Clinical Focus
- Adult Reconstructive Orthopedic Surgery
Professional Education
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Medical Education: NYU Grossman School of Medicine (1986) NY
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Residency: Hospital For Special Surgery Hand Surgery Fellowship (1991) NY
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Board Certification: American Board of Orthopaedic Surgery, Orthopaedic Surgery (1994)
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Fellowship: University Hospital (1992) CO
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Fellowship: University Hosp-Co (1992) CO
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Internship: Lenox Hill Hospital (1987) NY
All Publications
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Dual Mobility in Total Hip Arthroplasty: Biomechanics, Indications and Complications-Current Concepts
INDIAN JOURNAL OF ORTHOPAEDICS
2021
View details for DOI 10.1007/s43465-021-00471-w
View details for Web of Science ID 000707925800001
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Periprosthetic Joint Infection: Clinical and Bench
SCIENTIFIC WORLD JOURNAL
2013: 134786
View details for PubMedID 24453790
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High revision rate after total elbow arthroplasty with a linked semiconstrained device.
Orthopedics
2009; 32 (5): 321-?
Abstract
The clinical results of semiconstrained total elbow arthroplasty have been encouraging, especially in rheumatoid arthritis. This article presents medium-term clinical results, revision rates, and reasons for revision of a semiconstrained linked total elbow device (Solar Total Elbow; Stryker, Mahwah, New Jersey). We retrospectively reviewed 17 consecutive total elbow arthroplasty patients operated on between February 1994 and March 2001. Thirteen patients were available for clinical evaluation with an average follow-up of 8.4 years (range, 4-12.6 years). The presenting diagnosis was posttraumatic arthritis in 6 patients, rheumatoid arthritis in 6, and gouty arthritis in 1, with an average patient age of 63.4 years. The results were analyzed with regard to complications following the procedure, functional outcome using the Mayo Elbow Performance Score (MEPS), and radiological evaluation at latest follow-up. The mean MEPS improved from 32.1 to 65 at latest follow-up. Three patients had excellent results, 5 had good results, 1 had a fair result, and 4 had poor results. Seven patients required at least 1 revision surgery, including 2 with humeral component loosening, 2 with ulnar component loosening, and 2 with bushing failure. One patient required resection arthroplasty for deep periprosthetic infection. Three patients eventually sustained periprosthetic fractures. Five patients with rheumatoid arthritis and 2 patients with posttraumatic arthritis underwent revision surgery. Poor clinical outcomes and a high revision rate were noted in patients with posttraumatic arthritis. Further comparative studies with other semiconstrained devices are necessary to determine their clinical effectiveness in patients with rheumatoid arthritis.
View details for PubMedID 19472967
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Age at onset-dependent presentations of premature hip osteoarthritis, avascular necrosis of the femoral head, or Legg-Calve-Perthes disease in a single family, consequent upon a p.Gly1170Ser mutation of COL2A1
ARTHRITIS AND RHEUMATISM
2008; 58 (6): 1701-1706
Abstract
To identify the genetic abnormality responsible for osteoarthritis (OA), avascular necrosis (AVN) of the femoral head, and Legg-Calvé-Perthes disease in a single family, and to determine factors responsible for the distinct phenotypes manifested by different family members.Forty-two members of a 5-generation family were recruited and investigated. Diagnosis was made by independent orthopedic surgeons and radiologists. Histopathologic changes of the diseased tissue were examined. Linkage analysis was performed with markers spanning the COL2A1 locus. Haplotypes were constructed and mutation of the gene was detected. Structures of the wild-type and mutant proteins were modeled.Sixteen affected members were identified (5 with isolated precocious hip OA, 6 with AVN of the femoral head, and 5 with Legg-Calvé-Perthes disease). A p.Gly1170Ser mutation of COL2A1 cosegregated with the 3 diseases and was absent in controls. Of note, age at onset in relation to the closure status of the femoral head epiphysis was associated with the diseases, with Legg-Calvé-Perthes disease presenting prior to closure (at ages 6-14 years), AVN of the femoral head presenting during closure (at ages 15-18 years), and precocious OA of the hip presenting after closure (at ages 21-34 years). Molecular modeling predicted that the serine-to-glycine substitution loosens the helical structure of the protein.The p.Gly1170Ser mutation of COL2A1 in the family described is responsible for pathology confined to the hip joint, which presents as isolated precocious hip OA, AVN of the femoral head, or Legg-Calvé-Perthes disease. Age at onset in relation to closure of the femoral head epiphysis appears to be a critical factor in determining disease pattern.
