Fellowship Year in Summary

Fellowship Year in Summary

It is hard to believe that my fellowship year is already coming to a close, but what a year it has

been. Today, I would like to discuss the fellowship year, whether the goals of the fellowship

were met, what my experiences have been like, and where I see the fellowship going in the

future. First and foremost, this year has been an amazing learning opportunity and has been

filled with rich and diverse opportunities to learn in many ways. I began the year with a video

detailing my expectations and goals for the year. These included working with a range of

surgeons using a variety of hip and knee techniques, performing routine cases as well as

complex primary and revision procedures, operating in a variety of medical facilities, exploring

my interest in technology for joint replacements, and being able to personalize the fellowship

to my needs. Let’s look at each of these in turn.

Surgical Cases

I have had the privilege to participate in over 675 surgeries throughout the year, which is well

above the national average for adult reconstruction fellowship programs. Approximately 80%

of these cases have been primary joint replacement procedures, while the other 20% have been

a mixture of revision surgeries, periprosthetic fractures that occur around joint replacement

hardware, and infection cases. I spent approximately 85% of my time in the operating room

with all eight surgeons at the Texas Hip and Knee Center and the remaining 15% of my time in

clinic.

Surgical Variety

From my perspective, the most challenging but also most engaging aspect of the fellowship was

learning the intricacies of so many techniques and implant systems throughout the year. From

the knee replacement side, I learned measured resection, gap balancing, kinematic alignment,

and individualized alignment techniques. Knee exposures were performed through medial

parapatellar, mid-vastus, and sub-vastus surgical approaches. When performing hip

replacements, direct anterior, anterolateral, and posterior hip approaches were used. Implant

systems from every major implant manufacturer were used throughout the year, which

provided me with a tremendous opportunity to evaluate all of the them and get comfortable

with many types of instrumentation.

Facilities

During my time with Texas Hip and Knee, I performed surgeries in a variety of facilities as well.

The primary workhorse facility for the group is Texas Health Clearfork hospital, which is a

beautiful state of the art facility that operates primarily as a subspecialty specific facility. I also

had the opportunity to work at the Texas Health Joint Replacement Surgery Center, which is an

ambulatory surgery center utilized by the group, and Texas Health Harris Methodist Southwest

Fort Worth, which is a large regional hospital. Each of these locations provided a slightly

different surgical experience and exposed me to different environments where joint

replacement surgeries are performed.

Technology

One of my most important goals for fellowship was to further my exposure to medical

technology, which has absolutely been met throughout the year. I have performed a significant

number of surgeries with two different robotic platforms and gained valuable experience that I

will apply to my cases in the future. I also had multiple opportunities to evaluate other

technologies, including other robotic systems, multiple versions of computer navigation, and

augmented reality. I firmly believe that these forms of technology are only going to become

more heavily utilized in the future, so this experience has prepared me quite well for my future

practice.

Personalization

Another key aspect, and perhaps the most unique, of my fellowship year was its ability to be

personalized for my needs. The surgeons at Texas Hip and Knee recognize that each fellow will

begin the year with different levels of surgical experience, skill, knowledge, and exposure to

joint replacement surgery. They also feel that fellowship is a unique opportunity to fill any

gaps in knowledge and experience by tailoring the rotations and surgical experience to that

fellow. During my time here, I began the year working with each of the eight gifted surgeons in

the group to learn their techniques and implant systems. From there, as I continued developing

my surgical skills, I also began thinking about the techniques and implant systems that I would

most like to use in my future practice. As a result, the majority of my time with the group was

spent with the surgeons performing direct anterior primary hip replacements, robotically

assisted primary knee surgery, and a large variety of revision procedures. This provided me

with not only the foundation in all surgical techniques and many joint replacement systems, but

also allowing the majority of my time to be spent fine tuning the specific techniques and

systems that I will use after fellowship.

Outside the Operating Room

While the operative experience at Texas Hip and Knee was a key aspect of my search for the

right fellowship, the learning opportunities outside of the operating room have also been

equally important in my development as a joint replacement surgeon. Throughout the year, I

attended annual meetings at AAHKS (American Association of Hip and Knee Surgeons) and

AAOS (American Academy of Orthopedic Surgeons), but I also attended trainings on the

anterior based muscle sparing hip approach, an advanced direct anterior hip technique course,

and a robotic-assisted direct anterior training course. We also held bi-weekly didactic sessions

and quarterly journal clubs on a variety of topics that were presented by myself and medical

students from the Texas Christian University’s school of medicine. In addition, we held many

cadaver labs during which we evaluated new technologies, explored different implant systems,

and provided opportunities for medical students to begin developing their surgical skills. Lastly,

through our interactions with the medical students and their interest in orthopedic research, I

helped draft three journal articles that have been submitted for publication.

Conclusions

As you can see from the details above, this year has provided amazing breadth and such a great

experience as the fellow. I feel that my knowledge base and surgical skills have progressed

dramatically throughout the year. These experiences will undoubtedly benefit all of the

patients that I will see in my future practice as a joint replacement surgeon. I truly feel that the

Texas Hip and Knee Center provides an extraordinary fellowship experience and should be

highly sought after by future fellows. I certainly plan to continue sharing my experiences with

others as I transition to my future practice. I have accepted a position as a total joint surgeon

with UCHealth in Colorado Springs, Colorado, and cannot wait to head back home and get

started! I hope that this year’s blog entries have allowed you to learn more about arthritis, hip

and knee replacements, the future of our orthopedic subspecialty, and the wonderful surgeons

at the Texas Hip and Knee Center. I want to thank you for taking the time to read and learn

from this blog over the last twelve months and wish you all the best in the future!