HOSPITAL FOR SPECIAL SURGERY: SPECIALISTS IN MOBILITY SPRING 2007 Horizon 2006 ANNUAL REPORT Transforming Patient Care Through Science and Technology 3 Horizon IN THIS ISSUE: Transforming Patient Care Through Science and Technology 1 2006 Leadership Report 30 Caring for Children in the 21st Century 38 Financial Report 40 Professional Staff, Management, and Volunteers 43 Contributing Friends 49 On the Cover: A hydrogel sample is Officers and Board Members 60 ready for analysis to determine its potential A Lifetime of Philanthropy Endures 61 as a material to repair cartilage that lines the surface of the knee joint. Opposite page: Suzanne Maher, PhD, is one of many scientists at Hospital for Special Surgery seeking to solve the challenge of repair- ing damaged cartilage and other soft tissues. Diagram below: With a hydrogel implant placed into a cartilage defect, growth factors attract cells that generate new and healthy tissue. Executive Editorial Board Design Steven R. Goldring, MD Arnold Saks Associates Edward C. Jones, MD Printing Stephen A. Paget, MD Monroe Litho Aldo Papone, Chairman Deborah M. Sale Major Photography Thomas P. Sculco, MD Robert Essel Louis A. Shapiro Other Photography Philip D. Wilson, Jr., MD Brad Hess Editor-in-Chief Josh Friedland Horizon is published twice Managing Editor a year by the Development Linda Errante Department, Hospital for Special Surgery, 535 East 70th Assistant Editor Street, New York, NY 10021. Rachel Olszewski rmed with the latest technologies and clinical advances, A the physicians, scientists, and health professionals at Hospital for Special Surgery confront the challenges of musculoskeletal conditions today, while pursuing pivotal research that will bring the breakthroughs of tomorrow. 1 uring his first climb of the The once standard 12-inch incision for morning on Ragged Mountain in a total knee replacement has been virtual- DConnecticut, Graham Seaton lost ly replaced by surgery performed through his footing and fell 35 feet, landing with an incision of only three to four inches full force on his right leg. The October long. With hip replacement, the incision 2005 accident left him with catastrophic has been reduced from 10 inches to four fractures below the knee. But today, or five. “Although the most noticeable evi- Mr. Seaton is back mountaineering thanks dence of these newer joint replacement to the skills and novel approaches to techniques is the smaller incision, the real complex orthopedic challenges he found value of these procedures is in how well at Hospital for Special Surgery. patients do following the surgery,” says Mr. Seaton is one of thousands of patients each year who benefit from the incredibly focused expertise and depth of experience that only a specialty institu- Above: With tion can provide. “Hospital for Special arthroscopy, a minute Surgery represents the unique integration fiberoptic camera is of a world-class hospital and research inserted through incisions as small as an institute with the eventual goal of eradi- eighth of an inch to cating musculoskeletal conditions through view the inside of a scientific discoveries,” says Stephen A. joint for diagnostic and Paget, MD, Physician-in-Chief and the treatment purposes. Joseph P. Routh Professor of Rheumatic Left: Dr. Timothy Wright Diseases in Medicine. “When you place and his colleagues in the Department of the world’s best and the brightest in such Applied Biomechanics a productive and stimulating environment, in Orthopedic Surgery progress is assured for our patients.” are pioneers in the design and development of joint implants. A New World in Orthopedic Surgery Nearly 18,000 orthopedic procedures are performed each year at Hospital for Special Surgery. This wealth of experi- Thomas P. Sculco, MD, Surgeon-in-Chief, ence is the source of many of the and the Korein-Wilson Professor in advances in techniques and technologies Orthopedic Surgery, who pioneered the now in use around the world. modified technique for hip arthroplasty. In recent years, orthopedic surgery “Pain relief and improved mobility are has pursued less invasive procedures to accompanied by the benefits of less trau- address a range of conditions – from ma to the muscles and soft tissues, less disabling joint problems, to sports injuries blood loss during surgery, and an easier and spinal disorders, to major trauma. rehabilitation.” Arthroscopic procedures, once reserved In addition to new techniques for joint for repairing soft tissue injuries in the knee replacement, our surgeons and bioengi- and shoulder, have been expanded to neers continue to develop and refine sur- include applications for certain hip condi- gical tools and joint implants. Novel tions, such as labrum tears around the hip devices and smaller instruments are mak- joint, instability, and synovial disorders. ing less invasive surgery possible, while improvements in materials and implant designs are adding durability and flexibility 2 of motion. “Implant wear is influenced by infection prevention. Contributing to our patient weight and activity level,” says excellent record is a newly