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A PROUD TRADITION OF EXCELLENCE, WITH A NEW NAME.The Methodist Hospital is now Houston Methodist Hospital. This new name reflects the pride in who we are and where we are from. Our commitment to advancing medicine with global impact begins in Houston, Texas, where we pioneer a better tomorrow through research, cutting-edge innovation and breakthroughs to rewrite the future of health.
THAT’S THE DIFFERENCE BETWEEN PRACTICING MEDICINE AND LEADING IT.
13
LEADING MEDICINE: AN OVERVIEW 2
PURSUING MEDICAL DISCOVERIES 6
BREAKING NEW GROUND 10
DELIVERING BETTER OUTCOMES 14
EDUCATING FOR TOMORROW 20
18
14
22
CONTENTS
2 Orthopedics
Our patients range from professional athletes and performing artists to “weekend warriors” to student athletes — and everyone receives the same superior level of care from the moment they walk through our doors.
Houston Methodist Orthopedics & Sports Medicine exists
to provide our patients with outstanding, comprehensive
orthopedic care. We do this through unparalleled expertise
combined with innovative research, sophisticated technology
and a dedication to compassionate patient care. Our center
exemplifies orthopedic excellence and is recognized as a
hub of knowledge and progress where patients, educational
institutions, governing bodies and the medical research
community can turn for the best in current orthopedic
treatments and rehabilitation.
A NATIONAL LEADER IN ORTHOPEDIC EXCELLENCE
Ranked within the top 25 in the nation in 2013 by
U.S. News & World Report, Houston Methodist Orthopedics
& Sports Medicine is one of the largest, most active and
comprehensive orthopedic centers in the United States.
The center is comprised of a multidisciplinary team of
orthopedic surgeons, primary care sports medicine physicians,
rehabilitation therapists, occupational therapists and athletic
trainers who collaborate in the delivery of superlative care
to patients with musculoskeletal diseases and disorders. Our
expansive network of clinical programs is directed by renowned,
board-certified and fellowship-trained orthopedic specialists.
The center has emerged as a national leader due to
its high quality of clinical care, dedication to resident
and fellow education, and state-of-the-art clinical
and scientific research.
BLAZING THE PATH OF FUTURE ORTHOPEDIC MEDICINE
Houston Methodist Orthopedics & Sports Medicine has
developed or improved many orthopedic devices, procedures,
and therapies that have been translated into clinical practice
worldwide. Our ongoing commitment to orthopedic research,
through vigorous collaborations with numerous research
partners, helps to ensure our continuing leadership in the
diagnosis and treatment of orthopedic conditions.
THE LEADERS OF TOMORROW
Through our primary academic affiliation with Weill
Cornell Medical College and NewYork-Presbyterian Hospital,
Houston Methodist Orthopedics & Sports Medicine
provides fully accredited resident and fellowship programs.
Our curricula are designed to prepare the next generation
of orthopedic specialists through hands-on training and
extensive research programs.
ABOUT HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE2013 AT A GLANCE
TOTAL CASES
JOINT REPLACEMENT PROCEDURES
ACTIVE CLINICAL PROTOCOLS
43,7042,397
$1.4
9
5 ACADEMIC FELLOWSHIP AND RESIDENCY PROGRAMS
MILLION IN GRANT FUNDING
OVER
3Opthalmology
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
MESSAGE FROM THE CHAIR
Dear Colleagues, Expertise, compassion, innovation and patient focus are just a few of the reasons why patients seek treatment at Houston Methodist Orthopedics & Sports Medicine. I am extremely honored and proud to share our accomplishments and highlights over the past year.
In 2013, we used our close clinical association with elite athletes and performing artists to translate knowledge of repetitive and overuse injuries to our “weekend warriors.” In addition, we saw therapies that were originally reserved for professional athletes, such as platelet-enriched plasma procedures, cross over and benefit our orthopedic surgery patients.
At the Surgical Advanced Technology Laboratory, we are persisting in our work on a breakthrough technique that will significantly improve the way critical bone fractures are treated. Using a novel, regenerative approach to fractures that combines the mechanical advantages of biodegradable synthetic polymers with the biological function of natural biomaterial scaffolds, we are witnessing rapid healing in limbs that would previously have required amputation. We have been able to proceed with this research on bionanoscaffolds through a grant from the Defense Advanced Research Project Agency (DARPA).
We are helping to establish new surgical pathways for thumb joint replacements. We continue to stand at the leading edge in the advancement of sophisticated ankle implants through incorporation of a recently developed, three-component prosthetic that requires less bone resection and allows for greater joint rotation. In 2013, we also witnessed major advancement in cartilage replacement techniques for both the ankle and knee.
Our commitment to leading medicine compels our motivation toward excellence in orthopedic research, innovation and education. Our compassion and dedication to our patients inspires our aspirations for excellence in care.
