Program - having a direct impact on its residents through expanded access to training experiences, technology updates, and educational opportunities that are necessary in a residency training program.

Your online donation can be made at https://give.lsuhealthfoundation.org/tigerbones OR if you prefer, please mail your check made payable to: LSU Tiger Bones c/o LSU Health Foundation 2000 Tulane Avenue, 4th Floor New Orleans, LA 70112 Questions: 504-568-5717 We thank you for your support!

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Calendar

Grand Rounds Grand rounds are held on Fridays from 7-8am at the Lion’s Building, 6th Floor Conference Room with didactic lectures and lab follow.

August 15 Trauma Lower Extremity

September 27 Adult Reconstruction

October 25 Spine

December 6 Pediatrics

January 17 Trauma Upper Extremity February 21 Sports/Lower Extremity

March 20 Adult Reconstruction

April 17 Tumor

May 15 Hand

June 5 Residency and Research

Date TBD G. Dean MacEwen Lectureship (at CHNOLA)

Visiting Professor - Andrew Graydon, MD (New Zealand)

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LSU Health Sciences Center Department of Orthopaedic Surgery 1542 Tulane Avenue, Box T6-7 New Orleans, LA 70112 Phone: (504) 568-4680 Fax: (504) 568-4466 https://www.medschool.lsuhsc.edu/ortho