The New York Orthopaedic Hospital (NYOH) has one of the oldest Orthopaedic training programs in the country. Founded in 1866, the New York Dispensary was established to treat needy children afflicted by diseases of the musculoskeletal system.

In 1945, NYOH merged with the Presbyterian Hospital Trauma Service, and five years later joined the Columbia Presbyterian Medical Center in upper Manhattan. The discipline of Orthopaedic Surgery has been advanced due to innovations by NYOH luminaries such as Dr. Harrison McLaughlin, Dr. Robert E. Carroll, Dr. Frank E. Stinchfield, and Dr. Charles S. Neer. Dr. Louis Bigliani, department chairman and a pupil of Dr. Neer, continues the tradition of innovation through the development of new and streamlined surgical techniques, particularly in shoulder arthroscopy.

The Department of Orthopedic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center includes world-renowned experts who specialize in the care of children and adults with musculoskeletal disorders. The orthopedic departments provide the most advanced care for the full range of orthopedic conditions and are committed to providing world-class training for the next generation of orthopedic surgeons. In addition, researchers at NewYork-Presbyterian/Columbia Orthopedics are in the vanguard of developing new and better treatments for musculoskeletal disease.

New York Presbyterian Hospital at Columbia University is world-renowned for its patient-centered care and penchant for staying on the cutting edge through scientific and clinical research. At the Center for Hip & Knee Replacement (CHKR), as a part of the New York Presbyterian Hospital family, best hospitals in America, they are no different. Their orthopaedic surgeons perform over 2,000 hip and knee procedures every year, making it one of the most experienced in the country. Realizing surgery as a final option, CHKR surgeons emphasize collaborative patient-centered care and remain on the forefront of hip and knee treatments and replacements through cutting edge research and education.

At the CHKR, it is their mission to provide and formulate the best definitive treatment plan for each patient – from diagnosis to treatment to rehabilitation.

Through an efficacious approach to hip and knee treatment, it is their goal to provide each and every patient with the best long-term and clinically functional results that can be reached.

CHKR surgeons achieve these goals daily, through medical education, research, and patient feedback. Remaining dedicated to the practice, the CHKR remains one of the country’s best options for excellent hip and knee outcome.

Columbia University has been at the forefront of hip and knee replacement in the U.S. since the 1960’s, when these operations were first performed. The late Frank Stinchfield, M.D. (Chairman from 1956 to 1976) founded a program in total hip replacement at the hospital in 1968 (one of the first in the nation) when he hired British trained Nas Eftekhar. Nas trained at Wrightington, England with Sir John Charnley, the father of total hip arthroplasty. This monumental improvement in hip arthroplasty quickly sent mould arthroplasty (which Dr. Stinchfield had become widely known for) into obsolescence. In 1970, Dr. Eftekhar performed the first total knee replacement in the United States. The technique he developed, condylar knee replacement, is still used today.

Due to Dr. Eftekhar's pioneering efforts in hip and knee surgery, the Anne Youle Stein Foundation helped to officially start hip and knee research by indoctrinating "The Nas S. Eftekar, M.D. Documentation Center for Clinical Orthopaedic Research" in 1997. The Center for Hip and Knee Replacement (CHKR; which carries on the tradition of prospective outcomes data collection to this day) was founded in 2001 and has been under the direction of Dr. Macaulay since its inception. A testament to this center's rapid rise in recognition and prestige was provided by its honorable mention in New York Magazine's 2007 list of quality centers for hip replacement.

The CHKR has and will continue to provide treatment and education for hip and knee disorders, while remaining on the cutting edge of translational and clinical research. At CHKR, patients receive the best, dedicated clinical care and attention from our team of health care providers. It is the CHKR mission to place a premium on high quality patient care, while remaining on the forefront of research and training our hip and knee surgeons of tomorrow.

The objective of this project is to compare the stiffness of periprosthetic fracture fixation using one locked plate versus two orthogonal locked plates. This is a laboratory study using synthetic composite femurs with simulated, comminuted Vancouver B1 periprosthetic fracture at the distal tip of an intact cement prosthesis. Fixation was achieved first with one locking plate with unicortical screws and cables, proximally. Construct stiffness was measured before and after load cycling in physiologic orientation. Axial load, torsional strength, and resistance to three-point bending were determined by fracture site displacement. Additional anterior plating to the eight specimens was followed by repeat loading experiments. Results from this mechanical study will provide insight into providing the stiffer fixation for a complex type of periprosthetic fracture.

