2019 Traveling Fellowship Reports

AAHKS Guest Society Program
Guest Society Program

Australian Arthroplasty Society (ASA)

By Catherine McDougall, BPHTY, MBBS, FRACS (ORTHO)

It was an honour to be selected as the Arthroplasty Society of Australia representative for the AAHKS Guest Nation Travelling Fellowship this year. Sharing experiences and broadening exposure ensures we always challenge our own status quo and is the key to improving patient outcomes. I was excited to visit two different sites, the Brigham and Women’s Hospital, Boston and the Rothman Institute at Thomas Jefferson Hospital, Philadelphia bookending the superb AAHKS meeting in Dallas.

The Brigham and Women’s Hospital provided an opportunity to explore an academic centre with good arthroplasty volumes and research and training links with Harvard Medical School, all while enjoying beautiful Boston. Hosted by Dr Antonia Chen with the support of Dr Richard Iorio, I appreciated the exposure to primary arthroplasty, robotics and their impressive pre-operative optimisation and pre-habilitation pathways. We enjoyed abundant conversation and discussions, exploring varied, yet similar challenges in patient management across differing health systems. After a fantastic week in Boston, I looked forward to the AAHKS meeting in Dallas.

International Society Chair Dr Rafael Sierra and President Michael Bolognesi warmly welcomed the Australian and Argentinian guest nation contingents to Dallas. It was an inspired meeting. Having all the sessions in one room is a powerful statement – supreme confidence in the quality and depth of the presentations. Podium highlights for me included the plenaries on Pain Management and The Psychology of Total Joint Replacement and the expert Tips and Tricks in Revision knee Arthroplasty. The enthusiasm and support for the Women In Arthroplasty group is world leading and I was pleased to be invited to participate in the WIA events including the booth crawl and the ergonomics luncheon chaired by Dr. Audrey Tsao. The quality of the poster exhibitions was evidence of the strong academic grounding of AAHKS and over the course of the meeting I had both practice supporting and practice changing moments, surely an indication of a successful professional development activity.

Post Dallas, I headed to Philadelphia for nine days at The Rothman Institute and Thomas Jefferson hospital. I experienced first hand the extraordinary efficiencies of the ROSH, complex knee and hip revisions at Thomas Jefferson and explored my special interest, patient optimisation and infection risk mitigation, with some of the world leaders in this area. Thanks to Dr. Max Courtney and Dr. Matt Austin for coordinating my visit. Participating in the Joint Research team meeting with Dr. Javad Parvizi, Dr. Camilo Restrepo and team was a real highlight for me and I look forward to seeing many of those studies progress to publications and common practice as time progresses.

An international fellowship offers the unique opportunity to combine educational activities with diverse cultural and personal experiences. Leaf peeping in New England, Halloween in Boston’s Southend, a historical walk in Philadelphia, and seeing the Sixer’s and the Eagles (!) play, helped frame a thoroughly enjoyable and memorable experience. For me, one of the highlights was experiencing all this with my almost 3-year-old son and my father “the nanny.” As we continue to encourage diversity in orthopaedics, with all its benefits, some of the traditional pathways of training and education will be challenged. We need to view all our opportunities through a different lens. I am extraordinarily grateful to my family for supporting me to accept this fellowship as well as to my hosts for their flexibility and generosity in welcoming us.

For me, the trip was hugely beneficial. Professionally I expanded my knowledge and challenged my perspective. Personally, the ongoing collaboration and friendships with the many colleagues and departments I visited is something I look forward to in the future. I am very grateful to AAHKS, am proud to be a new international member and wholly recommend this fellowship to my colleagues. Thanks for the opportunity.

Argentinian Association of Hip and Knee Surgeons (ACARO)

By Pablo A. Slullitel, MD

The Arthroplasty Society of Australia (ASA) and the Argentinian Association of Hip and Knee Surgeons (ACARO) were the 2019 Guest Nations of the American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting in Dallas, Texas. I had the opportunity to represent ACARO in this 1-month-time traveling fellowship around the United States in 2 different orthopaedic institutions.

My first location was Joint Implant Surgeons / Mount Carmel Hospital in Columbus, Ohio, under the supervision of Dr. Lombardi and his team. I was amazed at the volume of total joint replacements performed over there, making this orthopaedic institution unique. During my time there, the surgical days started with skin incision at 6.30-6.45 AM, with each surgeon performing around 10 cases per surgical day, with 4 surgical days (and 1 clinical day) per week. I was able to see plenty of primary and revision arthroplasty cases, with 80% of the primary cases being same-day discharge. The process of outpatient total joint arthroplasty is very well designed at all stages of patient management. The surgical agenda is diverse, including anterior approach total hip arthroplasty; direct lateral total hip arthroplasty; revision hip replacement through lateral approach; unicompartmental total knee replacement (both medial and lateral); and primary total knee as well as complex revision knee replacement through para-patellar approach. Dr. Lombardi and his team were very kind and really easy to work with, assisting me at all times during my stay.

Later on, I attended the 2019 AAHKS Annual Meeting in Dallas, Texas, where I could enjoy podium and poster presentations as well as panel case-discussions with excellent research quality performed by experts from all around the world. The meeting had around 4,000 participants, and it was an excellent opportunity to keep my arthroplasty knowledge updated.

My second and last location was Barnes-Jewish Hospital / Washington University in St. Louis, Missouri, under the supervision of Dr. Clohisy. Since I am deeply interested in complex hip arthroplasty and in hip preservation surgery, this second visit was ideal to match my interests. Dr. Clohisy and his team perform a wide variety of complex arthroplasty and non-arthroplasty hip surgeries, including periacetabular osteotomies, proximal femoral osteotomies, hip arthroscopies, and surgical hip dislocation, among others. Luckily, I could also spend some time with Dr. Pascual-Garrido, who is also Argentinian and had performed her residency training at the same institution as I did. I was able to appreciate morning surgical-planning rounds, journal clubs and conferences of both arthroplasty and hip preservation cases. Above all, what captured my attention the most was the kindness of all the surgical team. All of the surgeons are very respectful people, always willing to teach. Dr. Clohisy, Dr. Pascual-Garrido, Dr. Shoenecker and Dr. Nepple invited Dr. Chen Gang (a visiting fellow from China) and I to join them for a nice dinner at a historic Italian restaurant, where we could enjoy an excellent meal, and relaxed conversations, both orthopaedic- and non-orthopaedic-related.

This once-in-a-lifetime experience enabled me to learn and understand different perspectives in the treatment of complex hip and knee pathologies. Undoubtedly, I am thankful to both institutions that hosted me. I am very grateful to the Hip Unit of the Orthopaedic Division at the Italian Hospital of Buenos Aires, Argentina, for providing me with the time off to relish such a unique learning experience. I feel honored for having been selected for this travelling fellowship. I would like to thank Dr. Rafael Sierra, president of AAHKS’s International Committee, for his presentation welcoming AAHKS international members and travelling fellows. I would finally like to express my gratitude to ACARO and to AAHKS for supporting this fellowship and making this opportunity happen, and to Josh Kerr for taking care of the logistics and organization of my trip.