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Services ListHigh-Quality Patient CareNorthShore Orthopaedic Institute is nationally recognized for delivering the highest quality care to patients.Outstanding surgeons combined with an ongoing partnership and team approach for more than 30 yearshas resulted in a culture dedicated to the best possible care. The result is truly “best-in-class” outcomes, withthe lowest statewide total joint readmission rates, ranked in the top 1.3 percent of hospitals in the nation.Adult Reconstruction (Joint Replacement) Complex and Revision Cases Robotic- and Computer-Assisted Surgery Rapid Recovery PathwaysSpine Spine Center of Excellence Motion-Preserving Technologies Regenerative Medicine ResearchSports Medicine Professional Team Expertise Regenerative Scaffolds and Growth Factors Pediatric and Revision ACL Surgery and ResearchOverall complication and readmission rates are half the national average andcontinue to improve, while more than 10,000 cases per year are performedby our surgeons. Our outstanding nursing staff has been recognized by ourNursing Magnet designation. Our total joint and spine programs earned thehighest Blue Cross Blue Shield Blue Distinction rating, and we have beenselected as the sole Chicago area United Health Care/Optum Center ofExcellence for Orthopaedics and Spine for bundled care, recognizing ourquality and value.The expert surgeons of the NorthShore Orthopaedic Institute work togetherwith nursing and administrative staff using technology advancements andsophisticated data analytics to continuously improve patient care. Dedicatedcare pathways and standardization have helped reduce variability, and virtualdashboards are provided to the team to continuously monitor patient outcomes.We continue to invest in informatics, and now predictive modeling, to helpuse a data-driven approach to enhance our personalized patient care.Hand and Upper Extremity Minimally Invasive New Techniques Innovative Implant Design Fellowship Training the Surgeons of the FutureFoot and Ankle Complex Ankle Replacement Hydrogel Implants for Arthritis Arthroscopic Ankle Surgery and BiologicsTrauma Team Approach to Geriatric Fractures Orthopaedic Trauma Rapid Care State-of-the-Art Skills TrainingThe Quality Committee, led by Arnold Cohn, MD, a member of the NorthShoreOrthopaedic Institute affiliate practice, the Illinois Bone & Joint Institute (IBJI), ischarged with reviewing quality issues, implementing quality initiatives, andmonitoring indications and complications of orthopaedic and podiatric surgery.In the Spine Division, we achieved significant milestones in our efforts to decreasereadmissions and surgical site infections based on the Center of Excellencebenchmarks. Even as surgical volumes increase to nearly 1,000 cases peryear, patient outcomes continue to improve, with only one return-to-surgerywithin 24 hours in 2016, and zero returns in 24 hours in 2017.Podiatry Stem Cells and Plasma Injection Synthetic Cartilage Multidisciplinary Foot Care4 Nor thShore Or thopaedic InstitutePediatric Orthopaedics Deformity Correction with 3-D Printed Models Nonoperative Infantile Scoliosis Treatment Magnetic Growing Rod ImplantsWe continue to use data analytics to improve the monitoring and quality ofour care, creating new dashboards for our physicians and care team. Newpredictive models for patient outcomes are being developed to help identifywhich patients would benefit from additional intervention based on individualfactors. We are also expanding our collection of National Surgical QualityImprovement data to all four campuses, which provides risk-adjusted datafor both inpatient and outpatient cases, as well as national benchmarking.Dr. Arnold CohnChair of the Orthopaedic Quality CommitteeOrthopaedic and Podiatric Surgical 02012201320162017Surgical volume grew by nearly 10 percent to more than 10,000 cases in 2017.Annual Repor t 2017-2018 5

