University of Rochester Medical Center In Motion Newsletter

InMotion

UR Medicine ORTHOPAEDIC S AND REHABILITATION News | Volume 16 | Fall 2018

URMC Awarded $6 Million to Study Deadly Bone Infections see page 4

Synthetic Cartilage a ‘Game Changer’ Sports Medicine Surgeon Offers for Arthritis P. 3 Insights on Benefits of Biologics P. 5

Scoliosis Patient Returns to Horseback Riding Competitions P. 6

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

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Dear Friends and Supporters of Rochester Orthopaedics:

Paul T. Rubery, MD Marjorie Strong Wehle Professor of Orthopaedics Chair, Department of Orthopaedics and Rehabilitation

Contents 3 Synthetic Cartilage for Arthritis 4 Deadly Bone Infection Research 7 AI & Tendon Repair 8 Toast to Your Health Wine Auction 10 Surgeries Performed in Ethiopia 11 Teaching Myanmar Health Workers 13 New Training Tools, Award 17 New Residents & Graduating Fellows

ON THE COVER Image of a false-colored Trojan Horse Macrophage, one of several discoveries

by The Center for Musculoskeletal Research that may advance new treatments and possible cures for bone infections.

Cover Photo by Karen Bentley, CMSR Investigator & Director of Electron Microscopy

It’s a tremendous pleasure to welcome you to the Fall 2018 edition of In Motion. While this has been the name of this biannual update on activity in the Department of Orthopaedics and the Center for Musculoskeletal Research since its inception, a quick review of the articles shows how particularly apropos the title is today!

The University of Rochester continues to lead in orthopaedic surgery and musculoskeletal research.

This issue details groundbreaking research by Dr. Eddie Schwarz and his collaborators concerning infection, and more importantly, potential prevention of infection in bone. This work is the focus of a $6 million grant from the NIH recently awarded to the CMSR. Novel surgical treatments utilizing synthetic cartilage implants for arthritis of the great toe and thumb are being introduced in North America through the work of Dr. Judy Baumhauer and Dr. Warren Hammert.

Drs. Alayna Loiselle and Constantinos Ketonis are one of the first musculoskeletal research teams to introduce Artificial Intelligence (AI) and machine learning into the clinically critical assessment of the strength of surgically repaired tendons.

Education has always been a cornerstone of Orthopaedics at Rochester. Dr. Gregg Nicandri is a dynamic young sports medicine surgeon, and a true educational innovator. His techniques are changing residency training and earning national accolades. Outreach to the world is also a hallmark of leading academic programs. In this issue of In Motion, we profile the activities of two of our faculty, Drs. Mesfin and McDowell, as they bring orthopaedic care and education to the developing world.

We are tremendously proud of our graduating Chief Residents and our incoming Interns in Orthopaedics.

The University of Rochester is committed to training a workforce that more closely reflects our patients and our community. Our outstanding incoming class of young surgeons is another step in the right direction by a Department In Motion!

Finally, the University of Rochester has embarked on an exciting planning process to address the growth of our Department, and to keep pace with the needs of an aging, yet active, population. As we develop the Musculoskeletal Institute at the University of Rochester (more to come), we are grateful for the type of support detailed in the story concerning “A Toast to Your Health” wine auction, and for the ongoing encouragement and support from grateful patients, loyal alumni, and dedicated friends like you!

Paul T. Rubery, MD 2

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

By the Numbers URMC Orthopaedics & Rehabilitation 350,000 300,000 250,000 200,000 150,000 13 14 15 16 17 18 19 20 21 22

UR Medicine Orthopaedics Projected Visits Fiscal Year 2013 - 2022 URMC’s Department of Orthopaedics & Rehabilitation is experiencing unprecedented growth and expansion. With more than 50 board-

certified physicians,

the department projects the following for Orthopaedics and Podiatry in FY2018:

14,855 Orthopaedic and Podiatry surgical procedures, 237,517 physician clinic visits, 331,346 incoming calls to the Orthopaedic Access Center and 19,498 eRecord

referrals.

Synthetic Cartilage a ‘Game Changer’ for Arthritis Healthcare systems in the US and worldwide are working to leverage the power of patient-reported outcomes to improve the quality and efficiency of care. One way this is being done is through the NIH-funded PROMIS, a statistically-validated measurement tool designed to capture patients’ perspectives after their care is complete.

The University of Rochester Medical Center is recognized as a worldwide leader in integrating NIH-funded technology in its clinical enterprise to collect patient input in real time.

As of July 28th, 2018, the Department of Orthopaedics and Rehabilitation has collected through UR Voice:

1,350,174 PROMIS scores • 577,950 individual evaluations • 154,792 unique patients •

A 2018 review from the American Academy of Orthopaedic Surgeons found only four percent of their faculty are women. At URMC’s Department of Orthopaedics, 21 percent

of our orthopaedic surgeons are women, and 23 percent of our faculty (including non-operative orthopaedists) are women.

In fact, 50 percent of our incoming interns are women.

Judith F. Baumhauer, MD, MPH, implanted the nation’s first FDA-approved synthetic cartilage for the treatment of toe arthritis in July 2016. At that time, the Cartiva® Synthetic Cartilage Implant (SCI) was a breakthrough, and hopes were high that this technology could one day be used to treat arthritis elsewhere in the body. That day has arrived.

Beginning in July 2018, URMC became one of five US academic medical centers to use the implant for thumb arthritis.

Warren Hammert, MD, chief of the hand and wrist division in the Department of Orthopaedics and Rehabilitation, has completed one of the first cases in this groundbreaking approach. As with toe arthritis, the synthetic cartilage is an alternative to fusing an arthritic thumb joint and preserves range of motion.

From the start, the question with synthetic cartilage was whether the implant could provide lasting pain relief to patients, and withstand the wear and tear of frequent motion. Millions of arthritis patients are interested in the answers; in just two years since the first Cartiva® toe surgery, 17,000 patients have received the implant.

Dr. Baumhauer, professor and vice chair of orthopaedics, was the principle

investigator of the MOTION study, a prospective, randomized multi-center study that evaluated the safety and effectiveness of Cartiva® for the treatment of arthritis at the base of the big toe, the most common site of arthritis in the foot.

In July 2018, she presented five-year follow-up results from the MOTION study at the annual meeting of the American Orthopaedic Foot and Ankle Society (AOFAS) in Boston. In the original MOTION study, 135 patients received the Cartiva® implant. Of these, long-term outcomes were available for 106 patients, with a mean follow-up of 4.4 to 8 years.

