The Adult Reconstruction Fellowship is available for two to three fellows per year. It offers an extensive one-year experience in the clinical care of patients undergoing primary and revision joint replacement of the hip, knee. The tertiary referral practice for a large geographic area ensures sufficient volume of complex and challenging revision hip and knee procedures. In addition, significant experience in hip preservation and the care of young adult patients with acetabular dysplasia and femoroacetabular impingement (periacetabular osteotomy and surgical dislocation of the hip) is offered.
The fellowship is principally organized as an apprenticeship with the fellows rotating with specific attendings and at locations on blocks throughout the year. Rotations will cover multiple institutions including the University Orthopaedic Center, University Hospital, The Orthopedic Specialty Hospital, Veteran's Affairs Medical Center, and LDS Hospital, all in Salt Lake City. The fellows will participate in all phases of patient care and will work closely with orthopaedic residents, midlevels and medical students.
The fellowship provides a breadth of exposure to basic and complicated primary hip and knee replacement, revision hip and knee replacement and hip preservation cases. Due to the large geographic region of referral, there is ample exposure to the range of complexity in cases, with significant referrals of complex primary cases, revisions, and complications. Diagnosis, classification and appropriate treatment of periprosthetic fractures is well represented as is the appropriate diagnosis and treatment of periprosthetic joint infections.
Fellows are taught primary hip arthroplasty primarily via the mini-posterior approach and the direct anterior approach as well as some exposure to the anterolateral approach for primary and revision cases. Conversion of prior surgeries to THA and the treatment of arthritis related to the sequelae of pediatric hip disease and hip dysplasia are taught. In regard to primary knee replacement, ligament balancing, gap balancing, measured resection, PCL retention and substitution, bicruciate retention, partial (uni and patellofemoral) arthroplasty, HTO's, TKA following HTO or other prior surgeries are all taught. Related to knee revisions, the fellows will learn the principles of bone, ligament and extensor mechanism deficiency management. Difficult exposures, gap balancing, level of constraint and implant fixation methods are also highlighted. Hip revisions will cover difficult exposures, including extensile approaches such as ETO's, the management of bone loss and instability through algorithmic approaches.
The fellowship offers a broad exposure to young adult hip preservation, ranging from the diagnosis to management. The range of diseases from femoroacetabular impingement (FAI) to hip dysplasia is seen, along with the sequelae of SCFE, Perthes and Avascular Necrosis. Fellows will learn hip arthroscopy, mini-open anterior debridement, surgical dislocations, core decompressions, and femoral and acetabular osteotomies (PAO).
Each fellow will be responsible for at least one clinical and one basic science research project to be finished by the end of the year. A clinical research coordinator maintains an extensive clinical database and can aid with data and statistical analysis. A well-equipped bioengineering laboratory is available. Teaching responsibilities will include participation in the residency training program and formal grand rounds presentations throughout the year. Applicants must have completed an accredited orthopaedic residency program.