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The Rubin Institute for Advanced OrthopedicsChiefs’ Corner:Words From the Leaders of the Rubin Institute for Advanced OrthopedicsJerome P. Reichmister, M.D.Chairman, Rubin Institute for Advanced OrthopedicsChief, Orthopedics, Sinai HospitalI have been the chief of orthopedics at SinaiHospital for 25 years, and I have practicedorthopedic surgery for even longer — 40 years.So I have seen a lot of incredible developmentsover the course of my career. But nothing hasstimulated me more professionally than what Isee happening right now at the Rubin Institutefor Advanced Orthopedics. I am continuallyexcited by the bright people who work here andby the jobs they are doing, from research, toteaching, to providing world-class patient care.Our team has ushered in so many advances,and with those advances come better and betterresults for our patients in Baltimore and throughout the global orthopedic community.Paul M. Apostolo, M.D.Chief, Orthopedic Surgery, Northwest HospitalDirector, Center for Hand and Upper Extremity Surgery,Rubin Institute for Advanced OrthopedicsWith our formal expansion to Northwest Hospitalin April 2015, the Rubin Institute for AdvancedOrthopedics now serves the entire northern andwestern Baltimore region. In addition to the fullarray of inpatient and outpatient services,Northwest Hospital is also home to the Centerfor Hand and Upper Extremity Surgery and theCenter for Diabetic Limb Preservation,complementing orthopedic services ranging fromcare of the spine, hip, knee, shoulder, hand andfoot to physical medicine and rehabilitativeservices for all ages. We’ve dramaticallyexpanded outpatient care with state-of-the-artexam rooms and dedicated X-ray and procedurerooms. Cutting-edge technology, quality ofservice and convenient locations allow our teamof physicians, nurses and therapists to achievethe best quality of life possible for our patients.Scott E. Brown, M.D.Chief, Department of Physical Medicine and RehabilitationMedical Director, Sinai Rehabilitation CenterPerhaps the thing we’re most proud of in theDepartment of Physical Medicine andRehabilitation is our strong collaborative workingenvironment with the Orthopedics Departmentand the Rubin Institute for AdvancedOrthopedics. When patients come to SinaiHospital for an orthopedic procedure, they seeboth our inpatient therapists as well as ourrehabilitation doctors, who are specificallydedicated to determining each patient’s6 LifeBridge Health Magazine Spring 2016rehabilitation needs. The same concern for theright rehabilitation care is also the focus atNorthwest Hospital. When you have rehabilitation therapists and doctors across specialtiesworking together seamlessly, patients get theright care at the right time. That’s what ultimatelyprovides the best patient care and accelerates theprocess of getting patients home safely, wherethey can resume their activities of daily living.

Protect All the Parts of YourSkeleton From InjuryWhen the cartilage, ligaments, tendons andbones that make up your skeletal systemare injured, daily activities becomedifficult. Keep your entire skeletal system safe andhealthy with these head-to-toe tips.NeckPrevent muscle strain and tension in yourneck by keeping your computer monitor ateye level and making sure your pillowcomfortably supports your head and neckwhile you sleep. Ask your doctor orphysical therapist to suggest stretchingexercises you can do throughout your day.SpineA common culprit of back pain isdisc degeneration, when the discsthat pad your backbone deteriorateor rupture. Keep your spine strongby exercising regularly, eatinghealthy food and practicing goodposture. When you lift somethingheavy, keep your back straight andput the stress on your legs and hips.ShoulderThe rotator cuff is a group of muscles that hold yourshoulder joint together. They allow your arm torotate as you reach, stretch and throw. Because thejoint is so mobile, it’s also unstable. Strengtheningexercises can prevent injuries. See a physician atthe first sign of pain, stiffness or weakness.HipWristTyping on a computer or frequentlyusing a mouse can lead to carpal tunnelsyndrome, a condition in which swellingcompresses an important nerve in yourwrist. Position your keyboard so thatyour wrists don’t bend upward when youtype. Take frequent breaks. And try avariety of mousepads, keyboards andtyping pads to create a comfortableworkspace.AnkleThe ankle joint is the most common sitefor sprains. To help prevent sprains,warm up thoroughly before exercise.Wear shoes that fit well. Add balanceand agility exercises to your routine.Age increases your risk for hip injuries. Strengthenyour hips by getting enough calcium and vitamin Din your diet. Nine in 10 hip fractures occur as aresult of falls, so avoid tumbles with a balancebuilding exercise program, such as tai chi.KneeThe knee bears much of our body weight, and it’sinjured more than any other joint. Protect it bywarming up thoroughly before exercise, maintaining a healthy weight, building your leg muscles andwearing shoes that fit properly.LegThe lower legs absorb most of the force when yourun. To ward off shin splints and more serious leginjuries, run on softer surfaces, build up any newexercise program slowly and get instruction onproper form.Spring 2016 www.lifebridgehealth.org 7

