orthopaedic surgery: providing state-of-the

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orthopaedic surgery: providing state-of-the
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AN UPDATE ON CLINICAL ADVANCES AND PATIENT CARE
AT NORTHWESTERN MEMORIAL HOSPITAL
ORTHOPAEDIC SURGERY: PROVIDING
STATE-OF-THE-ART SUBSPECIALIZED CARE
IN THIS ISSUE:
Northwestern Memorial Hospital offers comprehensive orthopaedic
Q&A: Degenerative
Spine Conditions
care including the treatment of complex and tertiary problems. Highly
PA G E A 5
skilled surgeons on the medical staff at Northwestern Memorial are
dedicated to providing subspecialized patient care in all areas of
orthopaedic surgery. This issue of Practice Advantage covers exciting
updates in the areas of degenerative spine conditions, musculoskeletal
oncology and total joint replacement.
WWW.NMH.ORG
C O N T I N U E D O N PA G E A 2
PA G E A 3
Orthopaedic Oncology:
Multidisciplinary Care for Patients
with Bone and Soft Tissue
Sarcomas and Bone Metastases
Total Joint Replacement: New
Technology and Integrated Care
PA G E A 6
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N O R T H W E S T E R N M E M O R I A L H O S P I TA L
Toll-free Physician Access:
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Exceptional Care in the Heart of Chicago
Northwestern Memorial Hospital is a nationally recognized
873-bed hospital with inpatient care provided in the Feinberg
Pavilion, Prentice Women’s Hospital and the Stone Institute
of Psychiatry. Northwestern Memorial is the primary teaching
hospital of Northwestern University’s Feinberg School of
Medicine and a major Midwest referral center. More than
1,570 physicians on the medical staff represent virtually every
specialty. Market research consistently recognizes the hospital,
the medical staff and nurses as the “most preferred” in Chicago.
Multidisciplinar y Collaboration in Or thopaedic Surger y:
Promoting Patient Safety and Advancing Research
Q: What role may regenerative technologies play in performing spinal
fusion and bone healing?
In the United States, the demand for orthopaedic care is rising steadily as the population of older adults interested
in maintaining an active lifestyle continues to grow. Northwestern Memorial Hospital is committed to providing
the full range of orthopaedic services including musculoskeletal oncology, sports medicine, total joint replacement
and the treatment of or thopaedic problems in the spine, hand, wrist, hip, shoulder, foot and ankle. The subspecialized trauma ser vice provides state-of-the-art care for even the most complex fractures of the long bones.
Patients who sustain spinal cord injury receive comprehensive care through the Spinal Cord Injury program which
is a joint effor t between the depar tments of Or thopaedic Surger y and Neurosurger y at Nor thwestern Memorial
and the Rehabilitation Institute of Chicago.
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Q&A
Orthopaedic surgeons on the medical staff at Northwestern Memorial are committed to promoting the health and
safety of their patients. “Our focus on patient-centered care and patient safety is evident throughout all our programs,” says Michael F. Schafer, MD, Chairman of Or thopaedic Surger y at Nor thwestern Memorial and the
Ryerson Professor of Or thopaedic Surger y at Nor thwestern University’s Feinberg School of Medicine. “A great
example is our high-risk spine team which we developed in conjunction with the department of Neurosurgery to
enhance patient safety in complex spine reconstruction surgeries. This multidisciplinary team involves internal
medicine, anesthesiology, critical care medicine and operating room personnel.”
Through the Sports Medicine program at Northwestern Memorial, physicians on the medical staff provide comprehensive care to athletes of all ages, genders and levels of ability. “Our surgeons are the team orthopaedic consultants
for Nor thwestern University’s undergraduate campus as well as the team physicians for the Chicago Bears, the
Chicago Cubs, the Chicago Fire and the Chicago Blackhawks,” says Dr. Schafer.
Exceptional Care in the Hear t of Chicago
Q&A: Degenerative Spine Conditions
C O N T I N U E D F R O M PA G E A 1
Researchers at Northwestern University’s Feinberg School of Medicine and Northwestern Memorial are active in clinical and basic research applied to the musculoskeletal system. “We are studying effective outcomes and developing
clinical outcome studies, taking into account not only the result of the treatment but also economic considerations,”
says Dr. Schafer. “Our faculty members are researching a wide range of novel approaches including the use of growth
factors to promote bone healing following bone grafting for spinal fusion, tissue engineering as applicable to tendon
and cartilage healing and methods to enhance the healing of long bone fractures.”