The outcomes demonstrate that Cartiva® SCI provides: • Durable pain relief, with patients achieving a 97 percent median reduction in pain.

• Sustainable functional improvement, with patients demonstrating a 176 percent median improvement in sporting activities.

• Motion preservation, with patients experiencing a 25 percent improvement in range of motion from baseline.

• A high rate of satisfaction with the treatment, with 93 percent of patients saying they would have the procedure again.

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

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COVER STORY

URMC Awarded $6 Million to Study Deadly Bone Infections

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one infection, while relatively rare, can be debilitating and potentially fatal. In recent years, researchers in the Center for Musculoskeletal Research (CMSR) at the University of Rochester Medical Center have made several discoveries that position them to advance new treatments and possible cures for bone infections.

Now, a nearly $6 million, five-year award from the National Institute of Arthritis and Musculoskeletal and Skin Disease at the National Institutes of Health will allow the group to create a new multidisciplinary research program devoted to studying bone infections.

CMSR has been among the top five NIH-funded orthopaedic research centers in the nation for more than 10 years, and Edward M. Schwarz, PhD, Burton Professor of Orthopaedics and director of CMSR, has been the top NIH-funded orthopaedic researcher in the nation three years running. Schwarz attributes this success largely to the quality of the faculty at CMSR and the center’s focus on promoting the next generation of scientists and national leaders. This new grant, awarded to Schwarz and a throng of researchers from across the University of Rochester and beyond, brings the center’s total forecasted grant revenue for 2017 to $28 million.

Infection in a joint replacement is the worst possible complication; the vast majority of these infections are caused by a type of bacteria called Staphylococcus aureus, including the dreaded methicillin-resistant strain (MRSA),

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CMSR has been among the top five NIH-funded orthopaedic research centers in the nation for more than 10 years, and Edward M. Schwarz, PhD, Burton Professor of Orthopaedics and Director of CMSR, has been the top NIH-funded orthopaedic researcher in the nation three years running. which causes sepsis and death in 13 percent of infected patients. Together with Karen Bentley, director of the Electron Microscopy Core at URMC, Schwarz showed that these bacteria can crawl deep into tiny channels in bones, possibly taking shelter there and later emerging to establish an infection.

Though S. aureus was originally thought to be incapable of movement, Bentley and Schwarz, in collaboration with James McGrath, PhD, professor of biomedical engineering at URMC, and his spin-off company, SiMPore Inc., showed in the lab that these bacteria can migrate through tiny pores in membranes.

This new grant will allow Schwarz and Hani A. Awad, PhD, professor of biomedical engineering and orthopaedics at CMSR, to investigate exactly how S. aureus gets into bones and to develop new treatments that target those mechanisms. Microbiologists Steven Gill, PhD, and Paul Dunman, PhD in the Department of Microbiology and

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

Immunology, will help the team develop new antibiotics to inhibit bone infection, which will be 3D-printed into spacers used in the treatment of infected joint implants. Delivering the antibiotic at the site of infection may save patients’ limbs and lives.

Schwarz has also been working to understand what makes certain patients more susceptible to S. aureus infections than others, including why some patients recover relatively easily, while others die.

In an international study of more than 300 patients with infected total joint replacements, Schwarz and his team, including John Daiss, PhD, and Chao Xie, MD, in the CMSR, found that patients fared well if their immune systems attacked a certain S. aureus protein, and poorly if they attacked another. Patients who produced antibodies attacking autolysin, a protein important for cell division, were protected. Those who produced antibodies against a family of iron sensing determinant (Isd) proteins, which help S. aureus sap nutrients from its host, were more likely to experience sepsis and even die.

The Clinical Research Core of this program will be run by Stephen L. Kates, MD, at Virginia Commonwealth University.

The anti-autolysin antibodies that will be used in this research were discovered in the Schwarz Lab and are now being commercially developed by Telephus Medical, LLC. Schwarz is the founder and chief scientific advisor of this URMC start-up company.

Sports Medicine Surgeon Offers Insight on Benefits of Biologics on PBS Program

Nic Minetor ] WXXI

In this episode, Sergeant Dan Brochu, at right, who was shot in the line of duty, shares how biologic therapy was an important part of his amazing recovery. Dr. Michael D. Maloney, at left, also shared his expertise about these therapies on the program.

In the field of orthopaedics, interest in biologics to treat medical issues continues to grow among physicians, researchers, and patients themselves.

Department of Orthopaedics physicians and researchers, along with their peers around the world are exploring biologics’ potential to improve outcomes for people with chronic conditions like osteoarthritis; to support the healing process in individuals who have been injured; and to accelerate recovery for patients who have undergone surgery.

Several University of Rochester Department of Orthopaedics and Rehabilitation faculty use biologics, including platelet-rich plasma injections and stem cell therapies.

These are relatively new procedures and research is in its early stages, but our faculty is already seeing promising results.

Michael D. Maloney, MD, professor of orthopaedics and sports medicine division chief, has used biologics to treat professional athletes, as well as older patients dealing with osteoarthritis. He will be a guest on Second Opinion, the nationally syndicated PBS television program. Dr. Maloney offered his insights on the role of biologics in orthopaedic care, the research to date on these therapies’ results, and how biologics might impact future treatment approaches. In Rochester, the episode is scheduled to air Thursday, November 15 at 8:30 p.m. on WXXI-TV.

2,000 JOINTS REPLACED Adult Joint Team Marks Surgery Milestone at Highland Hospital On June 21, 2018, Highland Hospital’s Evarts Joint Center celebrated the program’s 2,000th joint replacement surgery. Since the Evarts Joint Center opened in 2005, demand for orthopaedic surgeons and the center’s services has grown dramatically.

Pictured from left: Christopher Drinkwater, MD, Christina Catalfano, RPA-C, Thomas Myers, MD, Michel Neracker, RPA-C, Zainab Tarricone, and Linda Rodenberg celebrate the milestone.

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

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Back in the Saddle: Scoliosis Patient Returns to Competitions After Surgery Adolescence can be a challenging time, but everything seemed to be coming together for Sarah Bury. An excellent student, the Liverpool, NY eighth grader was also thriving as an equestrian, a sport she began at age 8 that had become her life’s passion. She was looking forward to high school, college, and more equestrian competitions.

But at 13, Sarah couldn’t even run the mile at school anymore without stopping for rest.

A checkup in early 2013 revealed that Sarah had scoliosis, a curvature of the spine that affects two to four percent of adolescents. Even though it was not present at all in the previous year’s check-up, now, the curvature was already more than 45 degrees.