The Rubin Institute for Advanced OrthopedicsThe International Center for LimbHelpingFor many 15-year-old boys, playing basketball is justa normal Tuesday afternoon activity. But for ColeChilds, it’s something of a miracle. Cole was bornwith congenital femoral deficiency, a rare condition thatstymies growth in the hip and leg. Doctors predicted that, if leftuntreated, his right leg would be 9 inches shorter than his leftleg by adulthood.When the pediatric specialists in theChilds’ home state of Colorado firstdiagnosed his condition, they told thefamily that amputation was almostcertainly in Cole’s future. But Cole’sparents refused to settle for such a grimprognosis. After much research, theydiscovered the team at the InternationalCenter for Limb Lengthening (ICLL), part John Herzenberg, M.D.of the Rubin Institute for AdvancedDirector, InternationalCenter for LimbOrthopedics at Sinai Hospital.Lengthening and“Some of the conditions we treat havePediatric Orthopedicsan instance of 1 in a million births,” saysat Sinai HospitalJohn Herzenberg, M.D., director of boththe ICLL and pediatric orthopedics atSinai. “People come to us from all over thecountry and the world because of ourexpertise and reputation.”Fixing the ‘Unfixable’Bradley Lamm, D.P.M., the ICLL’s headof foot and ankle surgery, echoes Dr.Herzenberg: “Many of our patients haveBradley Lamm, D.P.M.Head of Foot and Ankleissues that most doctors only see once ortwice in a career, but we see once or twice Surgery, InternationalCenter for Limba week. We fix the unfixable.”LengtheningIndeed, Cole’s “unfixable” conditionproved to be just the opposite in the hands of his ICLL team, ledby Dr. Herzenberg and Shawn Standard, M.D., head of pediatric orthopedics for the center. When Cole’s treatment ends thisyear, both of his legs are expected to be of equal length. Heanticipates a lifetime of walking, running — even shootingbaskets — completely independently, without the use ofprosthetics, shoe lifts or other assistive devices.Cole Childs travels from Denver, Colorado to receive treatment at theInternational Center for Limb Lengthening. He has been a patient atthe center since he was 2 years old.8 LifeBridge Health Magazine Spring 2016A Game-Changing TechnologyCole’s family and their doctors acknowledge that treatmentisn’t easy. Cole has undergone 13 surgeries to date —