Nor thwestern Memorial Hospital
251 East Huron, Chicago, Illinois 60611
www.nmh.org
Historically surgeons have performed
autologous iliac crest bone grafting
when performing a spinal fusion for a
number of different diagnoses including
arthritis, degenerative disc disease, spinal
instability, trauma and tumor. While the
healing rates have been pretty good, the
bone grafting procedure causes pain.
Up to 60 percent of patients even two
or three years after the procedure still
complain about hip pain. The development of a number of growth factors
including bone morphogenic proteins
(BMPs) has provided an alternative for
bone grafting in many cases. The use
of BMP has been shown to be just as,
if not more effective, than bone grafting. However, the FDA has issued a
warning against using BMP in procedures in the cervical spine because it is
associated with complications such as
radiculitis and swelling in the cervical
spine. So we still are searching for good
bone graft substitutes to heal the spine.
My colleagues and I are researching
potential regenerative technologies
for bone healing and spine fusion.
One of our interests is in the use of
stem cells extracted from human fat.
The concept is to obtain fat through
a liposuction procedure and then
extract the cells from the fat. Then
the cells potentially could be administered with an appropriate carrier in
the area where bone healing is needed.
I am in the animal model phase of
developing a therapy with this approach
that I hope will eventually lead to high
spine fusion rates without complications
from either bone graft or BMP.
Wellington Hsu, MD, is a spine surgeon on
the medical staff at Nor thwestern Memorial
Hospital and assistant professor of Surger y
and director of the Tissue Engineering Lab
in the Depar tment of Or thopaedic Surger y
at Nor thwestern University’s Feinberg School
of Medicine.
Q: How are you using new technologies to provide alternatives
to spinal fusion?
We are using new technologies to offer
surgeries for many of the same conditions that are traditionally treated with
spinal fusion. For example, physicians
have traditionally treated arthritis in the
cervical spine with an anterior cervical
C O N T I N U E D O N PA G E A 4
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C O N T I N U E D F R O M PA G E A 3
However, in our multidisciplinary
setting I can call on 10 to 15 other
specialists who treat spine problems
non-surgically. So we only recommend surgery for patients who will
likely benefit from the procedure.
We have investigated a number of
variables such as age, medical status
and physical function, all of which
can predict outcomes. We also research
these types of variables through database collection as well as retrospective
review to determine which patients
are good surgical candidates. Having
access to this type of information in
addition to a range of different spine
specialists who offer leading-edge
surgical and non-operative strategies
gives our patients an advantage in
terms of outcomes.
A
B
Images show postoperative plain radiographs of a 35-year-old patient with a 12-week history of
cervical myelopathy, complaining of bilateral hand clumsiness, weakness and balance difficulty.
MRI images demonstrated a large herniated nucleus pulposus at C56. The patient was subsequently treated with a C56 total disc arthroplasty (A) with the Prestige ST implant (B).
Northwestern Memorial Hospital
Physician Access Line (PAL)
866-899-7371
Call PAL for assistance with:
discectomy and fusion. Recently the
FDA approved two devices for performing cervical disk arthroplasty.
So instead of placing bone graft to
achieve fusion and bone healing, we
place an implant that will preserve
the motion at that segment. Longterm trials of two to five years have
shown that patients actually fare
better with this implant than with
fusion. Another example is a device
called the X-STOP® Spacer which
we use for the lumbar spine in a
subset of patients who have degenerative spondylolisthesis. We can
provide a motion-sparing procedure
by implanting this interspinous device.
It is an outpatient procedure and
A4 | PRACTICE ADVANTAGE | MAY/JUNE 2009
patients have no restrictions after
about two weeks. So in a subset of
patients with this diagnosis we can
provide significant relief with minimal risk.