The family’s online search led them to Paul T. Rubery, MD, chair of the Department of Orthopaedics, who was listed as one of the nation’s top specialists in scoliosis care. Dr. Rubery recommended fitting Sarah with a brace to try a non-surgical solution as a first step.

Sarah wore the brace through the summer of 2013 at night, but the curvature progressed and surgery became essential. Uncorrected, it could have caused permanent disability and threatened Sarah’s health. The curvature was compressing Sarah’s rib cage and affecting her breathing. If left untreated, it could have impacted her cardiovascular system.

“Dr. Rubery explained they were going to straighten out my spine using rods and screws that would stay with me the rest of my life,” Sarah said.

“You worry with a child’s spine,” said Sarah’s mother, Lydia. “Her biggest concern was, ‘Am I going to ride a horse again?’ It was her life.” Since age 8, Sarah had competed in the Interscholastic Equestrian Association, a national nonprofit organization that gives riders in

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Before

After

X-ray images show the curvature of Sarah Bury’s spine before surgery, and the successful straightening of her spine post-surgery.

grades 6-12 an opportunity to try equestrian sports.

The five-hour surgery immediately increased Sarah’s height by two inches.

Dr. Rubery told Sarah it might be a year before she could ride a horse again, but she surpassed all expectations. She got her surgeon’s permission to ride “low and slow” within two months’ time.

Sarah did have to wait a while to

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

jump, but that came back to her too.

She returned to IEA competition in February 2014 and qualified for regional finals, then the national finals. She’s since qualified for regionals every year, and in 2017, qualified for nationals again, placing eighth.

She competed at nationals in 2018 in Syracuse by special invitation, as the rider with the highest IEA competition points in New York State.

“Like many of my young patients, Sarah has tremendous energy and tremendous passion to pursue her talents in school, as well as a particular sport,” Dr. Rubery said.

“Additionally, some of the newer technologies we have to treat scoliosis benefited Sarah. These advances allow us to do less invasive surgeries with a lower impact on the natural anatomy of the spine. These techniques make it possible for patients like Sarah to recover well and go back to the things they love doing.”

Now 18 years old, Sarah is looking ahead. She’ll begin a five-year master’s program in applied statistics and actuarial science on a full academic scholarship at Rochester Institute of Technology this fall. And she’ll join the college’s riding team based out of Lehman Farms.

The scoliosis and the surgery to correct it are fading from memory, and she’s back to being Sarah. “As far as my life going forward, I am a completely normal person. We forget it ever happened for weeks at a time.”

Sarah has thrown away the brace she wore for months, along with any photos of her in it. The family will show you the before and after x-rays of Sarah’s surgery, though. The dramatic change to Sarah’s spine catches your eye – and after meeting Sarah, you get to see what the surgery has made possible in the years since, and the years yet to come. That picture couldn’t be clearer.

URMC Researchers Collaborate to Automate Ultrasound Interpretation In the laboratory of Alayna Loiselle, PhD, in URMC’s Center for Musculoskeletal Research, Dr. Loiselle and her team are working to identify novel strategies to improve flexor tendon healing in the human hand.

“We’ve used mouse models to understand scar formation after injury, and to determine functional outcomes from treatment,” Dr. Loiselle said.

To visualize the development of scar tissue, the lab uses ultrasound imaging.

“We have these ultrasound images that to non-experts are very difficult to interpret,” she said. “We can interpret them because we’ve seen thousands of images, and we have correlated them with histological data.”

When Constantinos Ketonis, MD, PhD, joined the URMC Orthopaedics staff, Dr. Loiselle approached him about her research. Dr. Ketonis’ own research interests involve the application of artificial intelligence and machine learning in the interpretation of medical imaging and the development of novel orthopaedic implants and devices. He also maintains a clinical practice in treatment of the hand, wrist, elbow, and shoulder.

The opportunity to marry basic science with clinical practice appealed to both researchers. “He immediately said, ‘I totally agree with what you’re doing, but you need to automate this and bring it to the clinics,’” Dr. Loiselle said. Dr. Ketonis saw a translational application for this research, which can have a significant diagnostic utility.

The process of interpreting many disparate images of scar formation is very repetitive, Dr. Ketonis observed, making it just right for computer automation. He and Dr. Loiselle have collaborated to train an artificial intelligence (AI) system to view and interpret the ultrasound images.

“The AI gets trained, and with every image it sees it gets more accurate,”

Quantification of Scar Tissue Volume from ultrasound images. Ultrasound images of un-injured

and repaired mouse hindpaws with segmentation of discreet tissues, including scar tissue. Current research is focused on understanding how scar tissue volume correlates with function in patients following flexor tendon repair and the development of machine learning algorithms to automate detection and quantification of scar tissue from ultrasound images.

Dr. Ketonis said. “You train the machine to know what a scar looks like with annotated images — what is known as training set — so it can eventually pick up scar in images it has never seen before. We know where the scar is, because we’ve already done the histology on these samples. The idea is to take that knowledge and use transfer learning to translate it to images from human tendons.”

Currently, clinicians use the outcome of physical therapy or other treatment to determine if a therapy is working. “Right now, we wait a long time to see if there’s any improvement,” Dr. Loiselle said.

“If we could learn more from imaging in a much shorter time frame, we could tell if a therapy is working much sooner.

This would lead to better outcomes for patients.”

With the mouse models phase of its research nearly complete, the Loiselle Lab has received funding for a human trial of its AI/ultrasound study. Drs. Loiselle and Ketonis trained therapists and launched their human trial in July.

“All the tendon repairs from the hand department here will get ultrasound when they go for physical therapy; we will look at scar formation and correlate that

with functional outcomes over time,” Dr. Ketonis said. “We will use these images to train the computer to start identifying human scar.”

The AI system will learn to recognize scars from thousands of different images, giving it a comprehensive understanding of the appearance of scar formation.

The system will automatically detect and quantify the scar after a flexor tendon repair and provide information on projected outcomes. This capability can then be incorporated into ultrasound systems in any hospital or imaging lab.

The challenge with ultrasound is more the interpretation than it is the acquisition. “Once this work is completed, anyone can put an ultrasound probe to a finger, and the computer will be the expert,” Dr. Ketonis said. “This will tell us if we should intervene earlier, or if continuing physical therapy is likely to work.”

Dr. Loiselle expects this AI capability to have a direct impact on patient care. “One of the clinical problems is that we don’t have any good biological therapies to improve these issues,” she said. “Making our animal models higher throughput with AI will expedite identification of new therapies, which will improve healing.”

