The Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center has grown and developed since I came here as orthopaedic surgeon-in-chief in July 1992 after fourteen years at the Brigham and Women's Hospital and always part of the Harvard Combined Orthopaedic Residency Program. The recent merger of the Beth Israel and New England Deaconess Hospitals in 1997 has brought about much pressure and continued evolution in the Beth Israel Deaconess Medical Center. The majority of orthopaedic activities remain at the East Campus (the new name for the old Beth Israel Hospital). The clinical activity involves a range of adult orthopaedics and is centered on the full time academic staff and the private "Beacon Street" practitioners.

          My area of interest is adult spinal disorders. Current areas of clinical investigation include spinal stenosis and rheumatoid disorders of the cervical spine. These areas have provided a basis for clinical investigations by Harvard residents. The addition of a nurse practitioner, Katherine Taft, has added to both patient care and clinical research. She helps develop nursing programs and has been instrumental in carrying out investigations of the use of methylprednisolone for the treatment of acute sciatica and of intraoperative autotranfusion.

          Dr. Donald Reilly remains very active and is pursuing clinical investigation in joint replacement surgery. Current areas of interest include cine-fluoroscopy of total knee replacements and a pilot study of the American Academy of Orthopaedic Surgeons MODEMS outcome assessment forms for the joint registry at the New England Baptist Bone and Joint Institute. Don's vigorous and enthusiastic teaching continue to be a hallmark of the Beth Israel Deaconess experience.

          New additions to the Department of Orthopaedic Surgery include Drs. Robert G. Davis, Gregory T. Altman, and Michael Vostrejs. Dr. Robert G. Davis, a graduate of the Harvard Orthopaedic Residency Program and Dr. Lyle Micheli's sports medicine fellowship, is vigorously pursuing sports medicine at the Beth Israel Deaconess Medical Center.

          Dr. Gregory T. Altman completed his orthopaedic training at Hamot Medical Center in Erie Pennsylvania. He then completed fellowships in trauma surgery with Dr. David Lhowe at Massachusetts General Hospital and Dr. Chip Routt at Harborview in Seattle. Greg joined the Department of Orthopaedic Surgery at Beth Israel Deaconess Medical Center in 1998 and pursues trauma surgery, sports medicine, and general orthopaedics. He helps organize and run both Sports Medicine and Trauma Conferences. Greg has a very strong influence on trauma activities at Beth Israel Deaconess Medical Center and is an excellent resource for the Chief Resident and the other staff who all share trauma call. We continue to function as a level one trauma center, which means that we are asked to care for the most complex injured patients.

          Dr. Michael Vostrejs was educated at New York Orthopaedic Hospital, Columbia Physicians and Surgeons. He completed a knee surgery fellowship with Dr. John Siliski at Massachusetts General Hospital and then a spine fellowship at the Brigham and Women's Hospital. He joined us this year to pursue general practice orthopaedics with an emphasis on spine surgery. All these faculty members participate in clinical teaching with great emphasis toward the resident activities.

          The private practitioners provide a constant input of clinical care with geriatric orthopaedics always one of the characteristics of the Beth Israel Deaconess Medical Center. Many of the private surgeons are active in research and teaching. Dr. Paul Glazer concentrates on spinal disorders and is a valued resource and teacher for the residents. In the recent past he has helped care for the majority of the traumatic spine injuries and runs our Tuesday morning Spine Conference. In addition, he is very active in the Orthopaedic Biomechanics Laboratory at Beth Israel Deaconess Medical Center.

          Dr. Steve Murphy remains active in the clinical application and study of joint preserving osteotomies about the hip, hip arthroscopy, and alternative bearing surfaces in total hip arthroplasty. Drs. Louis Meeks and Jeffrey Zilberfarb provide a great experience in sports medicine and arthroscopy. Jeff has been involved in important clinical research in traumatic elbow instability--in collaboration with our current Chief Resident, Dr. David Ring, and Dr. Jesse B. Jupiter at the Massachusetts General Hospital--that has been prominent at a number of national meetings over the last year. He is also involved in projects at the Orthopaedic Biomechanics Laboratory.

          The addition of the Musculoskeletal Medicine Unit, functioning in the orthopaedic unit of the Shapiro Clinical Center has provided an excellent interaction over regional Musculoskeletal disease problems. The Unit is currently staffed by a rheumatologist, Dr. John Donohue, and a nurse practitioner, Sharon Gates. The Orthopaedic Biomechanics Laboratory of the Beth Israel Deaconess Medical Center is a world renowned center for biomechanics research in orthopaedics. In addition, the lab trains numerous Harvard residents, Harvard medical students, and engineering students from the Massachusetts Institute of Technology.

          The Orthopaedic Biomechanics Laboratory has been in transition since Dr. Wilson C. (Toby) Hayes, PhD left for Oregon in 1998. Dr. Brian Snyder, MD, PhD of Children's Hospital has been acting director while a Harvard Medical School search committee searches for a new lab director.

          Now more than ever, the Orthopaedic Biomechanics Lab is a resource for orthopaedic researchers at all of the hospitals in the Harvard Combined Orthopaedic Residency. Dr. Snyder is investigating the biomechanics of metastatic defects in bone, the biomechanics of various lumbo-sacral fixation methods, basic biomechanics of fracture healing, as well as a breadth of clinical investigations centered in pediatric orthopaedics at The Children's Hospital. Dr. Mary L. Bouxein is involved in research on the etiology of osteoporosis, non-invasive methods to predict osteoporotic fracture risk, and growth factors for the acceleration of fracture healing. Dr. Ralph Mueller has been a leader in micro-computed tomography which he helped develop in Switzerland. He is using this technology to investigate connective tissue and biomaterials, bone architecture, and microstructural remodeling. Dr. David Wilson focuses on sports medicine subjects, particularly the mobility and stability of human joints. Dr. S. Daniel Kwak, PhD has a joint appointment at Harvard Medical School, Beth Israel Deaconess Medical Center and Children's Hospital. His investigations focus on the relationship between anatomy, kinematics, and contact, using both experimental and computer models. Dr. Guoan Li, PhD was part of the influx of talent from Pittsburg that accompanied Dr. James Herndon in his move from Pittsburgh. Guoan is continuing to focus on the interest in joint kinematics that he developed while working at the Musculoskeletal Research Center of the University of Pittsburgh Medical Center, and is also getting involved in number of new projects.

          One of the Harvard residents, Dr. Kevin Bozic, has been among the more active researchers in the Orthopaedic Biomechanics Laboratory. He has a number of grants and directly employs two research assistants. He is collaborating with Dr. Jesse B. Jupiter, MD of the Massachusetts General Hospital in studies of bioresorbable fixation and with Dr. Paul Glazer and myself in studies of coraline hydroxyapatite and electrical stimulation for enhancing spinal fusion.

          The Beth Israel Deaconess Medical Center continues to grow and adapt to the pressures placed by the current and always changing winds of health care. It continues to emphasize excellence in clinical care and its activities provide fertile areas for clinical investigation.