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Italian Hip Society

by Loris Perticarini, MD, Guest Scholar

The Italian Hip Society (SIdA) and the British Hip Society (BHS) were the Guest Societies during the 2018 American Association of Hip and Knee Surgeons (AAHKS) Annual Meeting in Dallas. I had the opportunity to attend the 2018 AAHKS Visiting Fellowship.

At the beginning, I attended Joint Implant Surgeons (JIS) in New Albany, directed by Dr. Lombardi.

I had the possibility to follow a high volume of hip and knee replacements performed by Dr. Lombardi and his team. The primary and revision cases were very interesting, as well as the efficient post-operative and recovery programs. Organization and work planning really impressed me. I also had the possibility to meet the Insall fellows, and the moments of leisure were not lacking. Dr. Lombardi assisted me with all my needs during my stay in New Albany.

Thereafter I attended the 2018 AAHKS Annual Meeting in Dallas where I had the opportunity to interact with orthopaedic surgeons come from USA and other countries. The meeting had 3,500 participants, and I gained a lot from the rich presentations at these conferences.

I spent the last two weeks of the visit at Duke University center, in Durham, where I had the opportunity to visit different hospitals and I was involved in a variety of surgical techniques with skillful surgeons.

Dr. Michael Bolognesi, chief of Duke Adult Reconstruction Unit, was fantastic both for surgery and for the opportunities provided during my free time. I was involved in fellow and resident meeting activities. The case discussion I attended with the “Duke prosthetic team” was very interesting.

I want to thank AAHKS and SIdA for the opportunity they gave me, and I’m grateful to hospitals staff that supported me during my fellowship.

British Hip Society

by Timothy G Petheram, MB ChB, MSc, FRCS (Tr & Orth), Guest Scholar

“The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.” Eleanor Roosevelt.

In late summer 2018 the British Hip society advertised the 2018 AAHKS travelling fellowship. This fully sponsored travelling fellowship, with the ability to choose two orthopaedic departments to visit across the USA, and attendance at the annual AAHKS meeting in Dallas, offered what can only be described as a truly once in a lifetime experience. As a young consultant, with an interest in revision arthroplasty and treatment of infection, this presented an opportunity to visit some of the surgeons and departments who have, and continue to, shape world opinion in these areas. I was delighted to be awarded the fellowship shortly after applying, even more so when the visits were confirmed as the Mayo Clinic and Rothman Institute.

In mid-October I left the UK for the journey to Mayo Clinic, Rochester, Minnesota. Mayo Clinic is a prime example of the ability of an institution to attract patients regardless of its geography by ensuring it provides a fantastically high quality, patient centred service. I saw that despite a geographical situation which can reasonably be described as somewhat remote, in the heart of Minnesota farmland, the Mayo Clinic attracts not just patients but also staff from around the country and world. Rafael Sierra, MD created an engaging timetable for me spent in outpatient clinics, theatre, and I also a managed a visit to the museum and Mayo History exhibits in the Hospital. I was struck by the ethos of the clinic which centred around clinical leadership in partnership with management, and has been a key feature of its success. A recipe for all hospitals and medical organisations to follow, and one which resonates strongly with the NHS, this is one of the main reasons I believe my department in the UK is so strong.

My clinical experience in Mayo was my first exposure to US Orthopaedic practice. I was pleased to witness medical practice which mimicked my NHS practice strongly in many good ways, including in particular patient centred, evidence based surgical practice. A strong ethos of research, and clinical decisions based on that research pervaded the department. Drs Sierra, Trousdale and Lewallen provided me with some excellent clinical exposure in clinics and theatre for my visit. Discussing and observing acetabular reconstruction with a cup half cage construct with Dr. Lewallen particularly stood out as a specific technique I take away with me.