View details for DOI 10.1002/art.23491
View details for Web of Science ID 000256724900017
View details for PubMedID 18512791
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Polyethylene Wear Particle Induced Osteolysis in Total Hip Replacement
MALAYSIAN ORTHOPAEDIC JOURNAL
2008; 2 (1): 1–7
View details for Web of Science ID 000447491500001
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Comparison of scars from total hip replacements done with a standard or a mini-incision
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
2005: 80-85
Abstract
Scar cosmesis is one of the proposed benefits of mini-incision total hip replacement as opposed to standard-incision procedures; however, there has been no scientific proof of this clinical outcome. The cosmetic appearances of healed incisions of 34 primary total hip replacement procedures done by one surgeon using either a mini-incision (20 procedures) or a standard-length incision (14 procedures) were compared at an average of 2 years postoperatively. Each scar's appearance was graded independently by two plastic surgeons using a standardized rating system. Patients answered a questionnaire regarding their subjective assessment of their scar. The blinded observers found that more mini-scars (six of 20) were rated poor than standard scars (one of 14) and that more standard-incision patients had scars that were rated good. More mini-incision patients (two of 20 versus zero of 14) had wound-healing problems. All the patients thought that their hip scar was acceptable in appearance, but 30 of 31 patients rated the relief of pain and total hip replacement longevity as higher priorities than scar cosmesis. The cosmesis of mini-incision total hip replacement scars may be inferior to standard-incision scars because of skin and soft tissue damage produced by high retractor pressures needed for exposure using a limited skin incision. Level of Evidence: Therapeutic study, Level II-2 (prospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
View details for DOI 10.1097/01.blo.0000191317.85422.c3
View details for Web of Science ID 000233794700015
View details for PubMedID 16330988
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Comparison of primary total hip replacements performed with a standard incision or a mini-incision
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME
2004; 86A (7): 1353-1358
Abstract
Primary total hip replacement performed through an incision that is =10 cm in length has been advocated as a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement.A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [=10 cm] and eighty-five with use of a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision.With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036).There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues of the hip, factors that would have produced a quicker recovery and a shorter hospital stay, than did the standard technique. The present study, which was based on the authors' initial experience with the mini-incision technique, failed to confirm the positive clinical outcomes reported by previous uncontrolled cohort studies, and the findings suggest that further analysis of this new technique is needed before it can be recommended for general use.
View details for Web of Science ID 000222475900001
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Comparison of primary total hip replacements performed with a standard incision or a mini-incision.
journal of bone and joint surgery. American volume
2004; 86-A (7): 1353-1358
Abstract
Primary total hip replacement performed through an incision that is =10 cm in length has been advocated as a minimally invasive technique. Proponents have claimed that mini-incision techniques reduce blood loss, transfusion requirements, postoperative pain, and the length of the hospital stay compared with standard techniques through a longer incision. However, we are aware of no well-designed comparison study that supports these claims. The purpose of the present study was to compare the short-term results of a mini-incision with a standard incision technique for total hip replacement.A consecutive series of patients who underwent 135 primary unilateral total hip replacements (fifty with use of a mini-incision [=10 cm] and eighty-five with use of a standard incision) by three surgeons at one hospital were studied. Each surgeon selected patients to have a mini-incision procedure and performed a standard approach in the remaining patients. A posterior approach was used for all procedures. In-hospital data were collected retrospectively, and the initial postoperative radiographs were analyzed. Because of the selection process, the patients who had a mini-incision had both a significantly lower average body-mass index (p = 0.008) and a lower average score on the American Society of Anesthesiologists rating (p = 0.006), indicating that they were thinner and healthier than the patients who had a standard incision.With the numbers of patients available, no significant differences were found between the groups with respect to the average surgical time, intraoperative blood loss, in-hospital transfusion rate, length of hospital stay, or the patients' disposition after discharge. The mini-incision group was found to have a significantly higher risk of a wound complication (p = 0.02), a higher percentage of acetabular component malposition (p = 0.04), and poor fit and fill of femoral components inserted without cement (p = 0.0036).There was no evidence that the mini-incision technique resulted in less bleeding or less trauma to the soft tissues of the hip, factors that would have produced a quicker recovery and a shorter hospital stay, than did the standard technique. The present study, which was based on the authors' initial experience with the mini-incision technique, failed to confirm the positive clinical outcomes reported by previous uncontrolled cohort studies, and the findings suggest that further analysis of this new technique is needed before it can be recommended for general use.
View details for PubMedID 15252080