PHYLLIS WHITE:

While you are on the plane to Chicago, you really ought to do that report for The Harvard Orthopaedic Journal. You've missed the deadline and they say it needs to go to the printers within the next week.

TST:

I don't know what to say. This journal is a great idea, which will serve as a springboard for getting our alumni association together. I am between Scylla and Charybdis. If I talk about managed care, the balanced budget act, diminishing reimbursement to academic medical centers and politics of Boston medicine, everybody will think I'm whining--they have their own set of problems. If I tell them that we have 35 inpatient beds, seven operating rooms and have double-digit growth both in our outpatient visits and surgical volume, everybody is going to get bored. If I tell them about what their old friends are doing, it is going to sound maudlin and like a Christmas letter.

PHYLLIS:

They are going to want to know what Clem Sledge, Fred Ewald, and Bill Thomas are doing now that they've retired, so why don't you start there. You don't seem to require too many facts to make a statement.

TST: Testy. Just because you are retiring after 28 years, you don't have to get cheeky now. I'll tell them that you weren't really 14 years old when you started to work in orthopedics at the Brigham. You're right, they will want to know that Clem, Fred, and Bill are fine. Clem has recently spent a lot of time at the Brigham since his retirement from the Brigham PHO Board but mainly to visit his new grandson who spent several weeks in the Neo-natal ICU before heading home with Claire, his mom. His wit and wisdom are missed but it is great to see him in the role of father and grandfather and having a chance to enjoy his boat and house in Maine. Bill Thomas has sold a few of his many houses and bought a few more. When we want to see him we just have a party and he is sure to show up. The FAA sends out warnings frequently as Thomas is flying his plane to the Vineyard, to Naples, and to places he doesn't even know. Fred and Sarah Ewald are doing fine and spending a good deal of time in Vail, Colorado. Just as these guys were my mentors and role models in Orthopedics, I hope I can learn their lessons on the artful form of retirement.

Thanks to Phyllis White for 28 excellent years - we'll miss you

PHYLLIS:

You probably ought to tell them about Partner's Orthopaedics and Jim Herndon. Isn't that what everybody asks you when they see you?

TST:

You're right. Jim Herndon, Harry Rubash, and I have had some challenges and opportunities over the past year but I am optimistic because our fundamental goals and objectives can be superimposed. nfortunately, there is not a template for how the Partner's department is to work, but with Drs. Kasser, Lipson, and Spector on the Executive Committee, I'm confident we can preserve and enrich the residency program. Should I tell them about how the management team approach with Jim and Harry frees me up to see more patients, do more operations, and stay clinically active?

PHYLLIS:

No. Why don't you tell them about new recruits at the Brigham, program changes, and expanded services.

TST:

We've maintained and expanded our strength in Joint Arthroplasty in spite of retirement of some of the leaders in the field. Dan Estok joined us bringing both his research interests, which he does with Bill Harris as well as an interest and expertise in hip revision surgery. My practice, coupled with that of Dick Scott, Bob Poss, Greg Brick, Tom Minas, John Wright, John Ready and John Schaffer as well as a strong presence in arthroplasty from the Harvard Vanguard Group, maintains our tradition as a center of excellence for Adult Reconstruction.

When Charles Brown joined us full-time and accepted the responsibility of the Head of Sports Medicine at the Brigham, he joined Scott and Tammy Martin, Mark Koris and Jonathan Schaffer at the newly opened 850 Boylston (Route 9) Brigham and Women's Hospital Sports Medicine and Rehabilitation Center. With strong input and leadership in shoulder surgery from J.P. Warner at the Brigham and MGH, the Sports Medicine Program is growing.

The Foot and Ankle Service under the direction of Mike Wilson has grown logarithmically in terms of volume, complexity of foot and ankle problems and both resident and fellow education.

The Upper Extremity Fellowship under the direction of Barry Simmons remains one of the preeminent fellowship training programs in the country. The unique exposure to hand, elbow, and shoulder problems with Barry and Mark Koris coupled with a superb pediatric experience with Peter Waters at Children's makes this a winning combination.

We are all excited about the addition of Mark Vrahas to coordinate, consolidate, and run the Trauma Program at the Brigham and MGH. This is going to be a great opportunity to take the expertise in Trauma from John Wright, Tom Minas, John Ready, Greg Brick, and others including the Chief Resident Service, and provide a service for tertiary trauma referrals as well as a means to enhance the academic program in trauma.

PHYLLIS:

With the expanded programs, new additions, and plans for further growth, don't you think they are going to wonder how you will fit all these people in at the Brigham?

TST:

Good point. They may be interested to know that we have finally come out of our ivory tower and metastasized into the community. We opened the 850 Boylston St. unit, which consists of 9 examining rooms, an x-ray suite, and a physical therapy facility specializing in sports medicine rehabilitation. This gives expanded ambulatory facilities that are conveniently located in our Western suburbs. The merger of the Brigham and Women's Hospital and the Faulkner Hospital has been a real boost to the Orthopedic Service. We took a leadership position in the transition and appointed Mike Wilson as Director of Brigham Orthopedics at Faulkner Hospital. We now do the majority of our outpatient surgery there. I look at that as a great opportunity for growth both in terms of outpatient surgery, some inpatient surgery and expanded facilities. We have just completed negotiations and opened a newly consolidated unit of the Brigham Orthopaedic and Arthritis Center at Braintree Healthsouth Hospital, a rehabilitation facility on the South Shore. This brings together our existing programs in Adult Reconstruction, Sports Medicine, Spine Surgery, and Pain Management plus gives us another mechanism for expansion.