HEAR COLE’S STORYLengthening at Sinai Hospital:And learn more about the InternationalCenter for Limb Lengthening atwww.lifebridgehealth.org/ICLL.Patients Stand Tallthree of which required 12 weeks ofon-site care at Sinai Hospital, followedby 12 weeks of recovery at homein Colorado.But a recent advance called thePRECICE Limb Lengthening Systemhas dramatically improved the process.Developed in part by Drs. Herzenberg andStandard, the PRECICE system features atelescoping titanium rod that is surgicallyimplanted inside the patient’s bone.Patients then use a handheld remotecontrol unit several times a day to magnetically extend the implant in very smallincrements. As the bone and skin aregradually (and painlessly) pulled apart,new bone and skin regenerate at an even,predictable rate. It’s a radical departurefrom the traditional method, which relieson cumbersome, cage like external fixatorsto achieve the same results.“This has been a huge game changer,”says Brandon Childs, Cole’s father. “Justthe fact that Cole can now wear regularpants makes such a difference in hisday-to-day life.”Bringing Expertise to the WorldThe goal of the ICLL is to make adifference in the lives of as many patientsas possible — not just in Baltimore, butglobally. The team regularly travels onsurgical missions to developing nations(see page 19) and provides training todoctors, residents and fellows on aninternational level.“We are recognized as a center wheredoctors from all over the United Statesand the world come to learn proceduresthat they can’t learn anywhere else,”explains Dr. Lamm.For patients like Cole, regular trips toBaltimore are a small price to pay for thelifetime of basketball games ahead.“When I think about the outcome we’reworking toward, I push through,” hesays. “I’m blessed to have these doctorsin my life.” Families Find Comfort atthe Hackerman-Patz HouseFor families undergoing the long journey of complex orthopedic treatment, theHackerman-Patz House across the street from Sinai Hospital provides a muchneeded home away from home. Designed in the spirit of an extended-stay hotel, thehouse includes 18 deluxe guest suites as well as common areas such as a playroom,kitchen, laundry room and business center.“For many of our patients, it’s not a typical surgery: Get your appendix out, gohome and you’re done. It’s a gradual, prolonged process,” explains John Herzenberg,M.D., director of both the International Center for Limb Lengthening and pediatricorthopedics at Sinai. “Having the Hackerman-Patz House makes life so much easierfor our patients because they can stay here for their whole treatment, in a place that’ssafe, comfortable, convenient and affordable.”“We also like it because it’s allowed us to connect with other families going throughsimilar situations,” adds Brandon Childs, the father of patient Cole Childs. “It’s helpedmake Baltimore our second home.”Spring 2016 www.lifebridgehealth.org 9

The Rubin Institute for Advanced OrthopedicsJoint PreservationCan Eliminate the Needfor Replacement Surgery10 LifeBridge Health Magazine Spring 2016