OutcomesNew PhysiciansLow Hospital ReadmissionsCompared against Centers for Medicare and Medicaid Services national averages, patients who undergo total knew and hip replacementsat NorthShore Hospital Campuses, experience far lower readmissions than other hospitals across the country. Our low readmission ratesearned us top designations in the nation and state.Total Hip Replacement 30-Day Readmission Rate54.54Total Knee Replacement 30-Day Readmission Rate54.54.443.54.4Trevor Bullock, DOFamily Medicine Sports MedicineMatthew Cavallero, MDTraumaJordan Goldstein, MDSports MedicineWard McCracken, DOFamily Medicine Sports MedicineThomas Moran, MDFamily Medicine Sports MedicineVerena Schreiber, MDPediatric OrthopaedicsChristian Skjong, MD (IBJI)Hand & Upper ExtremityAlexander Tauchen, MDAdult ReconstructionDiego Villacis, MDSports MedicineBrian Weatherford, MD (IBJI)TraumaStephen Wielgus, MDPrimary Care Sports MedicineAnne Marie Zeller, DOPrimary Care Sports Medicine3.5332.52.622.82.521.51.5110.50.5National Average201620171.71.3National Average20162017Low Infection RatesCases of post-operative infection after total knee and hip replacement at NorthShore are less than half of the Centers for Medicare andMedicaid Services national averages.Total Hip Replacement Surgical Site Infection32.5Jamal Ahmad, MDFoot & AnkleTotal Knee Replacement Surgical Site Infection32.82.5221.51.512.810.70.5National Average6 Nor thShore Or thopaedic Institute20160.80.52017National Average0.40.420162017Annual Repor t 2017-2018 7

LeadershipOutreachNorthShore Orthopaedic Institute Committees and MembersCommittee ChairsExecutive CommitteeJason Koh, MD, MBA (Committee Chair)James Kudrna, MDLalit Puri, MD, MBADavid Beigler, MD (IBJI)Seth Levitz, MDDavid Rahija, Senior Vice PresidentLeon Benson, MD (IBJI)Kristen Murtos, President, Skokie HospitalDavid Roberts, MDMark Bowen, MDMark Nolden, MDGary Shapiro, MD (IBJI)Arnold Cohn, MD (IBJI)Michael O’Rourke, MD (IBJI)Jennifer Shea, Assistant Vice PresidentRaju Ghate, MDAmy Jo Ptaszek, MD (IBJI)Howard Sweeney, MDLeon Benson, MD (Committee Chair) (IBJI)James Kudrna, MD, PhDLalit Puri, MD, MBARavi Bashyal, MDLeslie McClellan, Education CoordinatorDave RahijaDavid Beigler, MD (IBJI)Mark Nolden, MDJennifer SheaMark Bowen, MDCraig Phillips, MD (IBJI)Christian Skjong, MD (IBJI)Jason Koh, MD, MBAAmy Jo Ptaszek, MD (IBJI)Howard Sweeney, MDRichard Wixson, MD (Committee Chair)Robert Gray, MDCraig Phillips, MD (IBJI)David Beigler, MD (IBJI)Carrie Jaworski, MDAmy Jo Ptaszek, MD (IBJI)Leon Benson, MD (IBJI)Erin Klein, DPMLalit Puri, MD, MBAPatrick Birmingham, MDJason Koh, MD, MBADavid Roberts, MDMark Bowen, MDJames Kudrna, MD, PhDLowell Weil Sr., DPMNancy Goodman, Research ManagerSteven Levin, MDMichael Weisman, DPMEducation CommitteeResearch CommitteeDr. Jason L. KohDirector, NorthShore Orthopaedic InstituteBoard of Directors Endowed Chair of Orthopaedic SurgeryDr. Leon BensonVice Chair of Academic and Affiliate AffairsMark Mikhael, MD (IBJI)Quality CommitteeArnold Cohn, MD (Committee Chair) (IBJI)Eric Chehab, MD (IBJI)Mark Mikhael, MD (IBJI)Zemen Abebe, Dir. Periop Services SKErin Duval, Quality ImprovementCheryl Neislawski, Risk ManagementSandy Alexander, RNMarc Falleroni, MDMichael O’Rourke, MD (IBJI)David Beigler, MD (IBJI)Carol Heunisch, PharmDLalit Puri, MD, MBABeverly Beine, VP Periop ServicesJames Kudrna, MD, PhDTravis Raebel, PARose Boushek, Dir. Periop Services GBRobert McMillan, MD (IBJI)Gary Shapiro, MD (IBJI)Dr. Victoria Brander (right) is presented with the Unsung Heroes of Compassion Award by the Dalai Lama.Dr. Lalit PuriVice Chair of Clinical ExcellenceDr. Richard WixsonVice Chair of Research and InformaticsInternational Orthopaedic MissionsIn 2005, Drs. Victoria Brander and David Stulberg (bothmembers of NOI) helped found Operation Walk Chicago,which sends volunteer clinicians to such countries as Vietnam,Nepal, and Brazil to provide hip and knee replacements atno cost to indigent patients, while training local orthopaedicsurgeons and building lasting partnerships. Recently, Drs.Brander and Stulberg led a team of more than 50 physicians,nurses, and volunteers to Recife, Brazil on a two-week missionwhere they performed dozens of hip and knee replacementoperations. Her work has been recognized by the UnsungHeros of Compassion Award, presented by the Dalai Lama.establish one of the few orthopaedic centers in the entirecountry to provide ongoing assistance to the community.Future projects include returning to Recife and Katmandu, aswell as the Philippines.Amy Jo Ptaszek, MD, leads, with CRNA support fromNorthShore anesthesiology, orthopaedic medical missionsaffiliated with Nuestros Pequeños Hermanos and Holy FamilySurgical Center in Honduras. Underserved Hondurans withneglected, chronic pathology and post-traumatic deformityundergo surgery and follow up in the clinic.In addition, NorthShore Orthopaedic Institute physicianstravelled to Katmandu, Nepal, to aid in disaster relief after thedevastating earthquake. Their continued efforts have helped8 Nor thShore Or thopaedic InstituteAnnual Repor t 2017-2018 9

