Partnering with ColumbiaDoctors, the faculty practice of Columbia University Medical Center, to offer comprehensive orthopedics and sports medicine, NewYork-Presbyterian Lawrence Hospital provides effective conservative management, advanced surgical treatments and rehabilitation medicine designed to help patients return to a high level of activity and mobility in both sports and routine activities of daily living.
Patients present with a wide range of conditions: older adults suffering from cumulative degenerative joint pain, college athletes eager to have a tendon repaired so they can regain a competitive edge and even children with playground fractures. Whether injuries are long in coming or traumatic and unexpected, the expert physicians at NYP Lawrence Hospital can manage every detail of care from stabilization through recovery.
“Our department offers full-spectrum orthopedic subspecialty care at an academic level,” says Jeffrey A. Geller, MD, newly appointed Chief of Orthopedic Surgery at NYP Lawrence and Chief of Hip & Knee Reconstruction at Columbia University Medical Center. “We have specialists in hip and knee replacement, hip and knee arthroplasty, and orthopedic trauma. We offer all aspects of sports medicine subspecialty coverage, specialty spine, hand and upper-extremity care, and specialty foot and ankle care.”
For patients from around the region, this means local access to world-class medicine practiced by orthopedists who are also professors at an academic medical center.
“We have a level of orthopedic knowledge that is completely different from anything else available in Westchester,” Dr. Geller says.
NYP Lawrence has prioritized expanding trauma services, says Justin K. Greisberg, MD, Chief of Foot & Ankle Surgery and trauma specialist at Columbia University Medical Center. Today, patients can receive the same specialty trauma care at the hospital that they could receive in New York City, Dr. Greisberg says — even for complex fractures. All physicians in the emergency department are board-certified, and they have additional training in pediatric emergency care.
The team is equipped with the latest techniques and technologies in order to deal with any orthopedic trauma that may arise.
“We are bringing the city to Westchester,” Dr. Greisberg says. “Just the other day, I treated a fracture dislocation of the heel bone. I was able to perform that surgery at NYP Lawrence. Another patient was a ballet dancer who had dislocated the middle of her foot. She received successful treatment here and went home uneventfully. These cases illustrate the new level of specialty care we are delivering in the area.”
That extends to non-operative care when indicated, Dr. Greisberg says. The focus is always on determining the optimal approach.
“We consider conservative measures first,” he says. “However, some cases have better outcomes when surgery is performed sooner rather than later. We avoid surgery when possible, but when a non-operative approach will not be successful, we don’t waste a patient’s time.”
From an older adult who golfs on weekends to a 15-year-old gymnast who performs daring feats on a balance beam, sports medicine patients are diverse and complex, yet they share a common goal: to perform to the fullest extent of their capacity. Many injuries treated by sports medicine physicians involve repetitive stress on joints, muscles or tendons. Others are one-time occurrences, such as a sprain. Whatever the condition, NYP Lawrence sports medicine physicians use both operative and conservative measures to help patients get back in the game quickly and safely.
George J. Zambetti Jr., MD, Assistant Professor of Orthopedic Surgery at Columbia University Medical Center, has more than 30 years of experience in sports medicine and has served for decades as team physician for institutions including Fordham University.
The most common conditions Dr. Zambetti treats are related to the patella. Effectively addressing such injuries, which can cause anterior knee pain, may involve a whole-body approach to change the way the joint is used. For example, work on the abdominals and back may relieve knee stress and chronic pain.
“What many people don’t realize is that core strengthening is very important for the function of the knee,” Dr. Zambetti says. “If someone’s core is weak, he or she will put more stress on the knee joint and be more prone to stress-related problems. If the core and hip structures are strong, they can efficiently take some of the burden off the knee. The more a patient’s core, hips and glutes can absorb the stress of an activity, the less stress will be placed on his or her extremities, particularly the patellofemoral joint.”
Orthopedic Primary Care
“We are at the forefront of primary care orthopedics,” Dr. Zambetti says. “We believe that most of the issues we see as orthopedic surgeons — overuse syndromes, tendinitis, impingement problems — we should treat conservatively.
