Alumni Profile: Thomas P. Sculco’69

The Hands-On Surgeon-in-Chief of the Hospital for Special Surgery

Peter Wortsman

Thomas P. Sculco’69, surgeon-in-chief and medical director of the Hospital for Special Surgery, the institutional gold standard in orthopedic care—and himself a world-renowned orthopedic surgeon specializing in hip and knee replacement—likes to recount a conversation he had with one of his most famous patients, the late great Vladimir Horowitz. Dr. Sculco first treated the maestro’s wife, Wanda, and subsequently attended to a knee problem Horowitz was having. On their first meeting, the piano virtuoso, well into his 80s at the time, extended his hand and the orthopedist asked, “Mr. Horowitz, aren’t you concerned that I might crush your fingers by shaking your hand?” “Well, Dr. Sculco, you’re a surgeon, aren’t you?” the pianist replied with a wink. “You have as much respect for your hands as I have for mine, so I have no problem shaking yours.”

After more than 10,000 total hip replacements and countless replaced knees, those expert hands are still going strong. Columbia Medicine interviewed Dr. Sculco at his office at the Hospital for Special Surgery in New York in September 2013.

Founded in 1863, the Hospital for Special Surgery, the biggest and arguably the preeminent musculoskeletal center in the world, has been described as a tertiary medical center in a community hospital setting. With a staff of some 100 orthopedic surgeons who perform 28,000 orthopedic operations a year, HSS has, amazingly enough in the view of its surgeon-in-chief, “retained its relatively collegial family kind of feel. Everybody knows everybody, everybody cares about everybody.”

Much like the institution over which he presides and at which he has spent his entire professional career, Dr. Sculco manages to perform at the top of his game while maintaining a down-to-earth, unassuming manner. A native of Westerly, R.I., where his grandfather had migrated as a stone cutter from Italy and where his father, a Juilliard-trained jazz trumpeter who played with big band legends Tommy Dorsey, Harry James, and Benny Goodman, retired from the limelight to teach music at the local schools, Dr. Sculco still retains a healthy helping of small town civility. His open smile and seemingly easygoing way belie a fierce commitment to his calling, to the people in his care, and to those who report to him. Benjamin Bjerke-Kroll’09, a third-year surgical resident, calls him “a model mentor. A caring and compassionate surgeon and hard-working leader, Dr. Sculco manages to strike a rare balance of personability and professionalism with his patients and those lucky enough to train with him. He makes himself available to his residents whenever possible. You just want to be like him.”

From the Classics to Orthopedics
His was not a typical path to medicine and orthopedic surgery. A classics major at Brown University, Thomas Sculco originally aspired to become an archeologist. He was also intrigued by and did extremely well in biology, zoology, and comparative anatomy but did not take the full complement of pre-med classes. Impressed by his academic performance and his potential, the chairman of biology at Brown asked him, “Did you ever think about medical school?” That got young Sculco thinking. A beloved uncle was a neurosurgeon. On a whim he applied to just one medical school, P&S, figuring if it didn’t work out he would head off to Athens for a dig at the ancient Agora, in which he was scheduled to participate. In an admissions interview with the legendary P&S professor of medicine, Yale Kneeland’26, “your classic wise old internist,” who likewise came to medicine from a background in the humanities, they mostly discussed the virtues of studying Latin. And to the applicant’s great surprise and delight, shortly thereafter he received an acceptance letter. The beneficiary of a generous scholarship, Dr. Sculco returned the favor many years later by endowing a named scholarship at P&S.

Dr. Sculco fondly recalls Dr. Kneeland’s eloquence and wit in his class on physical diagnosis, his presentations always replete with memorable and mnemonic bon mots, including a description that leapt to mind of one particular heart murmur as “sounding like a humming bird flapping its wings.” Other favorite P&S faculty members were Drs. Malcolm Carpenter in neuroanatomy and P.R. Srinivasan in biochemistry.

Thomas Sculco’69 with students at the P&S Student/Alumni Forum in November 2013. From left are Michael Salna, Tavish Nanda, Cecilia Davis-Hayes, Dr. Sculco, Javier Sanchez, and Diana Lee.

Readily acknowledging that he has never met another classics major in orthopedic surgery, Dr. Sculco nevertheless believes that a background in the classics, and the humanities in general, “allows you to approach the patient in a holistic way.” The clear sentence structure of Latin, he firmly believes, teaches intellectual problem solving. “Medicine is problem solving. You take all the data, the history, the physical, the X-rays, the lab work, you put it together and synthesize it, and you come up with a solution. Latin helps you organize your thought process into a problem-solving mode. Taking the data, namely taking apart the sentence and putting the pieces back together, proved a great mental discipline ideally suited to the practice of medicine.”

While he did have to buckle down and study extra hard in basic science in the first two years to catch up on classes he had not taken, he hit his stride in the clinical experience. “The interaction with patients is what really grabbed me and made me love medicine.”