Cutting-Edge Researchand Informatic HighlightsPartnering to Assess New Techniques for Knee Regenerationand ReconstructionNorthShore researchers work closely with industry partners to develop and testnew techniques to aid in the treatment of complex injuries and to make surgerymore precise. Dr. Jason Koh helped develop the pivotal FDA trial to assess theability of a scaffold-based autologous chondrocyte transplantation system(Novocart 3DTM, Aesculap Biologics) to regrow cartilage to treat chondraldefects of the knee.Dr. Jason Koh teaches visiting European surgeons from the prestigiousESSKA-AOSSM traveling fellowship program.From developing new surgical techniques in regenerative medicine to the use of “big data” to track andpredict patient outcomes, the researchers at the NorthShore Orthopaedic Institute continue to identifynew ways to help transform patient care and treat the most complex cases. Over 90 scientific articles (seePublications, beginning on page 36) were published by our physicians during the past year in peer-reviewedliterature, including award-winning papers and cover articles. Collaborative partners include NorthShoreResearch Institute, Illinois Bone & Joint Institute, University of Chicago, Rehabilitation Institute of Chicago,Northwestern University McCormick School of Engineering and Cleveland Clinic. Multicenter trials werealso established with Mayo Clinic, the Hospital for Special Surgery, Cincinnati Children’s Hospital and othernationally recognized organizations.A strong research team provides comprehensive assistance to investigators and physicians in the followingareas: literature reviews, protocol revision, regulatory submission and annual reviews, patient screening,patient recruitment and enrollment, data collection, and study closure. In addition, the OrthopaedicBiomechanics Lab allows investigators to develop and test innovative new techniques for the treatmentof musculoskeletal disorders.10 Nor thShore Or thopaedic InstituteDr. Richard WixsonVice Chair for Research and InformaticsDr. Richard Wixson consults with a patient.Dr. Mark MikhaelDirector of Orthopaedic Spine ResearchResearching Mesenchymal Cell Allogeneic Grafts for Spine SurgeryIn a constant pursuit to find treatments that improve fusion rates and patientoutcomes, Mark Mikhael, MD, is conducting an independent study aboutthe mesenchymal allogeneic graft (ViviGen ), which uses donor stem cells.Expanding on work done in the lumbar spine, Dr. Mikhael is exploring the useof this novel graft to treat patients who have degenerative discs in necks withnerve compression causing arm and neck pain or even paralysis. The discmaterial or bony spurs that are compressing spinal cord or nerve roots arefirst removed; then the spine is stabilized using implants along with the donorgraft, which contains stem cells and proteins that send signals to the bodyto heal. Patients are evaluated at different points of their recovery throughoutcome surveys, X-rays and CT scans to assess healing. Dr. Mikhael said ofthe study thus far, “While it’s early in the research process, results to date arevery promising. Every patient is experiencing very good outcomes and fusionis occurring. It’s exciting to see that this research may improve the way wetreat these cases moving forward.”InformaticsPhysicians at the NorthShore Orthopaedic Institute identified the need for theorganized collection of clinical data on patients, as well as patient-reportedoutcomes, for both quality and research endeavors. Under the leadership ofRichard Wixson, MD, Vice Chair for Research and Informatics, new structuredclinical documentation forms were built into the Electronic Medical Record(EMR), allowing for the efficient, accurate and complete collection of patientinformation. Using existing data, NorthShore Orthopaedic Institute built oneof the most robust predictive models for readmission and complications injoint replacement patients, which has astonishing accuracy. This allows ourcare team to provide targeted interventions to the patients who need it the most.Grant-Supported Studies Explore Regenerative MedicineTreatments for Knee ArthritisThe Department of Orthopaedic Surgery received the NorthShore UniversityHealthSystem Auxiliary Fund Award for 2016 to 2018 (initial award 325,000),which provides the opportunity to advance research in the area of intra-articularplatelet-rich plasma injections (PRP) in the treatment of knee osteoarthritis.This study, represented by Dr. Koh and Trevor Builock, DO, explores using apatient’s own bioactive factors which play a fundamental role in tissue healing.During a single visit, growth factors, are retrieved from a simple blood drawand injected into the patient’s knee. The effects on the knee are assessedby patient-reported outcomes as well as by using advanced qualitative MRIimaging techniques to assess cartilage.Annual Repor t 2017-2018 11