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

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Toast To Your Health Fine Wine Auction Benefits Orthopaedics and Rehabilitation On September 16, 2017, nearly 300 attendees came out to support a “Life in Motion” at URMC’s annual Toast to Your Health Wine Auction. Hosted by Danny Wegman, the event raised $3.6 million in support of UR Medicine’s Department of Orthopaedics and Rehabilitation. By December 31, the department announced a total of $5.7 million as part of a ninemonth comprehensive initiative to

help support the new Musculoskeletal Institute. The department’s endowment will increase by $5 million or more through lifetime and estate gifts as a result of this tremendous effort. Special thanks to co-chairs Michael D. Maloney, MD and his wife, Kara S. Maloney.

The Department of Orthopaedics is proud to have one of the country’s foremost musculoskeletal research

The 2017 Auction was held at Wegman’s Organic Orchard, overlooking Canandaigua Lake.

Above, one of the nearly 300 bidders raises his paddle to bid on an auction item, helping raise $3.6 million by the end of the evening.

Special thanks to Danny Wegman (top right) for hosting this successful event.

At right, Auction co-chairs Michael D. Maloney, MD, and Kara S. Maloney share a laugh during the event.

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In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

programs, outstanding comprehensive care teams, and one of the largest and best training programs for New York’s young orthopaedic surgeons.

To learn more about our impact, go to everbetter.rochester.edu/mski. If you’d like more information or to make a donation, please contact Dianne Moll at (585) 329-5398.

Welcome New Faculty!

Raymond J. Kenney, MD Sports Medicine

Constantinos Ketonis, MD, PhD Hand & Wrist

Bilal Mahmood, MD Hand & Wrist

Susan M. McDowell, MD Orthopaedic Tumor

Susan Nelson, MD, MPH, FRCSC Pediatric Orthopaedics

Peter J. Obourn, DO Sports Medicine (non-operative)

Marc J. O’Donnell, MD Hand & Wrist

Stephanie E. Siegrist, MD Medical Director, Orthopaedic Urgent Care General Orthopaedic Surgery

Appointments & Promotions To view the complete photo gallery, please visit: smugmug. com/gallery/ n-hmFDLq/

P. Christopher Cook, MD was promoted to Professor.

David J. Mitten, MD was promoted to Professor.

John G. Ginnetti, MD, Assistant Professor of Orthopaedics, was appointed Chief of the Adult Reconstruction Division.

Rajeev K. Patel, MD, Associate Professor of Orthopaedics and of Physical Medicine and Rehabilitation, was appointed Interim Chair of the Department of Physical Medicine and Rehabilitation.

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

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URMC Surgeon Performs Successful Spinal Surgeries in Ethiopia

Dr. Addisu Mesfin (center), a spinal surgeon at URMC, stands with Drs. Hananiah and Abraham, of the AaBET Hospital in Ethiopia, where they performed life-altering spinal surgeries for patients in need.

Addisu Mesfin, MD, a URMC orthopaedic surgeon who specializes in spinal surgery, returned to his birth country in December 2017 to perform surgery at the Addis Ababa Burn Emergency and Trauma Hospital (AaBET) in Ethiopia. His trip was a medical initiative in cooperation with the Less Exposure Surgery (LES) Society.

“I first went two years ago, in 2016, and I gave several presentations to the orthopaedic and neurosurgery residents and faculty,” he said. “I decided that when I went back, I should definitely do some surgeries. So I talked to the implant companies I work with [including SpineFrontier and Corelink], and they donated some implants.”

Spinal implants are scarce in Ethiopia, where about 25 orthopaedic surgeons and neurosurgeons perform all of the spine surgery for a population of roughly 100 million people. AaBET is a trauma

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hospital similar to URMC’s Strong Memorial in Rochester, NY. “It’s a young population, so younger people get into car accidents, or they work in construction and they get injured.

There’s a lot of trauma there,” Dr. Mesfin said. “They do urgent surgery there and the surgeons are very good. In that one week we treated six patients, and we donated several implants there that they can continue to use.”

Assisted by Dr. Abraham, of St. Paul’s Hospital Millennium Medical College in Ethiopia, Dr. Mesfin treated burst fractures, cervical spinal cord injuries and performed anterior cervical fusions, laminectomy, and posterior fusion — all without the benefit of neuromonitoring, a specialty

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

not available at this trauma center.

Interoperative neuromonitoring uses electrophysiological methods to observe the function of nerves, the spinal cord and brain during surgery, to be sure there is no damage to these structures.

“It’s a lack of resources,” Dr. Mesfin explained. “In Canada, Japan, and other countries I have visited, they have neuromonitoring available once or twice a week. In Rochester, we have it every day. I’d prefer to have it, but we did well without it.”

In particular, the surgeons performed a deformity correction procedure on a 17-year-old girl with adolescent idiopathic scoliosis (above). “She’s a high school student and she was having pain along with the scoliosis. Her parents said she was getting depressed because of her appearance,” Dr. Mesfin said. “I told her, ‘You’re too old to brace, but we can do this surgery.”

Using implants donated by medical device company SpineFrontier, the surgical team straightened the girl’s back, relieving her pain and changing her life for the better. “It’s a bit of a risky procedure, but it went well.”

His next trip to Addis Ababa is planned for January 2019. “The patients and families were all very grateful for what we did,” he said. “It’s one of those things where I am itching to go back again.”

Non-Operative Spine Specialist Heads New Titleist Performance Institute Program Clifford Everett, MD, MPH, got an unpleasant surprise when he started playing golf again after an eight-year hiatus. “I couldn’t move correctly,” he said. “Here I’m an expert in back and spine physiology, and I couldn’t figure out what was wrong.”

He searched for a way to expand his understanding of his compromised golf swing, and discovered the Titleist Performance Institute (TPI), run by the premier manufacturer of golf clubs, balls, and other gear. Developed to improve the performance of professionals and now open to amateur enthusiasts as well, TPI uses technologies, including detailed swing analysis, advanced equipment fitting methods, and science-based player

conditioning to improve golfers’ ability to play without injury.

At TPI, Dr. Everett learned that his hip was the issue, and the information helped him resolve the problem and get back his game. He immediately recognized the value TPI could have to patients in the Greater Rochester area, where golf is a leading community pastime.

The Department of Orthopaedics and Rehabilitation has added a new service line in its physical therapy and athletic training group, and now collaborates with other TPI specialists in the area.

The primary goal of the new program is injury prevention, Everett said. The short golfing season in Rochester is one reason many golfers become injured just

as the season gets underway, he noted.