Back to the airport at Minneapolis and off to Dallas for the AAHKS annual meeting. Another first – my first US orthopaedic conference. A truly excellent meeting with a phenomenal quality of papers presented. The ratio of podium presentation to submission of 59:1615 led to some truly practice changing papers, something that cannot always be said of arthroplasty meetings. Both me, and my colleagues from The BHS who came over for the meeting were very impressed in particular by the scientific studies being presented. Never have I seen more prospective randomised relevant trials presented at an orthopaedic meeting. A further surprise lay in the keynote address. It seems that the AAHKS committee have friends in very high places, and it was the icing on the cake of a superb meeting to hear the musings of President George Bush in conversation with AAHKS Programme Chair Matthew Abdel on the stage, just yards from my seat. A remarkable man, and an utterly captivating hour spent listening to his articulate and insightful musings on past and present world politics for the consumption of the attendees of the meeting. A true highlight of the trip. I fully intend to return to the AAHKS meeting with my colleagues in the future.

Off next to Philadelphia and Rothman. A longer visit, I spent the best part of 2 weeks at Rothman, attending again clinics and theatres, but most importantly to me having the opportunity to bend the ears of a group of highly productive, world leading old and young orthopaedic surgeons. Matt Austin, MD put together a perfectly judged programme, balanced between clinics and theatre, primary and complex sessions, senior and more junior surgeons. All were hugely welcoming, happy to discuss their practice and lessons learned. Matt asked me at the end of the visit if I would change anything for future visits. I confirmed that to be honest, I would not. Clinics are a significant part of all of our practice. Meeting patients, deciding together with them whether to pursue sometimes risky and complex surgical journeys, is a crucial part of our work, and must not be forgotten against the glamour and excitement of the operating theatre. The chance to meet both world leading senior staff, as well as newer surgeons of my own seniority with whose challenges I could strongly relate, provided a rich and varied visit which I thoroughly appreciated. My time with Drs. Hozack, Parvizi, Purtil, Brown and Courtney was hugely enjoyable. The experience was truly broad. Dr. Hozack’s phenomenally productive theatre, with clear learning points in efficiency and watching a master at work performing the DA approach to the hip (and making it look very straightforward with superb exposure) was complimented by the complex cases being taken on by the younger consultants in Jefferson Hospital, and the astounding research productivity of Dr. Parvizi. Many specific lessons were learned. The programme was perfectly judged, and I received an extremely warm welcome, a meal being presented on my first evening in Philadelphia, an opportunity to attend the Journal Club at Dr. Lonner’s house on the last. A fantastic experience, and huge thanks to all at Rothman for welcoming me so.

The fellowship has been a truly once in a lifetime experience for me. The chance to spend a few weeks free of day to day clinical demands and the rigors of a busy day to day life allowed a rare opportunity to merely observe, cogitate and reflect on orthopaedics, and very specifically my passion of arthroplasty surgery. This reflection showed me huge similarities between my practice and that I observed in America. We face the same challenges. Patients are the same the world over, with the same problems of pain, immobility and loss of function, seeking the miracle of arthroplasty to solve these problems. The surgeons face the same dilemmas of first doing no harm, choosing the correct patients to offer surgery for, and guiding patient expectation to ensure a happy outcome. In the modern era we also have to consider how to achieve these aims whilst consuming a limited resource, an ever more present factor on both sides of the Atlantic. When things do not work out as planned, in particular when the spectre of infection rears its ugly head, we face the same battles in order to move our patients and ourselves beyond this devastating complication. There are obviously differences too, and I certainly also observed these, but it is the similarities that stood out more strikingly, and surprised me to a greater extent. As always seeing other hospitals and surgeons, one is reminded that there is more than one way to achieve an excellent outcome. This is a strong reminder to maintain an open mind to change and different ways of doing things. As Dr. Hozack explained to me, challenging the status quo and in particular areas of orthopaedic dogma, is crucial to progressing our subspecialty and continuing to improve outcomes for patients. The all purveying themes of patient centred evidence-based care, from strong teams who work together under strong leadership were evident throughout my journey, and are the necessary ingredients for this excellent outcome. It was clear that these are crucial ingredients that need pursuing and protecting in my own department to ensure our continued success.

I heartily thank the British Hip Society for choosing me for this tremendous experience, and the American Association of Hip and Knee Surgeons for creating the opportunity. Their generosity in funding my visit is extremely gratefully received. Of course, I have to remember my family, my wife and two boys, for managing without me at home for the time I was away. A truly once in a lifetime experience. Eleanor Roosevelt, I feel, would approve of this fellowship.