The adult reconstruction fellowship at the Hoag Orthopaedic Institute (HOI) and Orthopaedic Specialty Institute (OSI) is a new fellowship that began in 2012. The adult reconstruction surgeons of HOI and OSI have a commitment to education as well as the surgical volume and breadth that would be very beneficial for fellows to experience. OSI has served as a tertiary center for adult reconstruction surgeries for over a decade, and therefore draws not only a significant primary THA and TKA volume, but also a significant revision volume. The faculty have historically been very involved in teaching residents at the University of California, Irvine Department of Orthopaedic Surgery. The surgeons created a fellowship to share their experience and case load with orthopaedic surgeons who are looking to a career in adult reconstruction.
The primary location of the fellowship is OSI which is a private practice of 19 subspecialty trained orthopaedic surgeons across all disciplines in orthopaedic surgery. The practice is located in Orange, California and is regarded as one of the most respected practices in Southern California. The adult reconstruction specialists in the group are Drs. Robert Gorab, Steven Barnett, Jay Patel, Nader Nassif, and Carlos Prietto. Most of the inpatient adult reconstruction surgeries are done at the Hoag Orthopaedic Institute which is an orthopaedic specialty hospital in Irvine, California. HOI is a 70 bed hospital with 9 operating rooms. The facility has been operating for 2 years and has much state of the art equipment. In addition, the hospital is committed to having modern clinical pathways, nursing care, infection prevention efforts and educational programs for physicians and ancillary services. The faculty believe that fellows trained in adult reconstruction need to be exposed to this type of environment to ensure successful outcomes for their patients. The surgeons of OSI also operate at St. Joseph’s Hospital in Orange which is a large private community hospital that is a center of excellence for joint replacement. This hospital has 20 operating rooms, 435 beds, the second busiest emergency room in California, access to physicians in all medical fields, an electronic library with access to all major orthopaedic journals. Many complex revisions are done at this hospital in collaboration with plastic surgeons, vascular surgeons, and surgical oncologists.
The fellow’s surgical experience at OSI will exceed 600 cases and will be quite broad. The surgical experience is hands-on with graduated independence based on the fellow’s development over the year. Fellows will be exposed to multiple surgical approaches for total hip arthroplasty including the posterior and direct anterior approach. The surgeons of OSI are some of the thought leaders in the area of direct anterior THA and fellows will benefit from this greatly. For primary THA, fellows will be exposed to a number of different types of implants and fixation. The revision THA experience will include complex acetabular revisions including pelvic discontinuities, use of cages, porous tantalum implants and augments, metal on metal revisions, and acetabular allografts. The revision THA experience will also include complex femoral revisions such as extended trochanteric osteotomies, proximal femur replacements, total femur replacements, modular femoral revision stems. The primary TKA experience will teach different surgical exposures, cruciate retaining and posterior stabilized techniques, rotating platform implants, and computer navigation.The fellow will have exposure to both fixed and mobile bearing unicompartmental knee arthroplasty.The revision TKA experience will include use of augments, sleeves, cemented and cementless fixation, hinged prosthesis, and tumor prostheses.
The fellow’s weekly schedule will include 2-3 days in the operating room and 2 days in the outpatient setting per week. Dedicated research time is allocated for one half to a full day per week.
Fellows are expected to complete 2 research projects during the fellowship year with at least 1 manuscript written for submission to a journal. Both projects should be submitted to major national meetings such as the AAOS and AAHKS annual meetings. The fellows are heavily supported in their research efforts with 2 full time research associates and access to statisticians. The research is primarily registry based.
Regular educational conferences are held to support the fellow’s academic experience.These include preoperative planning/templating conferences, postoperative case review conference, morbidity and mortality, case presentations, journal club, and didactic presentations.Invited guest speakers are planned on a regular basis.
The fellow is supported to attend the national meetings and educational courses throughout the year to build their skill set.