Your knee aches every time you take thestairs. Or maybe your hip gives youtrouble when you walk the dog. “Uh-oh,”you think. “It’s only a matter of time until I needjoint replacement.”Not necessarily, says the team at the RubinInstitute for Advanced Orthopedics’ Center for JointPreservation and Replacement at Sinai Hospital.“We have many techniques that can forestalla joint replacement or even avoid it altogether,”says joint specialist Ronald Delanois, M.D. “Theearlier you see an orthopedist, the better. Don’twait until your joint is totally destroyed.”More Treatment OptionsIndeed, the Center for Joint Preservation andReplacement boasts an impressive arsenalof joint preservation tools, ranging from themore traditional — physical therapy, steroidinjections — to the most cutting-edge, includingcartilage transplants and regeneration.“For so long it was understood that you can’tregenerate cartilage,” explains Michael Mont, M.D.,the center’s founder and director. “But now wehave a number of evidence-based approaches thatprove you can. We can inject cells into the joint tostimulate hormones that help cartilage repair itself.We can even grow cartilage cells in a lab settingand then transplant them to the patient.”The Wasserman Gait LaboratoryFor many of the center’s patients, treatment doesn’tbegin until after a visit to the Wasserman GaitLaboratory at Sinai Hospital, one of the first labsin the world — and currently the only lab inMaryland — dedicated to quantitative gait analysis.The lab uses sophisticated computer technology toanalyze patients’ skeletal alignment, musclefunction, range of motion and forces acting on thebody during walking. It’s a unique perspective thatenables the center’s joint specialists to create themost optimized treatment plan for each patient.“For joint preservation to be effective, youreally have to pinpoint where forces are in thebody, how they are affecting the joint in questionand how can we move those forces away from thejoint,” explains Anil Bhave, P.T., director of theWasserman Gait Lab. “All of that can be determined here in the Gait Lab.”For some patients, the problems aren’t limitedto one joint; the hip, knee, ankle and back can allcome into play. But, according to Bhave, a 90-minute evaluation in the Gait Lab can help orthopedists determine which joints to target, and in whatways, even for incredibly complex cases.Advances in ResearchThe Gait Lab is also acritical partner inhelping the centerconduct ongoing jointpreservation research.For example, a recentstudy showed how newadvances in kneeRonald Delanois, M.D.Joint Specialist,braces can noninvaRubin Institute forsively counteract theeffects of osteoarthritis. Advanced Orthopedics’Center for Joint Preserva“Typically withtion and Replacementknee arthritis, youbegin to use the kneeless and less due topain, which onlyaggravates the condition. It’s a cascadeeffect that usually leadsto joint replacement,”says Bhave. “But thebrace in our studyJames Nace, D.O.unloads stress from the Joint Specialist, Rubinknee and forces it intoInstitute for AdvancedOrthopedics’ Centerfull extension, whichfor Joint Preservationallows the patient toand Replacementexercise and moveabout in his or hernormal fashion. Thatminimizes the wearand tear on the kneeand makes it possibleto significantly delaysurgery.”The ultimate goal ofjoint preservation,Anil Bhave, P.T.however, is to do moreDirector, Wassermanthan just delay surgery.Gait Laboratory“If seen by a specialistearly enough, a patient can achieve lastingoutcomes that eliminate the need for surgery— ever,” says joint specialist James Nace, D.O.“Joint replacements are unquestionablyvaluable procedures,” says Dr. Delanois. “But youwant to get as much mileage as you can withwhat you came to earth with.” DON’T IGNORE YOUR JOINT PAINTimely care can greatly expand yourtreatment options. Call 410-601-WELL(9355) to make an appointment with ourjoint specialists now.Spring 2016 www.lifebridgehealth.org 11

The Rubin Institute for Advanced OrthopedicsSmarter Treatment PlanningLeads to Better Outcomes forJoint Replacement PatientsFor Barbara McKee, competitive cyclist,it’s perfectly normal to bike 50 or 60miles at a stretch. But on a ride throughthe Blue Ridge Mountains in 2014, her bodysent her a warning signal.“I couldn’t swing my left leg over the bikebar; it would just get caught up,” she recalls.“I knew it was time for a visit to the doctor.”Barbara McKee is back to riding again, thanks to hipreplacement surgery.12 LifeBridge Health Magazine Spring 2016