constructed, Timothy Wright, PhD, F.M. Kirby Chair in state-of-the-art central sterile supply unit Orthopedic Biomechanics. “Our surgeons that serves the Hospital’s operating room and engineers are evaluating various suites. Features of the new unit include six implant-bearing surfaces such as metal- sterilizers, of which four are floor-loader, on-metal, ceramic-on-ceramic, and walk-in sterilizers, and an automated sys- cross-linked polyethylene. Our goal is to tem that tracks the processing and sterili- provide patients with low-friction, low- wear joint replacements that can with- stand a rigorous lifestyle.” Among the surgical tools that have been developed here is customized instru- mentation to lessen trauma to tissue during joint replacement surgery. These include an angled reamer that can be inserted without putting too much tension on the skin when surgeons prepare the bones for the implant, and a hemisphere – a small cutting device that makes it easier to carve out a new hip socket. Among the concerns of patients undergoing any surgery is the possible need for a blood transfusion. The Hospital zation of approximately 600 instrument In the new Central Sterile Supply unit, the is a leader in developing and incorporat- trays a day. “Every one of our trays is bar- average turnaround ing into practice the latest blood conser- coded and indexed for inventory control,” time, from the time an vation techniques. “Blood management says William McDonagh, RN, Assistant instrument tray goes is an important consideration in any Vice President of Perioperative Services. into the decontamina- tion area from the OR surgery,” says Gregory A. Liguori, MD, To further maintain the integrity of the through the washer Anesthesiologist-in-Chief. “To minimize sterile environment, dedicated elevators – to the sterilizer and intraoperative blood loss and the poten- one on the decontamination side and one then wrapped, is tial for transfusion with donated blood, on the sterile side, accessible only to peri- approximately three and a half hours. we use a number of approaches, including operative staff – transport trays directly intraoperative autologous blood recovery to and from the operating rooms. systems, often called cell saver machines.” The cell saver machine is used to collect Advancements in Radiology blood lost during the operation, filtering The Hospital has one of the most techni- and washing it so that it may be given back cally advanced musculoskeletal imaging to the patient. This technique is commonly departments in the country. It is one of used when significant blood loss is expect- only a few to use an open gantry magnetic ed, such as during spine surgery. resonance imaging camera in which radi- Utilizing this technique, the Hospital ology specialists can image virtually any has been able to reduce the need for sized patient in any position. The Hospital blood transfusions from the blood bank by for Special Surgery Musculoskeletal MRI 97 percent. Center, with five MRIs and two more sited Hospital for Special Surgery leads all and pending acceptance testing, will be hospitals in New York State in surgical the largest academic MR imaging center in the nation dedicated to musculoskeletal 3 medicine. And, with the recent opening of continuum of clinical and basic science the new Center for Musculoskeletal Ultra- that fosters translational research.” sound, the Hospital is realizing the multi- As part of this commitment, the faceted potential of ultrasound for both Hospital welcomed Carl Blobel, MD, PhD, diagnostic and therapeutic applications. in 2004 as Program Director of the “The new Center enhances diagnostic Research Division’s Arthritis and Tissue capabilities and treatment options for Degeneration Program, and the Virginia patients with musculoskeletal disease,” F. and William R. Salomon Chair in notes Helene Pavlov, MD, Radiologist-in- Musculoskeletal Research. Dr. Blobel’s Chief. “It features three ultrasound rooms that capture the real-time motion of mus- cles and tendons and provides exquisite resolution for more well-defined images. The equipment and the faculty expertise Left: During a spine allow us to offer innovative treatments, surgery, Piergiuseppe including image-guided therapeutic injec- Roma, RN, uses the cell saver technology to tions for conditions such as tendinitis clean the patient’s blood and arthritis.” for retransfusion. Dr. Pavlov and her colleagues are also Below: The work of at the forefront of using MR imaging for Gisela Weskamp, PhD, early diagnosis of osteoarthritis. “We’re Associate Scientist, looking at cartilage, which cannot be seen and Dr. Carl Blobel and their identification of on a routine X-ray,” she explains. “By visu- an enzyme that appears alizing almost to the microscopic level of to play a pivotal role cartilage striations, we can determine if in the development of the cartilage is starting to erode or becom- rheumatoid arthritis, was recently published ing compressed long before surgical treat- in the prestigious ment or long-term management may be scientific journal Nature necessary.” Immunology.