“People don’t keep up with their fitness over the winter, and they just head right out and start playing as soon as the weather improves. That’s how they hurt themselves.” Everett has established the Rochester TPI golf fitness program at URMC Orthopaedics, at the Penfield and Clinton Crossings facilities. He and his colleagues plan to help golfers maximize the function and motion of their bodies.

For more information on the TPI/Golf Movement Program, call (585) 341-9200.

Orthopaedic Oncologist Volunteers to Train Myanmar Health Workers

Susan McDowell (top left) stands with health workers from the Barefoot Doctors School in Myanmar.

Each year since her residency at Indiana University School of Medicine a decade ago, Susan McDowell, MD, sets aside several weeks to travel to Thailand to teach at the Barefoot Doctors School.

Her students are health workers in Myanmar, where access to quality health care and sanitation can be limited — or nonexistent.

The school equips healthcare leaders from Myanmar with basic skills, such as setting up a village’s water supply, administering vaccines, and treating malaria to empower them to help people in villages where professional health care is scarce. “We teach them how to

do preventative medicine, to improve the overall health of villages there,” Dr. McDowell said. “We make them aware of vaccines that are available for free from the [World Health Organization] and how to ensure everyone in the village is vaccinated.”

“Myanmar continues to be a volatile nation, so its residents also need access to orthopaedic trauma care,” Dr. McDowell noted. “We have several students in refugee camps or in states where clashes are still occurring, so they are seeing injuries related to fighting and the consequences of neglecting those injuries, like infections. If they know what

an infection looks like and can give an antibiotic, or keep someone from dying from an infected boil on their leg, that’s a great education that we’ve given them.”

Students of the program go to Thailand for five or six weeks a year, for three years. “I just started my third class of students,” Dr. McDowell said. “The first year I went, most of the students had very little background knowledge, so everyone was wide eyed. The second year, we asked them to keep logs of the patients they saw. We used those logs to frame discussions and understand what they’re seeing.”

This year, many of the students had smartphones for the first time, and people in their villages sent Facebook messages with questions to ask the instructors.

“They bring their personal experiences back. We can make the teaching very relevant to them.”

Dr. McDowell continues to go back each year because she says it’s clear that the program makes a major difference.

“I think I learn more than I teach every year,” she said. “It’s a pretty special program, and it’s my pleasure to be a part of it.”

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Rewriting the Rules of Residency Training

Schwarz Inducted into Medical and Biological Engineering Elite

Resident Bowen Qiu

The University of Rochester School of Medicine and Dentistry’s Orthopaedics residency program is already considered among the nation’s best, and in 2018, it will get bigger too. Amid steep competition from other academic medical centers nationwide, the department’s residency training program has earned the Accreditation Council of Graduate Medical Education’s (ACGME) approval to add another residency slot, for a total of eight residents per year.

“The 2018 class of incoming residents come from some of the top medical schools across the United States, underscoring that the University of Rochester is recognized nationally as a very high-quality orthopaedics residency training program,” said Paul T. Rubery, MD, chair of the Department of Orthopaedics and Rehabilitation.

In addition to coming from far and wide, the class reflects the department’s efforts to ensure diversity in its faculty and residency ranks. “It’s a key goal of the University and Medical Center to increase diversity so our work force reflects the community we care

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for,” Dr. Rubery said. “Having a diverse faculty allows us to understand the needs and perspectives of our patients better and provide more well-rounded and professional care. We have not yet reached our goals in terms of being fully reflective of our community, but compared to the rest of the nation, Rochester is progressing well in creating and maintaining a diverse faculty, and improving the diversity of our residency program.”

As it grows, the Orthopaedics residency training program is evolving to meet the needs of new generations of physician learners. Residency Program Director John Gorczyca, MD, and Faculty Instructor Gregg Nicandri, MD, developed a monthlong “Bone Doctor Boot Camp” training experience to deliver hands-on surgical skills training early in first-year residents’ training.

Visit issuu.com/urmc/docs/2108_ rm2018v1_042618final for a feature story and slideshow about the residency training program.

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Edward M. Schwarz, PhD, director of the Center for Musculoskeletal Research at URMC, joined the top two percent of medical and biological engineers as he was inducted into the American Institute for Medical and Biological Engineering (AIMBE) College of Fellows in April.

Schwarz received this honor for his efforts to prevent inflammatory bone loss, a common consequence of rheumatoid arthritis, infections, tumors, and wear and tear on prosthetic implants.

Schwarz is a leader in orthopaedic biologic therapy and stem cell research.

His lab is working on several approaches to develop living bone implants to repair large areas of bone damage caused by trauma or bone cancers. They use recombinant adeno-associated virus (rAAV) to revitalize allografts (donated cadaver bone) and stem cells to generate a patients' own living bone tissue on 3D-printed bone implants.

Schwarz's lab also developed a novel passive immunization for a devastating bone infection, caused by methicillinresistant Staphylococcus aureus (MRSA) (see page 4).

Election to the AIMBE College of Fellows is among the highest professional distinctions accorded to a medical and biological engineer, and honors those who have made outstanding contributions to "engineering and medicine research, practice, or education” and to "the pioneering of new and developing fields of technology, making major advancements in traditional fields of medical and biological engineering, or developing/ implementing innovative approaches to bioengineering education."

URMC Orthopaedic Surgeon Honored for Excellence in Teaching Future Physicians Gregg Nicandri, MD, received the Arthroscopy Association of North America (AANA) Stephen J. Snyder Excellence in Teaching Award at the association’s annual conference in Chicago in April.

This award is granted to an AANA Education Instructor who demonstrates exceptional dedication and skill.

Dr. Nicandri is an Associate Professor of Orthopaedics and an AANA Master Instructor, who teaches several courses annually to residents from across the US at the association’s Orthopaedic Learning Center in Chicago. Dr. Nicandri designed a prototype for an arthroscopic skills training model, now known as the FAST Workstation. He also developed the ASSET proficiency-based training tool, which objectively measures trainees’ arthroscopic skills acquisition, rather than relying on instructors’ subjective observation of training outcomes.

Perry Initiative: Young Women Explore Careers in Orthopaedics The University of Rochester Department of Orthopaedics and Rehabilitation outpaces the national average in the number of female faculty members and residents. At URMC, 23 percent of orthopaedic faculty members and 8 percent of trainees are women. The Department’s female faculty are working to boost those numbers even higher by encouraging young women to enter the field.

Each year, the department hosts the Perry Initiative, a national mentorship program that gives female high school, college, and medical students hands-on orthopaedics experience to encourage them to enter the field.

Emily Carmody, MD, associate professor of orthopaedics, led female faculty and medical students in a daylong learning session for about 40 local high school girls in March.