Knowing Where to GoMcKee, a New Jersey resident, returned to the RubinInstitute for Advanced Orthopedics’ Center for JointPreservation and Replacement, where she had undergonereplacement surgery on her right hip six years earlier. Thecenter is led by a team of joint replacement experts,including director and founder Michael Mont, M.D.;Ronald Delanois, M.D.; Janet Conway, M.D.; James Nace,D.O.; Barry Waldman, M.D.; Stephen Bell, M.D.; PaulApostolo, M.D.; and Robert Saltzman, M.D.; and BradleyLamm, D.P.M., an ankle replacement specialist and headof foot and ankle surgery for the Rubin Institute’sInternational Center for Limb Lengthening. (See page 8.)“There was never a question in my mind of where togo,” she says. “I want to be at the best place for the surgeryI’m having, and that will always be here.”The center’s breadth of expertise at both its Sinai andNorthwest locations are part of what makes patients likeMcKee want to return. “Every member of our team is wellversed in the latest minimally invasive approaches,” saysDr. Mont, McKee’s two-time joint replacement surgeon.“We’re also on top of the latest pain management techniques to make treatment as painless as possible.”“Our goal is to ensure each patient gets the treatmenthe or she needs with the least pain and the fastest returnto function,” adds Dr. Apostolo, chief of orthopedic surgeryat Northwest Hospital.McKee, for one, was delighted to find that she waswalking just four hours after her 2015 left hip replacementprocedure. “We had a party in my room,” she says with alaugh. “I thought my right hip replacement was easy, butthis one was even easier.”Getting Patients Back on TrackAnother contributing factor to the center’s success isthe extensive, individualized treatment planning andpostsurgical rehabilitation its team does in conjunctionwith the Wasserman Gait Laboratory at Sinai Hospital.“It’s really important to understand how the mechanicsof the body are working and integrate that into yoursurgical plan,” explains Anil Bhave, P.T., director of theWasserman Gait Laboratory. “With the hip joint, forexample, we can determine the exact direction in whichthe pelvis moves when the patient walks, which, in turn,allows the surgeon to determine the most precise locationfor the new hip joint.”That level of detail is why McKee is certain she wasable to go on a California bike trek a mere two monthsafter her 2015 surgery. “Everybody goes the extra milehere,” she explains. “It’s just phenomenal.” 6WAYS TO KEEPYOUR JOINTS HEALTHY Stay active.Regular physical activity can reduce joint swelling andstiffness, increase flexibility and ease pain. Weighttraining can also strengthen joint-supporting muscles. Lose weight.Excess weight puts stress on your joints, particularlythe knees, hips and feet. Protect yourself against injury.When possible, avoid repetitive motions. Alwayswarm up before exercising. If you are injured, seekmedical attention right away. Do not ignore the pain. Get enough sleep.Joints need rest. By getting enough sleep, you canavoid injuries and help prevent joint pain and swelling. Try physical therapy.Swimming or water-based exercise can improve jointhealth while reducing pain. Wearing a splint or customfoot support may also help support weak joints. Consult your doctor.Early treatment of joint problems can help preventmore serious joint damage.Is It Time for a Joint Replacement?If you have any of the following signs, speak withyour doctor about joint replacement: Your joint pain is disturbing your sleep. You’ve tried different noninvasive treatments,including pain medications, and they’re notcontrolling your joint pain. Your joint pain is limiting your ability to keep upa normal routine. Your joint pain makes it hard for you to get outof a chair, go up stairs or get up from the floor.FITNESS SERVICES CAN HELPLifeBridge Health & Fitness offers aquatics, groupexercise classes, weight-loss programs and more.Visit www.bestbaltimorefitness.com to learn more.Spring 2016 www.lifebridgehealth.org 13

The Rubin Institute for Advanced OrthopedicsOrthopedicTrauma TeamHeals PatientsAfter SeriousInjuryWhat I like about trauma care is that we’re notfocused on one area of the body. It’s somethingdifferent all of the time,” says David Leu, M.D.,an orthopedic surgeon with the Rubin Institute for AdvancedOrthopedics and part of the team of orthopedic specialists forthe Trauma Center at Sinai Hospital.The Trauma Center is one of just four Level II traumacenters in Maryland, a status that ensures 24-hour immediatemedical coverage by trauma surgeons — including orthopedictrauma specialists — for arriving patients. Many types ofinjuries can land a patient in the Trauma Center, but it’stypically one of two things: a car accident or a serious fall.“Our role as orthopedic trauma specialists is to healfractured bones and restore the alignment of the joint surfacesafter these incredible injuries,” explains orthopedic surgeonand trauma specialist Stephen Bell, M.D. “The patient’s ageand health, and the total scope of the patient’s injuries, add acomplexity to each case that makes it unique.”Solving that puzzle req

The Rubin Institute for Advanced Orthopedics Great Strides The Rubin Institute for Advanced Orthopedics is bringing next-generation care to the community — and the world. Bradley Lamm, D.P.M., head of foot and ankle surgery at the International Center for Limb Lengthening, brings advanced expertise