“ColumbiaDoctors Orthopedics currently has four board-certified primary care orthopedic specialists,” he adds. “Their focus is to treat a full spectrum of orthopedic injuries, especially sports injuries, in a conservative manner.”
Often, this involves advanced treatment for the chronic and overuse injuries that frequently afflict athletes. Patients may present with pain but no obvious tears or fractures.
He gives the example of knee pain when descending stairs. A primary care orthopedist will examine the motion of going down stairs, identifying where stress occurs, such as when the heel strikes the floor. The physician will also determine when stress happens with a particular activity — for instance, at the beginning or end of a training session. Then he or she will prescribe an appropriate remedy.
Patients may be surprised at first, but the orthopedic primary care physician will often prescribe Pilates and exercises such as sit-ups, planks and Russian twists for knee pain. Cross-training and other kinds of physical work are as much a part of the sports medicine armamentarium as surgery or medication.
“Primary care orthopedists treat each patient as a whole person,” Dr. Zambetti explains.
For athletes and other active individuals or for people who wish to regain a higher level of activity in their daily lives, physicians at NYP Lawrence embrace an orthopedic primary care model.
Alyssa Klein, PT, a member of NewYork-Presbyterian Lawrence Hospital’s inpatient physical therapy team, assists a post-operative patient. The physical therapy and rehabilitation team at NYP Lawrence Hospital has many patients up and walking within hours of their hip or knee replacement. They also offer expert off-site physical therapy services for orthopedic patients following discharge.
When a patient at NYP Lawrence has a primary sports medicine provider, it is a simple matter to shift to an orthopedic specialist, making for smoother transitions and minimizing redundancy.
“We all have access to the same electronic medical record system, which helps us avoid repeating tests,” Dr. Zambetti says. “Primary care orthopedists get to know their patients well and align their treatment programs with their particular needs and abilities, from the amateur to the professional level.”
Aging in Motion
Older patients have unique orthopedic needs. For instance, their joints may have deteriorated from long years of use, and conditions such as diabetes can complicate treatment.
“In these cases, preparation and medical optimization prior to surgery are at least as important as the surgery itself,” Dr. Geller says. “I can do a beautiful job with an anterior hip replacement, but if the patient has uncontrolled diabetes and develops an infection, it doesn’t matter how well the surgery went. We approach older patients globally, looking at issues such as their physical readiness for surgery and their rehabilitation options.”
The new orthopedics program includes a growing and dedicated clinical staff to provide additional support for the expanding surgical service. Dr. Geller reviews surgical equipment with orthopedics nursing team leader Deidre Cavanagh, RN.
Toward that end, clinicians and other staff at NYP Lawrence provide patients comprehensive education. Prospective joint replacement patients meet a social worker, physical therapist, nutritionist and others who help plan their entire surgical journey, down to the details of how they will get groceries after the procedure.
“This global, collaborative approach is comforting and reduces stress and anxiety,” Dr. Geller says. “We’ve had a positive response and reduced hospital time because patients can make effective preparations for recovery. This attention to detail, plus cutting-edge knowledge of the latest advancements in hip and knee replacement surgery, bring New York City care to Westchester in a smaller, more intimate atmosphere. My patients get the same care in Bronxville as they get on the Upper West Side.”
Total Ankle Replacement
Injured feet and ankles pose particular treatment challenges. Dr. Greisberg describes their complexity as akin to that of a symphony — everything works together in intricate harmony until there is a disruption, and the whole performance falls apart. Dr. Greisberg has extensive experience in performing complex procedures to help patients recover from foot and ankle injury.
“I get subspecialty referrals and also see people the day after injury,” he says. “A typical morning might include fractures and failed foot and ankle surgeries from other providers. Often an ankle surgery hasn’t gone well and patients are asking what to do next.”
Drs. Geller and Zambetti discuss a case in one of NewYork-Presbyterian Lawrence Hospital’s new operating rooms. The state-of-the-art suite of ORs sets a new standard of care for orthopedic surgery in Westchester County.