PHYLLIS:

Don't you think you should tell them about the Orthopaedic and Arthritis Center?

TST:

You're right. I am sure they will all remember the unique relationship that we enjoyed at the Robert Breck Brigham with our Rheumatology colleagues who remain leaders in the field. With Frank Austen stepping down as Chief but remaining active in research, Michael Brenner became Division Chairman. Michael Weinblatt recently stepped down as Head of the Arthritis Center because of increasing national responsibilities that will lead to his Presidency of the American College of Rheumatology. Dr. Jonathan Coblyn has assumed that role and is continuing our active program in comprehensive rheumatological care. We all realize that expansion and increased clinical and administrative responsibilities threaten this unique liaison between rheumatology and orthopedics at the Brigham. With great input from the Hospital, we consolidated our combined interests from Radiology, Pain Management, Metabolic Bone Disease, Orthopaedics, and Rheumatology into a rejuvenated Orthopaedic and Arthritis Center at the Brigham and its satellites. Under the administrative direction of Steven Fiore, this has given us a wonderful vehicle to coordinate comprehensive patient care, breakdown departmental and divisional silos, and foster new areas for research.

PHYLLIS:

You haven't mentioned research. I'm sure you won't be able to go into all the programs, projects, grants and awards but you should at least give them an overview of the research programs at the Brigham.

TST:

I'll try but the problem is that we have research programs with Michael Brenner and others in Rheumatology, Meryl Leboff in the Endocrine Department, Barbara Weissman and Carl Winalski in Radiology not to mention those activities within the Department. We have NIH, OREF, Whitaker, Arthritis Foundation, VA, and AO/ASIF grants in addition to many industry-sponsored grants.

PHYLLIS:

Don't mention the grants because aren't you going to try to get the alumni and others to support our research effort. Why don't you just tell them about some of the programs and research activities within the department.

TST:

I won't mention the grants.
Dr. Myron Spector is the Director of the Orthopedic Research Laboratory at the Brigham, which occupies 5,000-sq. ft. of laboratory space. There is close collaboration with the rehabilitation engineering (R&D) laboratory of the Brockton/West Roxbury VA Medical Center which has an additional 2,400 sq. ft. The major projects in the laboratory under Dr. Spector's direction include the elucidation of mechanisms underlying the response to injury and healing of musculoskeletal tissues as well as the pathobiology of certain musculoskeletal disorders. There is strong interest in the development of analogs of extracellular matrix to facilitate tissue engineering and cell regeneration. The core facilities of the laboratory include biochemistry, cell/tissue culture, and histology laboratories. The engineering resources include computer facilities for design and simulators for wear testing. The research is conducted by multidisciplinary teams including senior investigators, post-doctorate fellows, orthopaedic surgeons, as well as faculty and students at both Harvard affiliated institutions and MIT.

One interesting study in Dr. Spector's laboratory has been the use of matrices that serve as analogs of the extra-cellular matrix to allow for tissue engineering. In collaboration with MIT Professor I.V. Yannas, a collagen glycosaminoglycan (GAG) co-polymer has been used as a matrix for engineering for articular cartilage, menisci, ligaments, tendons and inter-vertebral discs. Physicians involved in this work include Drs. Scott Martin and Richard Ozuna as well as residents Martha Murray and Sonu Ahluwalia.

Dr. Julie Glowacki, Director of Skeletal Biology at BWH Orthopedics, has been very active in terms of productive research, grant funding, and interdisciplinary collaboration. In addition to her NIH support, she is funded by AO/ASIF, the Department of Defense, and several industry grants. Perhaps the most exciting and clinically relevant study to achieve national exposure was the article in JAMA this year reporting the high incidence of Vitamin D deficiency in post-menopausal women with acute hip fractures. This was done with Meryl Leboff, Director of the BWH Skeletal Health and Osteoporosis Program as well as John Wright from the Trauma Team. In their study over 50% of post-menopausal women admitted to the Brigham with acute hip fractures had deficient levels of Vitamin D. Forty per cent of the subjects studied had elevated parathyroid hormone levels and one-third had both low Vitamin D and high PTH levels.

Sonya Shortkroff remains active on multiple projects including completion of her studies of radiation synovectomy, which will lead to her Ph.D. thesis. A particularly interesting study is the collaboration with the Department of Nuclear Physics at MIT to develop boron-neutron capture synovectomy to replace our previous techniques of radiation synovectomy.