The accomplishments at Houston Methodist Orthopedics & Sports Medicine are made possible by the outstanding work of our physicians, nurses, administrators and staff. We invite you to browse inside these pages and explore the exciting developments in our realm of orthopedic care.
Warm regards,
Kevin Varner, MDInterim ChairHouston Methodist Orthopedics & Sports Medicine
JEFFREY KOZAK, MD Jeffrey Kozak, MD, joined the team of Houston Methodist Orthopedics & Sports Medicine after completing his fellowship in primary care sports medicine at Houston Methodist. He completed his orthopedic residency at the University of North Texas Health Science Center College of Osteopathic Medicine in Fort Worth, Texas and his primary care residency at Texas A&M University in College Station, Texas. During his fellowship, Dr. Kozak worked extensively with the Houston Dynamo, Houston Aeros, Rice University, RodeoHouston®, as well as community and high school athletic organizations.
4 Orthopedics
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
NEW HIRES
JOSHUA HARRIS, MD Joshua Harris, MD, joined Houston Methodist Orthopedics & Sports Medicine after completion of his medical and orthopedic residency at Ohio State University College of Medicine in Columbus, Ohio. He proceeded to complete his fellowship in sports medicine at Rush Medical Center in Chicago, where he was assistant team physician for the Chicago Bulls, White Sox, and DePaul University. Dr. Harris’ clinical and research interests include arthroscopic hip preservation, cartilage restoration techniques, stem cell therapy, the healing properties of platelet- rich plasma, endurance medicine and care of elite athletes. He has published over 60 articles in peer-reviewed journals, presented at various national and international symposia, and has been a journal reviewer for numerous publications including American Journal of Sports Medicine, The Physician and Sports Medicine and the Orthopedic Journal of Sports Medicine.
DANIEL LE, MD Daniel Le, MD, joined Houston Methodist in September of 2013 after completing his training at New England Baptist Hospital, in Boston, Massachusetts. During his residency, Dr. Le estimates he performed approximately 750 joint replacement surgeries. He is one of the few orthopedic surgeons in the country who currently performs minimally invasive hip replacement surgery known as the superior capsular or SUPERPATH approach. The superior capsular procedure preserves the integrity of the capsule and significantly limits postoperative hip restrictions. In collaboration with Brad Weiner, MD, vice chair (Academics) of the Department of Orthopedic Surgery, Dr. Le is developing a new total joint replacement rotation for residents in 2014.
SHARI LIBERMAN, MD Shari Liberman, MD, joined Houston Methodist Orthopedics & Sports Medicine after completing her orthopedic surgery residency at Baylor College of Medicine in Houston, Texas, and her hand and upper extremity fellowship at Stanford University School of Medicine in Stanford, California. Dr. Liberman’s clinical interests include Dupuytren’s disease, traumatic wrist injuries and peripheral nerve injuries of the upper extremity.
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
HOUSTON METHODIST ORTHOPEDICS & SPORTS MEDICINE MEDICAL STAFFKevin E. Varner, MD, Interim Chair
ORTHOPEDIC SPORTS MEDICINEWinfield Campbell, MDJoshua Harris, MDDavid Lintner, MD Mark W. Maffet, MD Patrick McCulloch, MD Bruce Moseley, MD John Seaberg, MDTimothy C. Sitter, MD
PRIMARY CARE SPORTS MEDICINEDavid A. Braunreiter, MD Vijay Jotwani, MD Jeffrey A. Kozak, DO Scott Rand, MD Kenneth M. Renney, MDChristian Schupp, MD Gregory M. Seelhoefer, MD
NECK & SPINEHoSun Hwang, MD Anthony J. Muffoletto, MD Bradley Weiner, MD Jeffrey B. Wood, MD
HAND & WRISTEvan Collins, MD D. Dean Dominy, III, MDKorsh Jafarnia, MD Shari Liberman, MD Vincent C. Phan, MD
JOINT REPLACEMENTWilliam J. “Bill” Bryan, MD Plinio Caldera, MD Mark Franklin, MDCarl A. Hicks, MD Stephen Incavo, MD Daniel Le, MD Ken Mathis, MD Eddie T. Matsu, MD James Pyle, MDChristopher K. Smith, MD Leland Winston, MD
FOOT & ANKLEPedro Cosculluela, MD Travis Hanson, MD Ray R. Valdez, MD Kevin E. Varner, MD
Physicians and scientists in the Houston Methodist Surgical Advanced Technology
Laboratory are at work on a breakthrough technique that will significantly improve
the way critical bone fractures are treated. In place of the traditional bone graft,
allograft, or artificial implant, orthopedic surgeons at Houston Methodist are using a
novel regenerative approach called BioNanoScaffolds.
This research has been made possible through a $7.9 million grant from the Defense
Advanced Research Project Agency (DARPA), an agency of the U.S. Department
of Defense responsible for the development of new military technologies.
“BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic
polymers with the biological functions of natural biomaterial scaffolds. This approach
achieves the correct strength requirements while enhancing the regeneration of
healthy bone tissue at the fracture site,” says Bradley K. Weiner, MD, professor and
vice chairman of the Department of Orthopedic Surgery and medical director of
the Surgical Advanced Technology Lab. BioNanoScaffolds provides rapid and
complete healing within four weeks of bony leg injuries that would normally result
in amputation.
“The polymer shell is made of a new material called polyether urethane, or PEU,
which is the most durable known material that can be safely reabsorbed in humans
over time. The shell holds the bone immobilized and works in concert with a novel
collagen-based scaffold that is loaded with bioactive nanoparticles. This will allow
accelerated bone healing,” says Weiner. The success of this research has resulted in
further funding. Currently, testing has been done using sheep as models. Increased
funding will provide for human clinical trials in both military and civilian patients.
6 Orthopedics
THE FUTURE OF MOBILITY: BIONANOSCAFFOLDS
“BioNanoScaffolds combine the mechanical advantages of biodegradable synthetic
polymers with the biological functions of natural biomaterial scaffolds. This approach achieves the correct strength requirements while enhancing the regeneration of healthy bone tissue at the fracture site.”
Bradley K. Weiner, MD Vice Chair, Department of Orthopedic Surgery (Academics) Medical Director, Surgical Advanced Technology Lab
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
STEM CELLS: REVOLUTIONIZING SURGICAL REPAIR Houston Methodist Orthopedics & Sports Medicine physicians are using stem cells to help accelerate
healing and recovery after surgery. The ability of stem cells to differentiate into specialized cells and
divide continuously allows them to replenish damaged tissue and promote healing within the body.
A primary use of stem cells in orthopedics is in the treatment of rotator cuff injuries, which are
classically refractory to complete healing and rehabilitation.
“There is a lot of literature to indicate that stem cells have great potential to induce and accelerate healing,”
said David Lintner, MD, orthopedic surgeon and chief of sports medicine at Houston Methodist Hospital.
During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of
the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this
channel to induce healing through replacement of damaged cells and replenishment of injured tissue.
“Stem cells hold a great deal of promise in orthopedics,” says Mark Maffet, MD, orthopedic
surgeon at Houston Methodist Sugar Land Hospital. “Right now, their use is cutting-edge
but I believe they will ultimately play a huge role in the success of surgical repair.”
The efficacious combination of rotator cuff surgery and stem cell therapy has caused orthopedic
surgeons at Houston Methodist to broaden its application. Lintner says the surgery has been so
successful in shoulders that he has begun to use stem cells in anterior cruciate ligament (ACL) and
meniscus repair surgeries.
“For ACL repair, the graft is soaked in a concentrate full of stem cells and other growth factors prior to
fixation,” says Maffet. “In other cases, we can simply suture the torn ligament and inject the stem cell
concentrate into the affected area.”
“It seems advantageous to use stem cells when a muscle, tendon, or ligament might otherwise have a
limited ability to heal, which is often the case with rotator cuff repairs,” says Lintner.
During surgery, the rotator cuff is repaired and a vascular channel is created in the bone at the site of the repair. Stem cells, which have either been harvested from the patient or a donor, are then implanted into this channel to induce healing through replacement of damaged cells and replenishment of injured tissue.
CARTILAGE RESEARCH: A BEND OF THE KNEE
Physicians at Houston Methodist Orthopedics & Sports Medicine are at the forefront of
orthopedic research in their ongoing studies of cartilage repair, resurfacing and regeneration.
Articular cartilage lines the bones within all joints and, due to its lack of blood supply, cannot heal
when torn or injured. In addition, articular cartilage consists of only one type of cell capable of
renewal - the chondrocyte - that becomes less active with age and injury. As a consequence, joint
repair that involves cartilage damage has been a longstanding challenge for orthopedic surgeons.
“We are currently involved in a multicenter study that is researching hystotechnologies and
tissue-engineered cartilage for articular defects. The research is focused on the meniscus — how it
behaves when it is torn and when it is repaired, how best to rest to restore it and how best to
rehabilitate it,” says Patrick McCulloch, MD, orthopedic surgeon.
Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to
study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting
small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different
angles. The x-rays are then combined to create 3-D images and measure the movement of the beads.
“In contrast to our original hypothesis, we found that meniscal repair sites did not gap when the knee
was taken through high flexion, or bent at a 90 degree or higher angle. We determined that it is not necessary
to restrict flexion after surgical meniscal repair,” says McCulloch. “We have subsequently performed several
studies using this new technique to look at the movement of the meniscus to evaluate the effects of weight
bearing, use of crutches, and different types of surgery, such as root repairs and the meniscus transplantation.”