Another dedicated mentor at P&S, Dr. Keith McElroy, a Canadian orthopedic surgeon on the clinical faculty and preceptor for his orthopedics rotation, inspired him to enter the field. “He got me very excited about all the amazing things you could do. Total hip replacements had just been introduced. You could see people who came in crippled and walked out with a smile. It seemed like a very uplifting specialty.”

After an internship and residency in general surgery at Roosevelt Hospital, he completed a three-year residency in orthopedic surgery at the Hospital for Special Surgery. After winning a prestigious Bowen-Brooks Scholarship from the New York Academy of Medicine that took him abroad to study orthopedic practice in several countries, he fulfilled his military service as an orthopedic surgeon at Andrews Air Force Base in Maryland. He then returned to New York to join the clinical faculty in the Department of Surgery (Orthopedics) at Cornell University and the staff at the Hospital for Special Surgery. He was named professor of clinical surgery (orthopedics) in 1991 and professor of orthopedic surgery at Cornell in 2002. He was appointed director of orthopedic surgery and chief of the surgical arthritic service at HSS in 1993 and surgeon-in-chief and medical director in 2003.

The Art and Craft of Hip and Knee Replacement, According to Dr. Sculco
Dr. Sculco likes to listen to classical music to aid concentration as he directs his surgical team through the three “movements” of an operation. “The beginning part of an operation, essentially the exposure, is usually pretty routine, how you get into the hip. But then you get into the guts of the operation, and it becomes more intense. Now you’ve got to create a new socket, a new femur. Everything gets relatively quiet until you get the hip or knee in. The next and last part of the operation is the closure, and that’s more relaxed. The hard work is done, you’re happy with what you’ve accomplished.

“As a rule, you want it all to be fairly routine. It’s when it slips out of the routine that problems occur,” says Dr. Sculco. Ten thousand total hip replacements and innumerable knees into the game, the seasoned orthopedic surgeon teaches his residents to respect the creative challenge. “Every hip is a little different. You are, after all, taking something that’s abnormal and you’ve got to create something that is as normal as you can get once you’ve replaced it. There’s a great deal of creativity involved, particularly in the more complex cases. It calls for problem-solving skills, some engineering, some sculpting, and, of course, a cool hand.”

He still recalls one of his first cases, that of an elderly woman with a severely malformed hip. “I’d been in practice for maybe two weeks, three at the most. The hip was completely dislocated, an arthritic and old congenital hip problem, the worst I’d ever seen. I showed the X-ray to my old mentor, Philip D. Wilson Jr.’44. I said, ‘I know I can do this case, but would you mind scrubbing in with me?’ It all went beautifully, absolutely no problem. I did the whole operation myself. But I always tell young surgeons: Beware of surgical hubris. Never be too proud to ask for help and advice. You can risk bruising your ego. Always remember it’s the patient that matters most.”

An Innovator in the OR
Ever an innovator in surgical technique, Dr. Sculco helped develop less invasive approaches. “In the past,” he says, “we were more radical than we needed to be with our incisions and our exposures. That increased blood loss and interfered with recovery. Bottom line, the function was delayed.” In the course of streamlining the operation, Dr. Sculco developed a series of instruments. “A few of them are patented, but all are out there for other surgeons to use. I’m happy to say that a lot of people, a lot of companies have copied them.”

Also interested in anesthetic technique, he championed the use of regional anesthesia. “It’s safer than total anesthesia, particularly in older patients. There’s much less morbidity, they bleed less, so hospital stay is reduced and they’re out and on their feet and back to their normal life in less time.”

‘I always tell young surgeons: Beware of surgical hubris. Never be too proud to ask for help and advice. You can risk bruising your ego. It’s the patient that matters most.’

Dr. Sculco’s interest in successful outcomes also extends to the lab. He has been engaged for a number of years in basic scientific research, trying to mitigate the effects of osteolysis, a reaction to wear of implants that produces inflammation and breaks down the bond between the implant and the bone. “We are trying to define the cellular mechanisms triggered by wear debris or reaction to wear debris, causing an inflammation that activates the osteoclast, a cell that can resorb bone and break down the bond between implant and bone.” He has published extensively on this and other basic scientific and clinical issues relating to joint replacement surgery.

The HSS Surgeon-in-Chief Keeps One Foot in the OR
His work week is carved out and carefully paced. Monday is reserved for administrative meetings, often from 6:45 a.m. until after 8 p.m. On Tuesdays, he schedules meetings in the morning, then sees patients. He operates on Wednesdays. Thursdays he mostly takes care of institutional business, meeting with department heads at Cornell, hospital chiefs at NewYork-Presbyterian/Cornell, and often also with members of the board of directors of HSS. Fridays he operates. He also operates one Saturday a month.