Dr. Greisberg draws on nearly 20 years of experience focused almost exclusively on feet and ankles, stemming from a fellowship directed by a pioneer of modern trauma care, Sigvard T. Hansen, MD, Director of the Sigvard T. Hansen Foot & Ankle Institute in Seattle. Under his training and in the years since, Dr. Greisberg has perfected surgeries to the forefoot, ball, hindfoot and ankle.
He notes, for example, that the hindfoot works like a universal joint. It must be mobile to meet the terrain but stable enough not to roll over the ankle. The ligaments and tendons must work to measure the foot’s position and help maintain balance, he adds. His training and experience equip him to deftly handle cases involving different regions of the foot and ankle.
“I perform a wide range of procedures,” Dr. Greisberg says. “Some surgeons perform the same operations every day, but I treat injuries to every part of the foot.”
Minimally Invasive Knee and Hip Replacement
At one time, knee surgery was a major procedure involving significant hospital stays. Today, however, NYP Lawrence offers minimally invasive partial replacements that can preserve two-thirds of the original joint, Dr. Geller says, along with all the knee ligaments.
Preserving the anterior and posterior cruciate ligaments is especially important to making the knee “feel like a knee,” he says. Patients are more likely to be able to make dynamic cutting and twisting movements with these ligaments in place. The ability to spare both is a technological breakthrough, and patients return home the same day as surgery.
“This is life-altering,” Dr. Geller says. “Partial knee replacements work well for many years, and patients can go back to many intensely strenuous activities. Similarly, we now have the technology to do full knee replacements while keeping all of the native knee ligaments, a groundbreaking procedure available only at highly specialized orthopedic facilities.”
Hip surgery is performed in anterior, minimally invasive fashion at NYP Lawrence, with the accompanying reduction in pain and length of hospital stay. Dr. Geller also performs hip and knee revision surgeries. These are challenging, he says, but rewarding for patients who have suffered with a badly implanted joint.
“Some of my happiest patients are those who have had a poorly done knee replacement revised,” he says. “When you can turn an unstable, swollen joint into a sturdy knee, you give patients back the ability to participate fully in the activities of life that they value.”
Achilles Tendon Repair
Another specialized procedure, Achilles tendon repair, involves restoring function after the tendon has ruptured. Typically an outpatient procedure, the repair involves locating and rejoining the ends of the Achilles tendon. The surgery often may be performed via minimally invasive techniques, Dr. Greisberg notes.
“Achilles tendon repair is one of the procedures I perform most frequently,” he says. “This is a highly successful surgery.”
Dr. Greisberg, a foot, ankle and trauma specialist, leads an expanded orthopedic trauma team offering advanced care for complex musculoskeletal injuries in a local setting.
Non-reconstructive ACL Repair
Given the frequency of ACL injuries, ACL reconstruction has long been in high demand. However, surgeons with ColumbiaDoctors are now able to perform repair without reconstruction, a rare but effective arthroscopic procedure, Dr. Zambetti says. Whereas reconstruction uses a graft from the patient’s body or a donor, in repair, the surgeon uses a series of sutures and attachment devices to reconnect the ligament.
A similar operation was performed in the 1980s, Dr. Zambetti adds, but it involved open surgery and lengthy rehabilitation.
“Now, the instrumentation has been refined to make it more accurate, and we have the necessary experience with these instruments,” he says. “Therefore, repair of the ACL has become more feasible and desirable.”
A Partnership for Success
NYP Lawrence’s commitment to orthopedic success benefits patients throughout the area. In addition to Dr. Geller’s strong and steady leadership and the new faculty from ColumbiaDoctors, the hospital has made an institutional commitment to investing in state-of-the-art equipment and is opening clinics throughout the area.
“We are building a larger orthopedic trauma referral center for Westchester,” Dr. Geller says. “Once that’s set up, we will have a hotline patients can call if they fall or otherwise need orthopedic care — even if they are in another hospital — and we will transfer them in.”
This means any patient in the area has access to top-flight academic orthopedic specialty care.
“Whether you see us in Westchester or in New York City, we are part of the same group,” Dr. Geller says. “We are the only academic New York City hospital providing orthopedic care for patients in Westchester.”
To learn more, visit nyp.org/lawrence.