8 Orthopedics
MAXIMIZING HUMAN PERFORMANCE
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Physicians at Houston Methodist pioneered the use of radiostereometric analysis (RSA) to study the movement of soft tissues in the knee during meniscus surgery. RSA involves implanting small metallic beads into the soft tissues around the knee and taking x-rays of the knee at different angles. The x-rays are then combined to create 3-D images and measure the movement of the beads. m1
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
ORTHOPEDICS IN SPACE
Space travel can be extremely hard on the
human body. The collaboration between
Houston Methodist and NASA is addressing this
through supervision of a teaching program
that instructs astronauts how to do in-flight
musculoskeletal ultrasounds. The purpose of
the program is to identify soft tissue injuries that
might occur in space where the use of other
scanners or x-ray equipment is not possible.
“We also provide the decision-makers at NASA
with the highest level of orthopedic screening and
evaluation possible, applying the same techniques
we use with professional athletes to ensure a
healthy astronaut corps,” says McCulloch, serves
as the orthopedic surgical consultant for NASA.
PLATELET-RICH PLASMA: A HEALING ELIXIR
Houston Methodist continues to implement new
clinical breakthroughs in orthopedics such as
regenerative medical treatment with platelet-rich
plasma (PRP) injection therapies. The theoretical
use of PRP lies in the efficacy of certain growth factors
found in PRP that help in healing and tissue repair.
PRP can be used when cortisone shots and
viscosupplementation with hyaluronic acid injections
stop working. Results so far have been good.
“In fact, European two-year studies show PRP has
significant benefit over both of those therapies.
PRP is a promising, safe and effective treatment
that can help repair rotator cuff injuries, Achilles’
tendon injuries, arthritis and a number of other
diagnoses. Many surgeons are hesitant to use this
therapy because it is so new, but as leaders in
orthopedics, the surgeons here at Houston Methodist
are comfortable with implementing innovative
procedures,” says Josh Harris, MD, orthopedic surgeon.
THE SLAP TEAR
Researchers and physicians leveraged the
relationships with professional sports teams to
initiate research topics. Orthopedic surgeons at
Houston Methodist generated the first research
papers from this unique partnering, looking
specifically at injury outcomes in professional
athletes. “To evaluate the best way to treat a
common throwing injury known as the SLAP
tear, we merged the stats of players who were
treated surgically and those treated with non-
surgical rehabilitation,” says David Lintner, MD,
chief of sports medicine. “We found that players
perform much better with non-surgical treatment,
and the research confirmed what many team
physicians had suspected but not documented.”
m2
tibia beads
Orthopedics10
LEADING INNOVATIONS IN JOINT REPLACEMENT
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Houston Methodist Orthopedics & Sports Medicine is a leader in the advancement of joint replacement, taking arthroplasty beyond the need for functionality into the desire to preserve and even optimize performance for a lifetime. Cutting-edge science and clinical research provide scientists and physicians the ability to accurately recreate normal function and motion of a joint, while continually pursuing the latest innovations in joint replacement technology.
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
THE NEWEST IDEAS IN KNEES
The population’s current health and longevity is steadily increasing the demand for joint
replacements as Baby Boomers seek to continue a robust and active lifestyle. Knee cartilage
is often the first to go. And, although surveys indicate that 85% of those who receive a knee
replacement are satisfied, this leaves 15% of this cohort unhappy.
“I believe that number is too high. We need to be asking important questions such as, ‘What are
the best methods to determine the proper implant for a given lifestyle? How can normal knee
function be maintained or recreated with implants that allow patients to run, jump, and climb –not
just walk? Should ACLs and PCLs be preserved?’” says Kenneth Mathis, MD, orthopedic surgeon and
joint replacement specialist.
Current models of implants are in the process of evaluation with more sophisticated tools of assessment.
“Using fluoroscopy, we can validate the computer-driven models to determine how accurately we
recreate function in a new implant. This has clear advantages over the evaluation of cadaver models
and guessing that implants will fit correctly in patients,” says Mathis.
In addition, the practice of severing the ACL and PCL is undergoing reevaluation. “In the past, we
only evaluated implants based on decreased pain and the duration of the implant,” says Mathis.
“Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential
to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may
lead to increased satisfaction.” Mathis has also contributed to the creation of a 120-question patient
survey that helps quantify the best implant match for each patient.
“In the past, we only evaluated implants based on decreased pain and the duration of the implant. Now we look at how implants function, and we believe that preserving ACLs and PCLs is essential to have close to normal function in highly functional patients. Saving all ligaments is ideal, and may lead to increased satisfaction.”
Ken Mathis, MD Orthopedic Surgeon
Orthopedics12
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
At Houston Methodist, hip replacement is accomplished through one of several minimally invasive techniques.
The mini-posterior approach splits rather than cuts the muscle and eliminates the need for numerous instruments.
Many believe the mini-posterior approach is the simplest and easiest approach to hip arthroplasty and provides
the greatest safety margin for the patient. The anterior approach also splits rather than cuts the muscles and
allows access to the hip joint from the front.
“In addition, we perform hip replacements via the anterolateral approach, which is also a less invasive procedure.