23 percent of faculty members and 8 percent of trainees are women at URMC’s Department of Orthopaedics and Rehabilitation.

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Sports Medicine Surgeon Helps Skiers on the Road to Olympics When he’s not in the operating room, Sandeep Mannava, MD, PhD, can often be found on a mountain, working as a volunteer physician for the US Ski & Snowboard Team. In January, the URMC sports medicine and shoulder and elbow surgeon traveled to the Olympic Training Facility in Lake Placid, as skiers competed in the final qualifying event before the 2018 Winter Olympics in Pyeongchang, South Korea.

In Lake Placid, Dr. Mannava treated injuries that skiers sustained from hurtling their bodies down the slope at 60 km per hour before hitting a jump, launching 60 feet in the air and completing a combination of several flips and spins before landing. Dr. Mannava notes, “Going to these types of events keeps me up to date on the latest and greatest not only in sports medicine, but also in orthopaedics and general practice medicine as well. It’s also great for the athletes to get top-notch medical care when competing in these intense and extremely physical events.”

Teaching a New Generation of Musculoskeletal Researchers URMC has taken a leadership role in training young musculoskeletal researchers to write grant proposals that receive funding from the National Institutes of Health (NIH).

Beginning in 2005, the United States Bone and Joint Initiative (USBJI) developed a course series to train the next generation of musculoskeletal researchers in the art of preparing high quality research proposals. Today, the Young Investigator Initiative (YII) represents one of USBJI’s flagship programs, and URMC physicians have been at the forefront of this program since its inception.

“We teach young investigators the principles of how to write a proposal that gets funded,” said J. Edward Puzas, PhD, the Donald and Mary Clark Professor of

Orthopaedics and a professor at URMC’s Center for Musculoskeletal Research. “We all depend on grant money, and there’s a real skill to writing a comprehensive, significant grant,” he said. “That skill is learned — it took me 15 or 20 years to figure it out. We want to cut that time down for young investigators, to help them launch an early career.”

YII differs from other grantsmanship seminars in that applicants have to be accepted into the program, and each participant is assigned two mentors who work one-on-one with the participant until his or her grant is funded.

With the value of this program well understood among young investigators, YII has become a highly competitive program. Since 2005, 761 young investigators have applied to enter the

Save the Date Orthopaedics Alumni Reunion April 4-6, 2019 Ballantyne Lodge in Charlotte, NC

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In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

program and 378 — roughly half — have been accepted. To date, 208 of the 378 participants (55 percent) have received funding. Total grant monies awarded exceeds $283 million, for more than 1,100 musculoskeletal research studies.

“With the awarding of an NIH grant to the University of Rochester, the Department of Orthopaedics is now the leading institution for maintaining this program,” Puzas said. “Supporting the initiative has been a team effort, with physicians and scientists across the country. All of the faculty on the team were at one time reviewers for the NIH. So participants get a real feel for what it takes to write a great grant. It’s doing a good thing for our field, and we’re going to keep it going.”

New Running Clinic Offers Specialized Treatment and Support for Athletes Katherine Rizzone, MD, MPH, assistant professor of orthopaedics, has launched a multidisciplinary Runner’s Clinic to help runners and running athletes of all ages and interest levels recover from injury. While many of the patients are elite scholastic athletes, others are enthusiastic adult runners; some of the program’s participants competed in this year’s Boston Marathon in April.

Dr. Rizzone has designed a clinic that puts together several services — medicine, physical therapy, nutrition counseling, and sports psychology — to help each runner get or stay healthy to compete at their highest level.

Dr. Rizzone published research on stress fractures in the Journal of Athletic Training in 2017. Her retrospective study of NCAA athletes’ injuries showed that stress fractures were highest among endurance sports, including crosscountry running, and nearly twice as high for female athletes as for males. The rate of recurrent stress fracture was 22 percent, and for season-ending injuries, it was 20 percent.

Recognizing the risk to runners, Dr. Rizzone developed specialized training and rehabilitation approaches to reduce the risk of stress fractures and other injuries, as well as help runners

safely rehabilitate.

Dr. Rizzone and her colleagues have formed a virtual team of patients who receive care and therapy at four of the Department of Orthopaedics and Rehabilitation’s outpatient clinics.

“Run URMC” members participate in group training, learning events, and drills to stay safe and at the top of their game.

To learn more about the UR Medicine Running Clinic, visit: urmc.rochester.edu/orthopaedics/ running-clinic.

Specialized therapies and equipment include: • A

zero-gravity treadmill that helps injured runners begin running again while putting less stress on their joints.

• Gait analysis software run off an iPad. • Physical therapy and conditioning routines that help runners rehab from injury, and train their bodies to address problems in their gait.

• Nutrition counseling. Inadequate nutrition is a common problem in runners that can lead to a serious injury, including stress fractures. Many runners aim to stay slim to improve their times, and short-change themselves in caloric intake. Nutrition counseling helps runners finetune their eating and activity so they are in balance.

Graduating June 2019 Class

Back Row (left to right): Jon Hedgecock, MD, Nathan Kaplan, MD, Joseph Schaffer, MD, Richard Okafor, MD Front Row, (left to right): Daren McCalla, MD, Benjamin Strong, MD, Sandeep Soin, MD

At the conclusion of their residencies, the 2019 graduating class will begin fellowships in a variety of areas at prestigious institutions.

• Dr. Jon Hedgecock Sports Medicine, University of Connecticut • Dr. Nathan Kaplan Adult Reconstruction, University of Indiana • Dr. Daren McCalla Spine, Houston Methodist • Dr. Richard Okafor Adult Reconstruction, Houston Methodist • Dr. Joseph Schaffer Sports Medicine, University of Rochester • Dr. Sandeep Soin Trauma, Orlando Regional Medical Center • Dr. Benjamin Strong Adult Reconstruction, Virginia Commonwealth University

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New National Model of Health Urban Outreach Pilot Project

The model for educating physicians was forever changed by the University of Rochester School of Medicine and Dentistry and then replicated at medical schools across the country as a standard in humanistic care. Today, URMC is well poised to lead the nation once again with multidisciplinary training that integrates nutrition, performance, sports psychology, and injury prevention to stave off disease and promote vitality.

On March 20, 2018, the University’s Rochester Philanthropy Council (RPC) hosted a special reception for Michael D. Maloney MD, Dean’s Professor, Department of Orthopaedics; division chief, sports medicine, and Edward M. Schwarz, PhD, the Richard & Margaret Burton Distinguished Professor in Orthopedics and director of the Center for Musculoskeletal Research, to help showcase their vision for an urban outreach pilot designed to impact disadvantaged teens in the Rochester City Schools.