The CHKR Joint Registry: Prospective Data Collection

The Center collects prospective data for most hip replacement and knee replacement patients. The patient survey includes items from the SF-12, WOMAC, Knee Society Score and Harris Hip outcome instruments. Another survey includes items which can only be answered by your surgeon. These questionnaires will serve to improve surgical techniques and implants for future generations.

CHKR Clinical Research - Current Projects:

This research study is a prospective randomized multicenter study comparing total hip arthroplasty (THA) to hemiarthroplasty in the treatment of Garden III and IV displaced femoral neck fractures. The comprehensive approach measures functional outcome in physically active, non-institutionalized hip fracture patients who are without concurrent hip disease at 6, 12, 18, and 24 months post-fracture. The primary outcomes are validated measures of functional status (SF-36, Western Ontario and McMaster University Osteoarthritis Index {WOMAC}, the Harris Hip Score and the Timed Up and Go Test). Although we anticipate that the functional outcomes at 6 months between the two groups will be similar, we expect to observe a significant divergence in functional status between the groups at two years.

This study of 300 patients is being conducted at several hospitals which include: Columbia University Medical Center, New York, NY, The North Shore Medical Center, Lynnfield, MA; Lahey Clinic, Burlington, MA; University of Pennsylvania, Philadelphia, PA; University of California at San Francisco, San Francisco, CA; University of Nebraska Medical Center, Omaha, NE; Baylor College of Medicine, Houston, TX; Lakewood Orthopaedic Surgeons, Tacoma, WA; Tri-County Orthopaedic & Sports Medicine, Morristown, NJ; Sinai Hospital of Baltimore, Baltimore, MD.

This randomized clinical trial aims to determine whether a more aggressive transfusion strategy maintaining postoperative hemoglobin at 10 g/dL or higher is associated with improved function and a decreased risk of adverse postoperative events.

The study population includes 2600 patients aged 50 or older with a history of cardiovascular disease who are undergoing surgical repair of a fractured hip. Patients are eligible for the study if their Hgb level drops below 10 g/dL within the first three postoperative days and will be randomized to either 1) receive enough red blood cells to maintain their Hg level at or above 10g/dL or, 2) receive a red blood cell transfusion only in the presence of symptoms from anemia or if their Hgb is below 8 g/dL (transfusion is permitted,

but not mandatory). Patients are contacted by telephone at 30 days and 60 days after surgery to determine vital status, ability to walk, and location of residence.

The results of this study will provide critical evidence to guide peri-operative transfusion status.

TKA recovery can be complicated by severe post operative pain. Efforts to maximally reduce postoperative pain result in greater patient satisfaction, decreased recovery time, greater range of motion, and shorter length of stay. Within the last decade an emphasis has been placed on increasing patient satisfaction by carefully managing post operative pain through pharmacological means. At the same time non-pharmacological measures have not been extensively explored. However, the American public actively explores holistic means for pain reduction with 36 percent of American adults have used some sort of holistic therapy within the last 12 months. In addition, patients often fear using pharmacologic measures to reduce postoperative pain because of potential side effects. Therefore, we believe patients are eager to incorporate holistic measures into there patient care.

Through the InMusiK Project, we hope to simply reduce perceived pain for our patients following a total knee replacement. Should the statistical analyses prove that music has even a slight benefit in reducing pain, a little music can go a long way in helping patients have a better experience immediately after their operation.

The specific plastic liners being studied are the Longevity® Crosslinked Polyethylene (plastic) liner and the conventional polyethylene (plastic) liner. Both liners are FDA approved devices intended for use in the treatment of hip disease. The Longevity® polyethylene liner is made from a crosslinked plastic which gives it a different structure than the conventional plastic liner. We suspect that the crosslinkedplastic may wear better in the long term based on preliminary laboratory data.

This study of 300 patients is being conducted at several hospitals including: Barnes-Jewish Hospital, St. Louis, MO; University of Michigan Hospital, Ann Arbor, MI; Maine Medical Center, Portland, ME; Pennsylvania Hospital, Philadelphia, PA; Scripps Clinic, La Jolla, CA; Latter Day Saints Hospital, Salt Lake City, UT; and Columbia University Medical Center, New York, NY. Columbia is the only site in the New York metropolitan area.