In this technique, a minimal amount of muscle-tendon insertion is detached from the front or the side of
the femur to provide safe access to the hip joint. Patients at a high risk for dislocation may benefit from the
anterolateral approach because there is no posterior disruption of the soft tissue,” says Stephen J. Incavo, MD,
orthopedic surgeon and section chief of adult reconstructive surgery.
Houston Methodist continues to provide high quality patient care in all aspects of reconstructive joint surgery.
“Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which
is expected to result in improved recovery and rehabilitation,” says Incavo.
Orthopedic surgeons here are also investigating methods to streamline operating room efficiency through the
use of dedicated surgical teams and disposable instruments. “Our equipment demands are enormous for
joint replacements. It’s manual labor to get them in the OR and working properly. The more we can streamline
this process, the better it will be for the patient,” says Incavo.
“Total hip arthroplasty through minimally invasive procedures potentially reduces operative trauma which is expected to result in improved recovery and rehabilitation.”Stephen J. Incavo, MD Section Chief, Adult Reconstructive Surgery Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College Program Director, Adult Reconstructive Surgery Fellowship
MULTIPLE APPROACHES TO HIP REPLACEMENT
Houston Methodist is one of the nation’s busiest and most progressive centers for hip replacement and complex revisionist hip surgery. Here, dedicated orthopedic surgeons perform extensive hip replacement procedures that are based on state-of-the-art techniques and represent the best outcomes with an equal focus on perioperative pain management and rapid rehabilitation.
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
NEW SURGICAL TECHNIQUES
Arthritis of the first carpometacarpal (CMC)
joint of the hand is a fairly common and frequently
debilitating condition. Surgeons at Houston
Methodist are forging new operative techniques
to correct problems of the CMC joint when
surgical resection of the trapezium is required.
“We are augmenting the tendon repair with a
device called the Mini TightRope. This provides
a unique and less invasive way to suspend the
thumb metacarpal after partial or complete
trapezial resection. We use this technique for
treatment of CMC arthritis, thumb CMC
instability, and to correct proximal migration
after a failed tendon reconstruction,” says
Korsh Jafarnia, MD, orthopedic surgeon and
clinical assistant professor. “We look forward
to achieving outcomes beyond expectations
with minimally invasive and percutaneous
techniques that maximize function.
A new, less invasive technique that demonstrates
this philosophy is endoscopic correction of
radial nerve compression. “Rather than making
an open incision beginning at the elbow, an
endoscopic cannula is inserted proximal to
the radial nerve. We are then able to work on
the radial nerve from the inside, guided by
the endoscope,” says Jafarnia.
Orthopedics14
NOVEL APPROACHES TO CARE IN HAND AND UPPER EXTREMITY
“We are augmenting the tendon repair with a device called the Mini TightRope. This provides a unique and less invasive way to suspend the thumb metacarpal after partial or complete trapezial resection. We use this technique for treatment of CMC arthritis, thumb CMC instability, and to correct proximal migration after a failed tendon reconstruction.” Korsh Jafarnia, MD Clinical Assistant Professor, Baylor College of Medicine
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
TREATING THE UNCONVENTIONAL ATHLETE
The Center for Performing Arts Medicine (CPAM) encompasses the expertise of
more than 100 physicians with specialized knowledge and skills who provide
integrated care to the particular needs of performing artists.
Working with a research-driven team to provide specialized care to professional
performing artists, Evan Collins, MD, orthopedic surgeon and vice chair of
CPAM, speaks nationally on the repetitive stress injuries and conditions
frequently experienced by musicians and the need for protocols specific to this
unique population. Dedicated to this effort, Collins and CPAM work in
collaboration with the Shepherd School of Music at Rice University on
an original research project. The study focuses on mechanical and biological
impact, the role of “capacity” in repetitive stress, and overuse injuries and
conditions musicians experience over the course of their long career.
The study is an extension of a recently completed paper Collins co-authored
with colleagues; Effective Hand & Upper Extremity Treatments for Performing
Artists and Musicians: Identifying Evidence Based Research. The goal of the
study is to establish evidence-based protocols and a “gold standard” level of care
for a unique type of “athlete” currently not represented in sports medicine protocols
developed for “traditional athletes.” This data will support development
of early training programs and preventive care integral for the lifelong careers of
musicians and broader performing artist population. It will also contribute
to a global database and translate into a higher standard of care and universal
protocol for non-musician patients experiencing similar tendinopathic
and repetitive stress conditions.
“Our research on repetitive and overuse syndromes with professional
musicians will easily translate to the general population. These initiatives
at Houston Methodist are just the beginning of a real shift in the paradigm
of how we care for patients,” says Collins.
“Our research on repetitive and overuse syndromes with professional musicians will easily translate to the general population. These initiatives at Houston Methodist are just the beginning of a real shift in the paradigm of how we care for patients.”