“In a lot of orthopedic departments when somebody becomes chair oftentimes they stop being clinically active. At this institution that doesn’t work very well, because you need to be in the trenches,” he says. “I’m in the OR several times a week, where I’m walking around, talking to the nurses and technicians, so I get a good feel of how the place is running. Plus I’m a surgeon, I like doing surgery. I don’t want to be sitting behind a desk in my office all day.”

For Dr. Sculco, postoperative interaction with patients is not just a professional responsibility, it also satisfies a personal need. “You can be down. Say something didn’t go well, you’re down about it. You keep telling yourself: I wish I had done it this way. Then you see patients for follow-up appointments. A patient will tell you: ‘Your surgery really changed my life!’ And it just rejuvenates you. And all of a sudden you find that the issues you were fretting about seem to go away. That’s what makes medicine what it is. Despite all the headaches and the bureaucracy we have to deal with, nothing can take away from the fact that you have a unique relationship with another human being. It’s a special bond. That’s why I love what I do.”

His office is filled with treasured tokens of appreciation from grateful patients, including artwork by sculptors Mark Di Suvero and Donald Gummer, calligraphy from China, a ritual bejeweled dagger from a Saudi Arabian princess, and a bronze representation of a pair of healthy knees.

“I’m a Globalist. I Like to Know How Things Are Done Elsewhere.”
The Bowen-Brooks Scholarship from the New York Academy of Medicine, which took him to top specialty hospitals in Finland, Switzerland, Holland, Italy, and Great Britain, not only gave him a privileged first-hand look at orthopedic practice abroad, but also instilled a lifelong passion for intellectual border crossings.

“I’m a globalist,” he says, “I’ve been a globalist all my life. I want to know how things are done in other countries, learn from and borrow the best and bring the knowledge back home.”

Years later he would apply the same eagerness to engage in international dialogue to help found and direct the Bone and Joint Seminars in Salzburg, Austria, to train orthopedic surgeons from eastern and central Europe. The program has since evolved into an educational forum for young surgeons from all over the world. In recognition of his pivotal role, in 2013 he was awarded the Austrian Cross of Honor, First Class, for Science and Art. Dr. Sculco has been saluted with many other honors in the course of his career, including the 1991 Hip Society’s Otto Aufranc Award and its 1995 Charnley Award, the 1999 Arthritis Foundation Lifetime Achievement Award, and the 2005 P&S Alumni Gold Medal for Outstanding Achievements in Clinical Medicine. A member of the Hip Society and founding member of the Knee Society, of which he will serve as president, he has served on the board of directors of the American Academy of Orthopedic Surgeons and is currently on the board of directors of the Arthritis Foundation.

As if he did not already have enough on his agenda, he was the driving force in 2005 in the establishment of the International Society of Orthopedic Centers. He is executive director of the society, which now has 17 member institutions on four continents. The society brings together musculoskeletal specialists from the top academic institutions to share cutting edge research findings and innovations in patient care. The format, according to an article in the journal Medical Meetings (September/October 2010), “is designed to foster idea generation and collaboration rather than simply disseminate knowledge.” In Dr. Sculco’s words, “Here you have the biggest players [in orthopedic surgery] around the table, a group of very talented and very experienced people trying to resolve the issues we share and to learn from each other.” Every meeting also includes a cultural program, often a concert. It helps with the harmony.

Dr. Sculco also established an exchange program with China and travels there once or twice a year to teach and, on occasion, perform surgery. He has established a symposium run by HSS on hip and knee replacement that has been featured at the Chinese Orthopaedic Association meeting in Beijing for the past three years. He regularly has a Chinese research fellow working with him. Aside from the clinical and research aspects of his Chinese connection he enjoys trying to speak the few words of Mandarin that he knows.

Outside the OR and the committee room, music remains for him an abiding passion. His favorite way to unwind is to attend a concert with his wife, Cynthia. A member of the faculty of the NYU College of Nursing, Cynthia Sculco received her master’s degree and doctorate in education from Columbia Teachers College. They have two children, daughter, Sarah Jane, a college guidance counselor at Millennium High School in Brooklyn, and son, Peter’09, an orthopedic senior resident at HSS. Dr. Sculco also serves on the board of directors of Carnegie Hall. “Some colleagues like to play golf or go to the beach; some like skiing. The ideal vacation for me is to travel with my wife to Salzburg and in a week’s time take in five operas and maybe three or four concerts.”

In a memorable appearance as a guest on “Mad About Music,” Gilbert Kaplan’s popular radio show on WQXR, Dr. Sculco recounted how once, upon hearing Herbert von Karajan direct the Vienna Philharmonic in a performance of Bruckner’s Eighth Symphony at Carnegie Hall, he leaned over to his wife and whispered: “If they’re playing music in heaven, this is what they’re playing.”

Back home on planet Earth in the meantime, Dr. Sculco devotes most of his waking moments to conducting the affairs, setting the tempo, maintaining harmony, and ensuring optimal outcomes at the Hospital for Special Surgery, where he recently completed a second term at the helm.