Specifically, this summer, teens ages 13-18 from the Rochester City School District and Webster schools participated in a 16-week pilot program. Medical professionals, scientists, and coaches provided guidance on nutrition, sleep, academics, athletics, and injury prevention to improve athletic performance and academic results. With the pilot complete, the team is working to expand access to these resources to other youths, especially those in socioeconomically disadvantaged areas of the Rochester community.

You can invest in pilot projects such as this, as well as educational funds to support personnel, or a range of programmatic needs. These can be leveraged many times over to merit additional external funding to the benefit of the program and the Rochester community.

For more information, please contact Dianne Moll at (585) 329-5398 or dianne.moll@rochester.edu.

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Medical professionals, scientists, and coaches provided guidance on nutrition, sleep, academics, athletics, and injury prevention to improve athletic performance and academic results.

Your Gifts Make an Impact on the Department of Orthopaedics

Welcome Eight New Residents!

The new interns began their training on 6/26/2018.

Annual Giving Online

Devon Anderson Oregon Health & Science University

Visit rochester.edu/annualfunds Click on “Make a Gift” and choose Department of Orthopaedics in Gift Designation section.

Brittany Haws (Research) Wake Forest School of Medicine

By Mail Checks payable to “University of Rochester Department of Orthopaedics” may be mailed to: University of Rochester Gift Office

Alan Hwang Keck School of Medicine, University of Southern California

PO Box 270032 Rochester, NY 14627-0032

Securities or Stocks If you are interested in making a gift of securities,

Serena Liu Wayne State University

please contact (or have your broker contact) Deb Rossi in Gift and Donor Records at (585) 275-3903.

Gift Planning

Mackenzie Neumaier Rutgers University

IRA Charitable Rollover Individuals 70.5 years and older can make a charitable distribution directly from an Individual Retirement Account tax free. A charitable distribution counts toward your required minimum distribution

Michelle Smith Drexel University

(RMD) up to $100,000 per person.

Bequests and Other Testamentary Gifts A bequest to the Department of Orthopaedics is simple to accomplish

Nahom Tecle Rush University

and allows you to have a future impact. A provision in your will ensures that programs you care most about are supported. You can also name the department as a beneficiary of retirement assets, life insurance, or investment accounts.

Linda Zhang New York Medical College

Life Income Gifts Fund a charitable gift annuity and enjoy a charitable deduction today and fixed income for life for one or two beneficiaries. Fund a charitable remainder unitrust and enjoy a charitable deduction today and variable income for life or a term of years, for one, two or possibly more beneficiaries.

Thank You for considering support of the Department of Orthopaedics.

For more information, please contact Dianne Moll, Sr. Director of Medical Center Advancement, at (585) 329-5398. To learn more about our impact, go to everbetter.rochester.edu/mski.

Five Fellows completed their training on 7/31/18 Sophia Davis, MD Foot and Ankle Fellow

Raymond Kenney, MD Sports Medicine Fellow

Eric Emanski, MD Spine Fellow

Michael Morris, MD Hand/Upper Extremity Fellow

Christina Seifert, MD Trauma Fellow

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CMSR Research Redefines Cause of Rheumatoid Arthritis Flare A study led by the Center for Musculoskeletal Research and the University of Rochester School of Medicine and Dentistry has determined that rheumatoid arthritis (RA) flare is not caused by autoimmunity. Instead, RA disease progression and symptomatic flares occur from lymphatic system dysfunction, said Edward M. Schwarz, PhD, CMSR director and Burton Professor of Orthopaedics.

Schwarz’s laboratory focuses on inflammatory bone loss from RA, infections, tumor metastasis, and other conditions. This study examined advanced knee arthritis in mice to determine if lymphatic contraction to clear joint inflammation can be restored.

Mice with chronic erosive inflammatory

arthritis have damaged lymphatic vessels that do not contract, significantly reducing the exit of inflammatory cells from arthritic joints. “I call it the ‘Toilet Bowl Hypothesis,’” Schwarz said. “When the toilet bowl is flushing — that is, when the lymphatic system is working normally — patients have no symptoms. When it overflows at the time of original diagnosis, or it gets clogged with inflammatory cell in advanced RA, patients experience a flare.”

The study tested a hypothesis that a biologic treatment for RA (Remicade), which inhibits the body’s inflammatory response, restores the function of lymphatic vessels that drain inflamed joints, and improves inflammatoryerosive arthritis in mice.

The results were striking: anti-TNF therapy reduced joint inflammation, bone erosion, and osteoclasts — cells that break down bone tissue. In addition, anti-TNF treatment promotes repair of lymphatic vessels and restores lymphatic contractions, which increased the transport of inflammatory cells from the joint and ameliorated the arthritis.

The report, “Treatment of TNF-Tg Mice with Anti-TNF Restores Lymphatic Contraction, Repairs Lymphatic Vessels, and May Increase Monocyte/Macrophage Egress,” was published in the journal Arthritis & Rheumatology. CMSR has now commenced a NIH-funded clinical trial to test the anti-TNF therapy on human beings with RA (ClinicalTrials. gov, Identifier: NCT02680067).

Lead in Bone Grafts Explains Spinal Fusion Failures In his work in the field of Osteotoxicology — the study of toxins in bones — J. Edward Puzas, PhD, has focused his research on lead and its effect on bone health. This brought him to the problem of failed spinal fusions, particularly in patients who receive a bone graft as part of the procedure.

A spinal fusion eliminates motion between vertebral bodies, with the ultimate goal of relieving chronic pain for afflicted patients. A number of risk

factors like obesity, smoking, or diabetes affect the outcome of this surgery, but people who may not have these risk factors still see a 20 percent failure rate in the procedure.

Many of these patients receive an allograft from a commercial bone graft company. “These companies check the bone for everything: infection, transmissible diseases…but they never checked it for lead,” Puzas said. “So we started collecting the leftover bone pieces

after surgery and testing them. Most of them had no detectable lead, but 15 to 20 percent had dangerously high lead levels.”

Puzas and his team matched the leadladen bone grafts with patients, and determined that many of the failed spinal fusions used the grafts with high lead levels.

“We are going to start pushing the bone graft companies to measure the lead left in their grafts,” Puzas said.

UR Medicine Department of Orthopaedics and Rehabilitation and CMSR have Outstanding Representation at AAOS and ORS Annual Meetings Dozens of faculty and residents from UR Medicine’s Department of Orthopaedics and Rehabilitation, as well as researchers and trainees from the Center for Musculoskeletal Research presented research, taught instructional courses, and gave poster, keynote, and podium presentations at the 2018 American Academy of Orthopaedic Surgeons (AAOS) Annual Meeting and the Orthopaedic Research Society (ORS) meeting, both held in March in New Orleans, LA.