Evan Collins, MD, MBA Vice Chair, Center for Performing Arts Medicine
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Orthopedics16
NEW ALTERNATIVES TO OLD TECHNIQUES: OPTIONS FOR PATIENTS
Specialists at Houston Methodist Orthopedics & Sports Medicine are leading the way in the advancement of
sophisticated ankle implants and cartilage replacement techniques. Here, the orthopedic surgeons and dedicated
surgical team treat a variety of ankle injuries, from acute trauma to chronic problems that result from old
injuries or surgeries performed elsewhere that have failed.
The ankle has historically been a difficult joint to replace, primarily due to the large amount of bone
resection required and the lack of excess tissue necessary for adequate healing and recovery. Working with a
recently developed three-component implant that requires less bone resection, known as the Scandinavian
Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion in
the ankle compared to traditional fusion.
Cartilage replacement is a new technique in use at Houston Methodist when arthroscopy of the ankle fails.
“The problem with an ankle sprain is the cartilage is often damaged which can cause chronic, long-term
consequences such as arthritis. The articular cartilage can be bruised when too much pressure is exerted on it but
the injury to the cartilage doesn't manifest until months later,” says Pedro Cosculluela, MD, orthopedic surgeon.
“The damaged cartilage or exposed bone can be replaced by small cylinders of cartilage and bone that are
obtained from areas that are not weight-bearing, or from allografts or cadaveric tissue. A second option is
to use cadaver grafts and remove a plug to cover the hole that’s in the patient’s ankle,” says Kevin Varner, MD,
interim chair of the Department of Orthopedic Surgery. “Both ankle replacement with the STAR prosthesis
and cartilage replacement are new, viable alternatives to standard ankle repair that consisted primarily
of joint fusion,” says Varner.
TACKLING THE DAMAGED ANKLE
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Working w ith a recent ly developed three-component implant that requires less bone resect ion, know n as the Scandinavian Total Ankle Replacement (STAR), surgeons are able to provide patients with increased range of motion in the ankle compared to traditional joint fusion.
Based on its reputation of excellence in sports
medicine, Houston Methodist is the destination
of choice for Houston’s premier sports teams and
fine arts organizations. “We’re extremely proud
to be the official health care provider for the
Houston Texans, Houston Astros, Houston Dynamo,
Rice Athletics, and RodeoHouston,” says David
Lintner, MD, chief of sports medicine at Houston
Methodist Hospital. “Performers can suffer from
injuries as well – not just athletes. And so we
are also the official health care provider for the
Houston Symphony, Houston Ballet and the Houston
Grand Opera. We are able to provide them with the
best care available, but we learn from them as well.
Performers and athletes give us unique insights into
the extremes of human performance.”
Houston Methodist’s commitment to excellence in
sports medicine at all levels is evident in its support
of the Houston community student athletic programs.
Physicians serve as team doctors and consultants
to many of the areas middle and high school teams.
During the fall sports season, the physicians host
Saturday morning clinics to help student athletes quickly
get treatment for, and recover from, injuries incurred
during a week of practice and games. The clinics provide
easy access to specialists and physical therapists as
well as on-site imaging and rehabilitative services.
CARING FOR THE UNIQUE NEEDS OF ATHLETES, FROM ELITE PROFESSIONALS TO STUDENT ATHLETES
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Orthopedics18
The specialists at Houston Methodist Orthopedics & Sports Medicine aspire to maximize all aspects of human performance through the multidisciplinary collaboration of leading orthopedic surgeons, primary care sports medicine specialists, athletic trainers and physical therapists.
Houston Methodist is the destination of choice for Houston's premier sports teams and fine arts organizations.
ATHLETIC TRAINING PROGRAM: REGIONAL HEALTH CARE EXTENDERS
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
The Houston Methodist Athletic Training Program has 19 full-time
trainers that serve over 500 schools across the region. “Our program
is unique because of its purpose and execution,” says Jace Duke,
ATC, LAT, operations coordinator of Athletic Training Services.
“As regional extenders, our trainers take Houston Methodist’s
world-class medical services beyond the walls of the hospital and into
communities where top-notch sports medicine care is often unavailable.”
In 2013, Houston Methodist expanded its outreach to east and
north Texas by partnering with several large school systems
to provide athletic trainers to support their athletic programs.
COMPREHENSIVE PHYSICALS THROUGH PRE-PARTICIPATION STUDENT PHYSICALS EVENTS
5001,500
19 FULL TIME LICENSED ATHLETIC TRAINERS
OVER
OVER
SCHOOLS SUPPORTED THROUGH THE ATHLETIC OUTREACH TRAINING PROGRAM
HOUSTON MITIE AT A GLANCE
26SURGICAL SPECIALTIES FROM ACROSS THE WORLD
SQUARE FEET OF EDUCATION AND RESEARCH SPACE
40,000
20,000MORE THAN
LEARNERS SINCE INCEPTION
6,300MORE THAN
LEARNERS IN 2013
HOUSTON METHODIST INSTITUTE FOR TECHNOLOGY, INNOVATION & EDUCATION (MITIESM)
MITIE offers multidisciplinary, hands-on learning opportunities using advanced imaging systems and robotics.