Dr. Tom Minas is combining his strong clinical interest in non-arthroplasty solutions with both clinical and basic science interests in cartilage regeneration to offer some novel therapies to a complex subset of patients. This started with an interest in osteotomy and perichondral grafting, and has led to the largest American experience in autologous chondrocyte implantation. Tom has been a US leader in refinement of surgical technique, setting up FDA approved trials and, in conjunction with scientists at Genzyme Corporation, is studying basic mechanisms of chondral repair. Moreover, he has set up a Brigham Registry to prospectively evaluate his patients.

The Total Joint Registry under the Direction of Dr. Robert Poss continues to be a springboard for many of the clinical studies in adult reconstruction. His work with the Muller Foundation and the Hip Society coupled with new information technologies bodes well for the future of this program.

Dr. Jonathan Schaffer continues his work with the Designs Systems Group in medical informatics and has been active in setting up the Brigham as well as the Partners Web page. He has been accepted into the Kellogg Graduate School of Business at Northwestern University and will commute on an every other weekend basis for the next two years.

PHYLLIS:

What about you?

TST:

Oh yeah. I've continued my collaboration with Dr. Steve Goldring which began while I was at the Baptist. Richard Scott and I have several collaborative projects ranging from polymers to proteins. Julie Glowacki and I are looking at cartilage in osteoarthritis and the effect of several nutrients on cartilage health/repair.

PHYLLIS:

Well - do you think it sounds like a Christmas letter?

TST:

I hope not but I'm looking for feedback from my friends and colleagues before the next issue.

Thomas S. Thornhill, M.D.
Professor of Orthopaedic Surgery,
Harvard Medical School

Orthopaedist-in-Chief, Department of Orthopaedic Surgery, Brigham and Women's Hospital

President-elect, The Knee Society

Board of Trustees; Brigham and Women's Hospital, BWH/Faulkner, Arthritis Foundation

Clinical Faculty

Robert Poss, M.D.
Professor of Orthopaedic Surgery,
Harvard Medical School

Vice-Chairman, Department of Orthopedic Surgery, Brigham and Women's Hospital

Director, American Board of Orthopaedic Surgery

Richard Scott, M.D.
Associate Clinical Professor of Orthopaedic Surgery, Harvard Medical School
Past-President, The Knee Society

Barry P. Simmons, M.D.
Associate Clinical Professor of Orthopaedic Surgery, Harvard Medical School

Director, Hand and Upper Extremity Service

President, Musculoskeletal Education and
Research Institute

Gregory W. Brick, M.D.
Assistant Clinical Professor of Orthopaedic Surgery, Harvard Medical School

Board of Trustees,
Brigham Orthopaedic Foundation

Jonathan L. Schaffer, M.D.
Assistant Professor of Orthopedic Surgery,
Harvard Medical School

MBA Candidate,
Kellogg Graduate School of Business

Charles H. Brown, Jr., M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Director, Sports Medicine Service

Daniel M. Estok, II., M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

James H. Herndon MD, MBA
Chairman, Partners Department of Orthopaedics
Partners Healthcare Professor of Orthopedic Surgery,
Harvard Medical School

Jon J.P. Warner, MD
Chief, Shoulder Service
Associate Professor of Orthopedic Surgery,
Harvard Medical School

Mark J. Koris, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Scott D. Martin, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Team Physician: The New England Revolution, Bridgwater College, Wellesley College, and
Wheelock College

Tamara L. Martin, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Team Physician: Women's World Cup, Wellesley College, Wheelock College and Bridgewater College

Tom Minas, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Leader in the Field of Autologous
Chondrocyte Implantation

Richard M. Ozuna, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School
Director, Spine Service

John E. Ready, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Director, Tumor Service

Michael G. Wilson, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Director, Brigham Orthopaedic Department,
Faulkner Hospital

Director, Foot and Ankle Service

R. John Wright, M.D.
Instructor in Orthopaedic Surgery,
Harvard Medical School

Resident Coordinator,
Brigham and Women's Hospital

Director, Orthopaedic Trauma Service

Clinical Faculty-Harvard Vanguard Medical Associates

Robert Chernack, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

John A.K. Davies, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School


Jerry L. Knirk, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Robert E. Miegel, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Mark E. Steiner, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Craig R. Stirrat, M.D.
Clinical Instructor in Orthopaedic Surgery,
Harvard Medical School

Basic Science Faculty

Myron Spector, PhD.
Professor of Orthopedic Surgery,
Harvard Medical School

Director, Orthopedic Research Laboratory,
Brigham and Women's Hospital

Julie Glowacki, Ph.D.
Associate Professor of Orthopedic Surgery,
Harvard Medical School

Co-editor, The Aging Skeleton - Academic Press

Election to the American Society for Bone and Mineral Research Council

Hu-Ping Hsu, M.D.
Instructor in Orthopedic Surgery,
Harvard Medical School

Biomechanical changes in the animal
model of total joint arthroplasty

Schuichi Mizuno, Ph.D.
Instructor in Orthopedic Surgery,
Harvard Medical School

Cartilage regeneration and
mechanical signal transduction

Anuj Bellare, Ph.D.
Research Fellow in Orthopedic Surgery,
Harvard Medical School

Polyethylene wear

Sonya Shortkroff, M.S.
Research Associate, Harvard Medical School

Biochemistry/Cell Culture