• Identifying physicians
ancillar y ser vices such as specialized nursing, physical and
occupational therapy and social ser vices to suppor t each
diagnosis and treatment of sarcomas in the soft tissues and
patient’s specific needs.”
bone of the extremities and pelvis. They
The bone is the third most common
also are experienced in treating
site of metastasis for many cancers
patients who develop bone metastasis.
including breast cancer, lung cancer,
In conjunction with the Rober t H. Lurie
prostate cancer, kidney cancer and mulComprehensive Cancer Center, these
tiple myeloma. “This unique patient
subspecialized physicians focus on
population can benefit from a defined,
addressing the unique needs of these
multidisciplinar y team to address
patients through multidisciplinar y sartheir unique needs,” says Dr. Yasko.
coma and bone metastasis programs.
“Working with our colleagues who are
“Due to the rarity of sarcomas these
exper ts in these diseases along with
patients should be taken care of by
highly skilled team members within the
physicians who have specific exper tise
suppor tive disciplines, we work to
in treating these tumors, including physi-
palliate pain, preser ve function and
cians trained in musculoskeletal radiology
provide a high quality of life for patients
and pathology,” says Alan W. Yasko, MD,
with advanced disease.”
MBA, orthopaedic surgeon on the medPatients who have sarcomas in the
extremities and pelvis may require addi-
professor of Or thopaedic Surger y, vice
• Scheduling appointments
tional services to preserve their limbs. The
chairman of Or thopaedic Surger y and
• Providing information on
Center for Limb Preservation and Wound
chief of Or thopaedic Oncology in the
inpatient admissions
Care at the Bluhm Cardiovascular Institute
Depar tment of Or thopaedic Surger y at
physician communication
There are a number of different
ways to treat the spine. And there
is an art to determining which
patients will benefit from surgery
versus non-operative care. As a
surgeon, I primarily perform surgery.
Physicians specializing in or thopaedic oncology on the medical
staff at Nor thwestern Memorial Hospital offer exper tise in the
ical staff at Northwestern Memorial and
for referral
• Facilitating physician-to-
Q: How does a multidisciplinary
approach benefit patients
who have degenerative spine
conditions?
Orthopaedic Oncology: Multidisciplinary Care for Patients
with Bone and Soft Tissue Sarcomas and Bone Metastasis
Northwestern University’s Feinberg School
of Medicine. “We optimize patient out-
PAL is a resource for physicians
and staf f managed by representatives dedicated to ser ving
the needs of the community.
A registered nurse is available
to attend to clinical inquiries.
When you refer a patient through
PAL, a packet is sent to your
patient including confirmation
of the appointment with a physician on the medical staf f at
Nor thwestern Memorial, parking
information and maps.
WWW.NMH.ORG
of Northwestern Memorial is dedicated to
X-ray shows a prosthetic
reconstruction of the knee.
comes with a multidisciplinar y approach
typically involving more than one of the available modalities to
treat sarcomas, including chemotherapy, radiation and surger y.
We work together as a team that is comprised of exper ts in
medical oncology, radiation oncology and surgical oncology
including specialists in thoracic surger y, vascular surger y and
providing comprehensive care for these
patients. “We work with our colleagues
in vascular surger y and plastic surger y to address the complex
issues involved in limb preser vation,” says Dr. Yasko. “This collaboration is a prime example of how we bring the full exper tise
of our subspecialized colleagues to the table when we develop and
follow through with each patient’s individualized treatment plan.”
plastic surgery. Our team includes oncologic physiatrists at the
Rehabilitation Institute of Chicago and a support network of
WWW.NMH.ORG
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Toll-free Physician Access:
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Total Joint Replacement:
New Technology and Integrated Care
Surgical Webcasts at
Northwestern Memorial Hospital
The volume of hip and knee replacement surgeries in the
viding comprehensive care from surgery through rehabilitation,”
United States is expected to triple in the next 10 years as the
population of baby boomers comes of age. “The sheer number
of patients who are suffering from significant ar thritic conditions in the hips and knees already has grown significantly,”
says Lalit Puri, MD, MBA, orthopaedic surgeon on the medical
staff at Nor thwestern Memorial Hospital and assistant professor of Or thopaedic Surger y at Nor thwestern University’s
Feinberg School of Medicine. “Many of these are patients who
expect to maintain their active lifestyles. They are seeking out
total joint replacement not just to alleviate pain, but also to
enable them to continue the activities they enjoy. Fortunately
says Raju S. Ghate, MD, or thopaedic surgeon on the medical
staf f at Nor thwestern Memorial and instructor of Clinical
Or thopaedic Surger y at the Feinberg School. “There is good
evidence showing that high-volume centers have lower complication rates in terms of not only the surgical procedures but
post operative nursing complications as well. For this reason
there has been a national push toward getting patients treated at centers such as Nor thwestern Memorial.”
technological improvements have given us an ability to meet
our patients’ needs and expectations. This includes younger
patients in need of joint replacement who likely would not
have been eligible a decade ago.”