Surgeons and other health professionals are able to continually refine and acquire new skills that allow them to
perform at optimal levels throughout their careers. Using procedural laboratories and sophisticated simulation tools,
our research programs are focused on the development and assessment of emerging technologies and technical skills
to improve the care of patients through less-invasive therapies. At MITIE, the finest researchers and clinicians are
building on our legacy of ingenuity and accelerating the discovery and delivery of better care and better cures.
LEADING MEDICINE
One of the largest and most comprehensive education and research facilities in the world, MITIE is leading the practice of medicine for physicians and health care providers.
For more information, visit mitietexas.com
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Orthopedics20
20,000
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
ORTHOPEDIC SURGERY RESIDENCY PROGRAM
For over 50 years, Houston Methodist has served as a teaching hospital for Orthopedic surgery residents.
Today, the Houston Methodist Orthopedic Surgery Residency Program is accredited by the Accreditation
Council for Graduate Medical Education (ACGME) and is under the directorship of Bradley Weiner, MD,
vice chair (Academics) of the Department of Orthopedic Surgery. The residency program provides a
unique structure designed on a foundation of evidence-based care, surgical mentorship and academics.
Our residency program accommodates three residents per year for a total of 15 residents. Our teaching faculty
integrates attending physicians in all subspecialties including joint reconstruction, spine, sports medicine, hand
and upper extremity, foot and ankle, trauma, pediatrics, oncology and general orthopedics. All attending
physicians are fellowship-trained, and their average duration of resident teaching experience exceeds eight years.
Orthopedic surgery residents experience hands-on surgical training with subspecialty rotations,
mentorship style. Within the Methodist Institute for Technology Innovation and Education (MITIE),
considered by many as the top surgical simulation center in the world, cadavers are used to teach anatomy
and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical
techniques. Residents work exclusively with one or two attending on the service – in clinic, on the floors,
in the ORs and in personalized didactic and case sessions. This immersion-style of subspecialty training
provides the best possible educational setting for our residents.
Our residents are actively engaged in research from their first year of residency, and are required to dedicate
four months to Orthopedic research carried out in the Surgical Advanced Technology Laboratory (SATL)
with a focus on nanotechnology and tissue engineering.
ADULT RECONSTRUCTIVE SURGERY FELLOWSHIP
A one-year fellowship in Adult Reconstructive Surgery is designed to provide clinical and research experience in
total knee and hip replacement, with an emphasis on muscle-sparing reconstructive surgical approaches.
“Our fellows get a broad exposure to a high volume of diverse patients. They will see straightforward and
complex hip and knee replacement cases and will learn a variety of state-of-the- art techniques and procedures,”
says Stephen J. Incavo, MD, orthopedic surgeon and hip and knee replacement specialist.
Research is a highlight of the fellowship program, and the Houston Methodist research facilities are
available to each fellow to help facilitate investigation that is performed in direct collaboration
with teaching faculty and the dedicated staff of engineers, clinical research specialists and computer scientists.
PREPARING FOR TOMORROW: ORTHOPEDIC SURGERY ACADEMIC PROGRAMS
Within MITIE cadavers are used to teach anatomy and surgical approaches, and cadaveric specimens and sawbones are utilized in the teaching of surgical techniques.
TRAINING THE NEXT GENERATION OF SPORTS MEDICINE SPECIALISTS
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
Orthopedics22
Houston Methodist provides comprehensive residency and fellowship programs aimed at training the next generation of sports medicine specialists.
ORTHOPEDIC SPORTS MEDICINE FELLOWSHIP
The Orthopedic Sports Medicine Fellowship at Houston
Methodist is unique based on its high clinical volume
and “hands-on” teaching experience in the clinic and
on the field.
“We believe that sports medicine is about more than just
arthroscopic surgery,” says David Lintner, MD, chief of
sports medicine at Houston Methodist Hospital. “Our fellows
have huge clinical and surgical volumes. They also cover
games and practices for professional and college teams, and
spend almost as much time in the training room and on the
field as they do in surgery and clinic. Sports medicine is about
helping athletes realize their full potential on the field.”
PRIMARY CARE SPORTS MEDICINE FELLOWSHIP
This one-year fellowship provides fellows in certain
specialties, such as internal medicine, family medicine,
pediatrics, emergency medicine and physical medicine/
rehabilitation, with a broader understanding of the
unique needs of the athletic population – setting a
precedent in sports medicine training. The fellowship
operates out of two hospitals in the Houston Methodist
system – Houston Methodist Sugar Land Hospital and
Houston Methodist Willowbrook Hospital – and is
academically attached to the Houston Methodist Family
Medicine Residency Program.
“Although the primary care sports medicine physicians
are under the Department of Orthopedics, our fellowship
emphasizes care of the whole athlete,” says Scott Rand,
MD, FAAFP, CAQSM, director of the Primary Care
Sports Medicine Fellowship at Willowbrook Hospital.