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For full summaries, abstracts and more on each presentation, poster and lecture, visit urmc.rochester.edu/orthopaedics/presentations

In Motion | UR Medicine Orthopaedics & Rehabilitation | Fall 2018

The Ways We Pay: Orthopaedics Researchers to Study Impact of Medicare Reform on Patient Care

Researchers from the University of Rochester Medical Center will use new funding from the National Institutes of Health to determine whether a new Medicare payment model has deepened racial and socioeconomic disparities in joint replacement care.

Racial and socioeconomic disparities, especially among older Medicare beneficiaries, are well-documented in joint replacement care and the researchers worry this well-meaning reform could make things worse.

The Centers for Medicare and Medicaid Services introduced the Comprehensive Care for Joint Replacement Model in April 2016 to improve coordination and quality of medical care for joint replacements.

The model bundles all joint replacement care — from surgery to rehab — into a single payment, holding hospitals financially accountable for the quality and cost of care across that spectrum.

“The bundled payment model may motivate hospitals to adopt measures that could worsen racial and socioeconomic disparities of hip and knee replacement surgery utilization and outcomes,” said Caroline P. Thirukumaran, MBBS, MHA, PhD, assistant professor of orthopaedics and public health sciences in the Center for Musculoskeletal Research at URMC. Thirukumaran, who will lead the study, also believes the bundled payment reform could hurt safety net hospitals, which care for a high proportion of racial minorities and low socioeconomic status patients who are in poorer health.

With this $1.5 million, four-year grant from NIH, Thirukumaran hopes to pinpoint which healthcare decisions contribute to the disparities, such as

rehab facility choice, to ultimately inform policy.

Adding specific language, incentives, and measures to reduce disparities in healthcare access and outcomes to the bundled payment reform may be a viable first step.

This is the first population health grant from the NIH awarded to the URMC Department of Orthopaedics and CMSR, which has been among the top five NIHfunded orthopaedic research centers in the nation for more than 10 years.

Thirukumaran’s co-investigators on this project include: Yue Li, PhD, professor of public health sciences; Laurent G. Glance, MD, professor of anesthesiology & perioperative medicine; Xueya Cai, PhD, research associate professor of biostatistics and computational biology; Addisu Mesfin, MD, associate professor of orthopaedics; and Rishi Balkissoon, MD, MPH, assistant professor of orthopaedics.

Guest Lecturer Addresses Modern Pelvic Surgery Techniques The 13th Annual John D. States, MD Lecture Series in Orthopaedic Trauma featured guest lecturer Milton “Chip” L. Routt, Jr., MD, an internationally recognized expert in treating pelvic ring and acetabular disruptions and acetabular fractures. Dr. Routt is a board-certified orthopaedic surgeon and professor in the Department of Orthopedic Surgery at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth).

His lecture was a fitting tribute to John D. States, MD, for whom the series is named and who pioneered research in preventing and treating automobile crash injuries, shaping seatbelt safety standards for decades to come.

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University of Rochester Medical Center Department of Orthopaedics & Rehabilitation 601 Elmwood Avenue, Box 665 Rochester, NY 14642

NONPROFIT ORG U.S. POSTAGE

PAID

UNIVERSITY OF ROCHESTER PERMIT 780

URMC ORTHOPAEDICS & REHABILITATION PROVIDERS Arthritis & Lower Extremity Joint Replacement John G. Ginnetti, MD (Chief) Rishi Balkissoon, MD, MPH Christopher J. Drinkwater, MD Mark H. Mirabelli, MD (non-surgical) Thomas G. Myers, MD Jennifer H. Paul (non-surgical) Benjamin F. Ricciardi, MD Lucien M. Rouse, MD Gillian L. Soles, MD Foot and Ankle A. Samuel Flemister (Chief) Judith F. Baumhauer, MD, MPH Benedict F. DiGiovanni, MD John P. Ketz, MD Irvin Oh, MD Hand and Wrist Warren C. Hammert, MD (Chief) Ronald M. Gonzalez, DO Constantinos Ketonis, MD, PhD Bilial Mahmood, MD Richard J. Miller, MD David J. Mitten, MD Marc J. O’Donnell, MD Danielle M. Wilbur, MD

Metabolic Bone Disease Emily E. Carmody, MD Susan M. McDowell, MD General Orthopaedic Surgery Stephanie E. Siegrist Orthopaedic Trauma John T. Gorczyca, MD (Chief) Catherine A. Humphrey, MD Kyle T. Judd, MS, MD John P. Ketz, MD Gillian L. Soles, MD Pediatric Orthopaedics James O. Sanders, MD (Chief) Paul T. Rubery, MD (Department Chair; Scoliosis) P. Christopher Cook, MD Susan Nelson, MD, MPH, FRCSC Natasha O’Malley, MD, MSc, FRCS (Tr. & Ortho.)

Podiatry Michael Gruttadauria, DPM Ayaz Habib, DPM David E. High, DPM, FACFAS Pearce Sloan, DPM, FACFAS

Shoulder and Elbow Ilya Voloshin, MD (Chief) Robert D. Bronstein, MD Brian D. Giordano, MD John P. Goldblatt, MD Michael D. Maloney, MD Sandeep Mannava, MD, PhD Richard J. Miller, MD Gregg T. Nicandri, MD Spine Center Robert W. Molinari, MD (Chief) Paul T. Rubery, MD (Department Chair) Clifford R. Everett, MD, MPH (non-surgical) Donna G. Ferrero, MD (non-surgical) Emmanuel N. Menga, MD Addisu Mesfin, MD John A. Orsini, MD (non-surgical) Rajeev K. Patel, MD (non-surgical) James O. Sanders, MD (pediatric scoliosis) David P. Speach, MD (non-surgical)

Sports Medicine Michael D. Maloney, MD (Chief) Robert D. Bronstein, MD Brian D. Giordano, MD John P. Goldblatt, MD Maria V. Karapidis Pouria, MD (non-surgical) Raymond J. Kenney, MD Sandeep Mannava, MD, PhD Mark H. Mirabelli, MD (non-surgical) Gregg T. Nicandri, MD Peter J. Obourn, DO (non-surgical) Katherine H. Rizzone, MD, MPH (non-surgical) Lucien M. Rouse, MD Ilya Voloshin, MD Tumor Service Emily E. Carmody, MD Susan M. McDowell, MD