Faculty and 2018-19 Fellows
The Adult Reconstruction Fellowship is available for 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 and 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.
This year the Adult Reconstruction Fellowship has received an Orthopaedic Adult Reconstruction grant from the OMeGA Medical Grant Association for a second consecutive year. This is a big achievement for the department and we appreciate the continued support. Read more details here.
Clinical Experience and Education
The fellowship is principally organized as an apprenticeship. Fellows rotate with specific attendings in blocks at the University Orthopaedic Center, University of Utah Hospital, and Veteran's Affairs Medical Center, 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 a range of complexity in cases, with many 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.
Clinical Hip Experience
Fellows are taught primary hip arthroplasty via the mini-posterior approach, the anterior based muscle sparing approach, and the direct anterior approach with 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.
Hip revisions will cover difficult exposures, including extensile approaches such as ETO's, the management of bone loss and instability through algorithmic approaches. Fellows will be exposed to complex acetabular reconstruction including acetabular augments, jumbo cup reconstruction, double cup reconstruction, cup cage reconstruction, the distraction technique, and custom triflanges.
The fellowship offers a broad exposure to young adult hip preservation, ranging from 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 surgical dislocations, and femoral and acetabular osteotomies (PAO).
Clinical Knee Experience
Primary knee replacement experience includes ligament balancing, gap balancing, measured resection, PCL retention and substitution, bicruciate retention, partial (uni and patellofemoral) arthroplasty, and TKA following HTO or other prior surgeries. Knee revision experience will include learning the principles of bone, ligament and extensor mechanism deficiency management. While also highlighting difficult exposures, gap balancing, level of constraint and implant fixation methods.
A major emphasis of the Adult Reconstruction Fellowship at the University of Utah is to provide unique clinical research opportunities in the adult reconstruction arena. We have special interests in:
- Improving surgical techniques and implants for joint replacement of the hip and knee
- Increasing the understanding of hip morphology and hip pain in young adults
- Evaluating the outcomes of hip preservation surgery
- Providing and improving value in the adult reconstruction arena
- Hip and knee biomechanics
- Using fluoroscopy to improve implant positioning
- Patient reported outcomes using PROMIS measures
- Periprosthetic joint infections
Our fellowship program has been an integral part of our success and is supported by a dedicated research staff including statistical support from the University’s Study Design and Biostatistics Center. Aside from the interests listed above, we encourage the fellows to develop their own research ideas which can be discussed by the faculty to assist in the development of those research projects. In support of the fellow research projects, our research staff provides assistance with IRB and regulatory work, project management, protocol development, chart review, study procedures, analysis, and manuscript writing. Additionally, access to the University’s data warehouse and surgical database is available under a unique IRB umbrella for secondary data analysis. This allows for more expedited approval on most retrospective studies.
Harold K. Dunn, MD, Orthopaedic Research Laboratory
In addition to the clinical research capabilities, a well-equipped bioengineering laboratory is available. The Harold K. Dunn, MD, Orthopaedic Research Laboratory specializes in multidisciplinary biomechanical, computational, and clinical approaches to answer questions related to orthopaedic pathologies. The laboratory consists of two wet labs, a machining/tool room, and a motion analysis core facility. Fellows interested in utilizing this resource should request support promptly.
As part of our fellow research program, we require the fellows to complete at least two projects by the end of the year. One of these projects must be in the clinical research realm. The second project is flexible and includes the options of an additional clinical research project, basic science studies, book chapters, or creating a surgical technique movie for submission to AAOS. For fellows who may be more passionate about research, multiple opportunities are often available.
University of Utah Hospital; University Orthopaedic Center; Veterans Affairs Medical Center