More than half of the fellowship training focuses on
non-musculoskeletal medical problems in athletes
such as metabolic issues, heart screenings, asthma,
concussion management, altitude medicine and medical
problems in endurance athletes.
Primary care sports medicine is about providing the
right care at the right time from the right provider for
athletes of all sports. One such example is concussion
management which requires more study in the field of
neurology than a orthopedist would normally pursue.
“We see between three and six concussion patients a day,
so we develop the expertise to appropriately treat
concussion given this volume. This includes treating the
initial injury and understanding sport-specific issues
that can influence crucial return-to-play decisions,” says
David A. Braunreiter, MD, CAQSM, director of the
Primary Care Sports Medicine Fellowship at Houston
Methodist Sugar Land Hospital.
“This specialty and our fellowship specialize in a
population of people, not a specific disease process,” says
Dr. Rand. “Athletes typically don’t like to go to the doctor,
because they are generally healthy and know a lot about
their own body. So we seek the appropriate treatment,
which doesn’t always mean surgery. Athletes just want to get
fixed when they are broken and become better athletes,
and that’s what we help them do.”
PHYSICAL THERAPY RESIDENCY
The physical therapy residency is an APTA-credentialed
post-professional residency for physical therapists who want
to become a board certified sports physical therapist.
“In addition to caring for patients in the clinic, our
PT residents also participate in structured learning
with the orthopedic surgeons and fellows. We have
weekly hands-on training on specific topics, including
the cadaver lab at MITIE ®. However, they are also
covering sporting events out in the fields and on the
courts, which are integrated with the athletic trainers and
physicians,” says Matt Holland, PT, CSCS, director of the
Physical Therapy Residency Program.
Leading Medicine: An Overview Pursuing Medical Discoveries Breaking New Ground Delivering Better Outcomes Educating For Tomorrow
The primary care sports medicine fellowship provides a broader understanding of the unique needs of the athletic population – setting a precedent in sports medicine training.
Dr. David Braunreiter, MD, CAQSM Director, Primary Care Sports Medicine Fellowship at Houston Methodist Sugar Land Hospital
At Houston Methodist, we’ve built a legacy of ingenuity that spans multiple decades and disciplines. In the last 95 years, we’ve transformed from a humble 19-bed community hospital to a global leader in health care, treating patients from 90 countries in more than 8,150 visits last year. In 2004, Houston Methodist established a long-term affiliation with Weill Cornell Medical College and New York-Presbyterian Hospital in New York City. Through this affiliation, three internationally renowned institutions collaborate to bring tomorrow’s advances to our patients today. Together, we provide cutting-edge clinical and biomedical research, and education and training for future physicians and scientists. One of the nation’s top research medical schools, Weill Cornell Medical College ranked No. 15 in the 2015 U.S. News & World Report Best Medical Schools list. For Houston Methodist clinicians and researchers, “leading medicine” is a holistic call for excellence in every aspect of patient care. We consistently rank among the best hospitals in the country. In 2013, U.S. News & World Report named Houston Methodist the “Best Hospital in Texas” for the second consecutive year, with 12 specialties recognized in the Best Hospitals list. Houston Methodist is consistently recertified to Magnet status for exceptional nursing. Because of our reputation, the finest researchers and clinicians from around the world are joining us to build on our legacy of ingenuity and accelerate the discovery and delivery of better care and better cures. That’s the difference between practicing medicine and leading it.
FAST FACTS*
132Operating Rooms
2,157Licensed Beds(1,721 operating beds)
4,471Affiliated Physicians
8,150International Patient Encounters (from 90 foreign countries)
15,791Employees
85,042Inpatients in 2013
234,944Emergency Room Visits in 2013
616,317Outpatient Visits in 2013
*Houston Methodist data includes five hospitals in Greater Houston
HOUSTON METHODIST LEADING MEDICINE YESTERDAY, TODAY, AND TOMORROW
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See all the ways we’re leading medicine at hmleadingmedicine.com
Accelerating discovery and delivery to patientsAt Houston Methodist, we are dedicated to defining the future of medicine. We engineer discoveries in the lab to become clinically useful products, channel the best innovations through early stage clinical trials and actively transition those innovations to our industry partners. Our commitment to the full cycle of discovery and delivery sets us apart as leaders who provide patients from around the world access to the latest health care advances.
LEADERS IN RESEARCH
More than 840 active clinical protocols$55m TOTAL RESEARCH FUNDING IN 2013
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Houston Methodist Hospital6565 Fannin Street Houston Texas 77030 houstonmethodist.org/orthopedics
LEADING MEDICINE YESTERDAY, TODAY AND TOMORROW.At Houston Methodist we have a proud tradition of revolutionizing medicine. Our past achievements have built a legacy that spans multiple decades and disciplines, and that same culture of excellence inspires us to be the pioneers of tomorrow.