Arthroplasty Service

Let me comment a bit about the arthroplasty service and then bring in the comments of the other division chiefs. We continue to be extremely strong in both hip and knee primary and revision arthroplasty. Dan Estok is the fellowship director and our 3 fellows from this year were our top 3 choices. Dr. Keith Reinhardt from Hospital for Special Surgery will be joining an academic group on Long Island, Dr. Josh Lindsey from the University of Washington in Seattle will be going to his home state of Wisconsin and Dr. Brian Palumbo will be returning to an academic group in Tampa, Florida. These are 3 of our best in a long the line of tremendous fellows and we are very proud to have them in our family. I think that the strength of our fellowship has been its diversity. Both Greg Brick and John Ready do the majority of their hips through a direct anterior approach, while the rest of us continue with a mini posterior approach. This gives the residents and the fellows an opportunity to see many different options. Another significant component of our arthroplasty fellowship is the added value brought by Tom Minas as he does over 100 osteotomies a year and our Cartilage Repair Center (CRC) is the largest in the country. More about the CRC in the Sports division report.

Operation Walk Boston

One of the most rewarding aspects of the Arthroplasty Service has been and still is our program of Operation Walk Boston. Operation Walk Boston is now in its 7th year. The first year I took 2 people with Operation Walk Denver, to Panama and since then we have been going as Operation Walk, Boston to the Dominican Republic (DR). Our hospital is Plaza de Salud in Santo Domingo This past year, we did 61 total hip and total knees of a severity that you can see in Figure 1A & B. When I started at the Robert Breck Brigham Hospital in 1979, many of rheumatoid patients were in this shape as there were no good disease modifying drugs. Fortunately, we do not see this anymore in Boston and most of the severe rheumatoids that I operate on are actually in the Dominican Republic.

The five surgeons that went with us this year were Dennis Burke from the Massachusetts General Hospital, David Mattingly from the New England Baptist, David Dalury from Baltimore (our former fellow), Wolfgang Fitz from BWH and me. We took five anesthesiologists (all with BWH connections) and a team of about 50 people, all volunteers. Roya Ghazinouri, former supervisor of inpatient PT and now working in BWH care improvement has been on every mission and is the COO organizing a large group of talented and dedicated professionals from Nursing, PT, PACU, Pharmacy and CPD. Dr. Jeff Katz who heads our outcomes research group has gone with us the past several years and we have now written over 5 papers that highlight the outcomes in these patients. It is very interesting that the slope of the improvement in these patients is actually greater than what we see in Boston. Jeff has created a program that brings several volunteer HMS students who are invaluable in the research effort.

Moreover, Op Walk Boston is now an integral part of the HCORP Residency. Started by Coleen Sabatini several years ago, this has morphed into a robust program where we take a PGY3, 4 and 5. Each functions in key roles both surgically and heading our three services. This past year our PGY 3, Carl Harper additionally ran the blog, Ellen Fitzpatrick PGY 4 was our CMO and Colin May our PGY5 on his third mission was active in surgery, patient care and education or DR students.

I am very proud of the fact that we do not operate on anyone in the Dominican that we would not operate on here and the patients are thoroughly evaluated preop. Moreover, our Dominican colleague, Dr. Luis Alcantera keeps a watchful eye on this patient population. We will go back next spring for our mission. I find this one of the most rewarding things that I have done in my career and I would strongly suggest that any of you with the opportunity get involved in one of these endeavors do not miss the chance.