Orthopaedics Biomechanics LaboratoryIn 2014, the NorthShore Orthopaedic Institute established an OrthopaedicsBiomechanics Laboratory to examine the mechanics of joint injury anddevelop and test new techniques to improve our physicians’ ability tohelp patients. The lab has the capability to perform single and multi-axisbiomechanical testing; finite element analysis; contact pressure; and area,strain and motion analysis. Current research efforts focus on cartilage repairand regeneration techniques, as well as shoulder repair techniques. Inthis facility, advanced custom devices under robotic control apply preciseloads to specimens under dynamic conditions to evaluate the ability of newprocedures to restore normal joint biomechanics. The work of the lab insuch areas as meniscus damage and repair has been featured in the leadingorthopaedic journals and has helped establish fundamental knowledge.Justifying Patellar Instability Treatment by Early Results (JUPITER)Patella instability and dislocation can be devastating to young patients, causingpain and loss of function, and can lead to arthritis. To determine the best possibletreatment for these injuries, Dr. Koh and researchers from the Hospital forSpecial Surgery and Cincinatti Children’s Hospital initiated “JUPITER”, ahypothesis-driven, multi-center, prospective cohort study. Its specific aims are tocompare the results of non-operative and various surgical treaments, such asmedial patellofemoral reconstruction (MPFL) for patients under the age of 30.Outcomes are assessed at 6,12, 24, and 60 months, including assessmentof function, activity, and quality of life. Joining Dr. Koh in participating are Drs.David Roberts and Verena Schreiber. Investigators from Harvard, the MayoClinic, and Shriner’s Hospital system have also joined this trial.Advancing Ankle Replacement SurgeryIn the mid-2000s, it was identified that first-generation ankle replacementswere prone to early failure. It was at this point that Steve Haddad, MD, becameinvolved in the design and implementation of three ankle replacement systems(INBONE II , INFINITY and INVISION , Wright Medical Technology).Dr. Haddad and the team first worked to create an implant that anatomicallymatches the three major bones of the ankle. He then worked to develop asecond prosthesis (INFINITY) that removes less of the patient’s bone thanprior implants. By preserving the patient’s natural bone, any future revisionankle replacement surgery becomes technically feasible. Finally, with therecently launched INVISION ankle replacement, surgeons can revise implantsthat have failed, even those that have failed with significant bone loss.Most recently, Dr. Haddad received a 100,000 grant from the OrthopaedicResearch and Education Foundation to study wear patterns among anklereplacements and improve durability. This is a critical element to makingsustainable ankle replacements for the future, something Dr. Haddad considersto be the most important contribution to the next generation of surgeons.Evaluation of Zimmer CAS PSI X-Ray Knee in Total KneeArthroplasty: Technical OutcomesRaju Ghate, MD, is working closely with Zimmer to investigate how custompatient-specific 3-D printed guides can enhance total knee replacement.The purpose of this clinical study is to assess the positioning of customizedguides of Zimmer CAS PSI X-Ray Knee using optical navigation in patientswith osteoarthritis requiring primary total knee arthroplasty (TKA).Figure B(A) Computer-controlled knee testing robot(B) Contact pressure map showing increased pressure with meniscus injury (Koh et al., JBJS 2016)The proposed study is a single-center, prospective, case series, and noncontrolled clinical trial. Patients will get a total of seven to nine radiographsdepending on the anatomy of the leg to generate the CAS PSI X-Ray Kneeguides. Primary TKAs will be performed where the position of the CAS PSIknee guides will be generated from X-ray and their position determined usingSesamoid Navigation System. The surgeon will determine to either move onwith the CAS PSI Knee guides generated from X-ray based on the SesamoidNavigation system readings or use currently approved instrumentation suchas MRI patient-specific guides or conventional instruments.Dr. Steven HaddadSenior Attending PhysicianFigure A12 Nor thShore Or thopaedic InstituteAnnual Repor t 2017-2018 13