Surgeons on the medical staff at Nor thwestern Memorial
are focused on pioneering methods to provide greater accuracy in placing the components for joint replacement in order
to achieve the best function for the patient. “Computer-aided
surger y is one solution by which to potentially increase the
accuracy of the surgeon,” explains Dr. Puri. “We are working
on developing new technology associated with computer-aided
knee replacement because we theorize that more accurate
placement will improve function. In addition, performing these
procedures though less invasive techniques may result in
quicker recover y and reduced pain for our patients.”
X-ray shows middle aged patient with ar thritis of the hips.
The total joint replacement program at Northwestern Memorial
incorporates all aspects of patient care including anesthesia,
nursing and discharge planning in order to create an integrated
experience for the patient. “We are a high-volume center pro-
New technology in joint replacement components has resulted in dramatically improved bearing sur faces which may allow
for greater longevity in hip replacements. “We also have more
options now in terms of fur ther customization of the implants
with the new technology available in both knee and hip joints,”
says Dr. Ghate. “For example, the original implants were
designed based on male anatomy only. However, there are
now several companies that have designed joints for both
women and men so that we can utilize gender-specific implants.
Through customization and patient-centered care our goal is
to continually improve this therapy so that our patients can
regain normal knee or hip function and be able to painlessly
do all the things they did before their knee or hip caused
them pain.”
Minimally invasive surger y (MIS) has revolutionized the field of
surgery over the last 20 years. Surgeons on the medical staff at
Northwestern Memorial Hospital have led the way in advancing
MIS to treat a wide range of conditions. View four minimally
invasive surgeries per formed at Northwestern Memorial on our
Web site at ihealth.nmh.org.
Minimally Invasive Webcasts:
· Achalasia Treatment: Through Laparoscopic Heller
Myotomy Esophageal Surger y
Recorded 12/02/2008
Featured Physician: Nathaniel J. Soper, MD
· Scoliosis Surger y: A Minimally Invasive Approach
Recorded 10/ 7/ 2008
Featured Physician: Richard Fessler, MD, PhD
· Robotic Hysterectomy for Endometrial Cancer
Recorded 7/17/2008
Featured Physician: M. Patrick Lowe, MD
Receive Your Free
Physician Referral Directory
The director y includes all the physicians on the
medical staff at Northwestern Memorial Hospital,
representing 50 specialties and more than
1570 physicians. Call 1-866-899-7371 or
e-mail us at [email protected]
· Hybrid Maze Procedure
Recorded 4/9/2008
Featured Physician: Richard Lee, MD
Patient Power Audiocasts:
Also listen to Nor thwestern Memorial physicians discuss
complex health topics on our Patient Power audiocasts
on ihealth.nmh.org.
The surgical webcasts and Patient Power audiocasts
target both physicians and patients.
Northwestern Memorial Hospital is pleased to provide you with Practice Advantage,
the center section, which provides the most up-to-date clinical advances available
to your patients. We hope you find the information timely and informative.
TOLL-FREE PHYSICIAN ACCESS: 866-899-7371
We Welcome Your Feedback
E-mail us at [email protected] or visit our Web site at www.nmh.org
and select “For Healthcare Professionals.”
Physicians Practice is provided by the Division of
Public Relations, Marketing and Physician Ser vices of
Nor thwestern Memorial as a ser vice to the community.
If you have comments or suggestions regarding this
publication or would like to reproduce any par t of this
publication, contact us at 312-926-2038 or write to:
Director of Marketing Ser vices
Nor thwestern Memorial Hospital
240 E. Ontario St., Suite 450
Chicago, IL 60611-3223
or e-mail to tbur [email protected]
© 2009 Nor thwestern Memorial Hospital
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