Academic HighlightsPartnerships with the University of ChicagoNorthShore’s academic program grew exponentially over the past several years.We strengthened our relationship of eight years with the University of ChicagoMedicine Department of Orthopaedic Surgery and Rehabilitative Medicine.Leon Benson, MD, serves as Vice Chair of Academic and Affiliate Affairs.“Orthopaedic residents at the University of Chicago like their NorthShorerotation primarily because the attendings are committed,” said Dr. Benson.“That means we’re providing a good educational experience and addingan element of fun. We believe if you have a collegial relationship with yourmentors, everything’s better.” Through our partnership with the University ofChicago, we train 15 residents annually.Partnership with Rush Medical CenterOur podiatrists partner with Rush Medical Center to train podiatric residentsunder the supervision of NorthShore’s Michael Weisman, DPM, Division Headfor Podiatry, and Podiatric Physician Leader Jeffrey Alexander, DPM. There arenine residents: three residents per podiatry training year with a total of threetraining years.NorthShore Orthopaedic Institute FellowshipsThe NorthShore Orthopaedic Institute expanded partnerships to offer handand upper extremity, sports medicine, primary care sports medicine, foot andankle, and adult reconstruction fellowships. Sports MedicineOur shared Sports Medicine Fellowship with the University of Chicagoincludes two sports medicine fellows who alternate and rotate every threemonths between NorthShore and the University of Chicago. Physicianinvolvement is strong, and the sports fellows gain vast exposure to sportsrelated injuries by assisting with the Chicago Bears training room and theEvanston Township High School training room. Primary Care Sports MedicineThe Department of Family Medicine supports a Primary Care SportsMedicine Fellowship under the leadership of Carrie Jaworski, MD, DivisionHead of Primary Care Sports Medicine. The one-year, one-personfellowship focuses on acute musculoskeletal management. This fellowshipalso exposes family medicine physicians to primary care sports medicinephysicians and orthopaedic surgeons, in addition to sports neurology,cardiology and nutrition.14 Nor thShore Or thopaedic Institute Hand and Upper ExtremityWe share a hand and upper extremity program with the University ofChicago that includes two hand fellows who alternate and rotate every threemonths between NorthShore and the University of Chicago. NorthShore’sinvolvement strengthened the University of Chicago’s hand fellowshipprogram co-directed by Craig Phillips, MD, and as a result, the programattained even greater national prominence and attracts elite candidates fromall over the world. Joint CareIn 2016, we welcomed our first NorthShore-based hip and knee fellow,under the leadership of Lalit Puri, MD, Division Head of Adult Reconstruction.Our fellow participates in more than 400 surgical cases per year, travelson our annual Operation Walk Chicago mission trip, and helps generatepeer-reviewed clinically relevant research. Foot and AnkleIn 2017, three Illinois Bone & Joint Institute orthopaedic surgeonsintroduced a new Orthopaedic Foot and Ankle Fellowship. This fellowshipwas created to cover the gamut of foot and ankle pathology by facultywith special expertise in certain elements of this subspecialty. Thisbalanced fellowship will provide a comprehensive experience in training thenext generation of orthopaedic foot and ankle specialists.Education and Motor SkillsThe NorthShore Orthopaedic Motor Skills Lab, under the leadership of itsdirector, Howard Sweeney, MD, is a critical educational tool that allows oursurgeons to teach and reinforce motor skills. Most importantly, it createsa space for the residents and physicians to improve skills before going tothe operating room. The lab includes an arthroscopic simulator specificallydesigned to train our students, residents and fellows in arthroscopic surgery.NorthShore’s Physician Assistants and InternsIn addition to our fellowship programs, the NorthShore Orthopaedic Instituteorganizes and onboards more than 25 physician assistant (P

Gurnee, IL 60031 Lake Barrington 28156 W. Northpoint Pkwy, Ste. 224 Lake Barrington, IL 60010 Libertyville 720 Florsheim Drive Libertyville, IL 60048 Affiliated Surgicenters Ravine Way Surgery Center 2350 Ravine Way, Ste. 600 Glenview, IL 60025 Orthopaedic Specialists of the North Shore 4433 W. T