Adult Reconstruction Review 2020

Thoughts on programs that I've interviewed at only and or heard on the trail:

University of Buffalo: A gem in the north. Strong attendings with a long history of teaching fellows. Minimal research requirements. Supposedly acquiring new attendings that will only strengthen the program. Learn the unique muscle sparing Watson Jones which is their supine anterior based THA. They currently don't do DA. Knee experience also seems strong with I believe a large amount of robotics but I can't be sure. Revision experience seems comprehensive and complex primaries are routinely done. Ability to "float" between attendings during the week when attracted to nice cases. ACGME so no paid call. Can go and do trauma cases at the trauma hospital if so inclined.

University of Kentucky: Brand new, no fellows yet. Young enthusiastic PD from WashU. Long history of training residents. DA and no robotic TKA yet but supposedly on the horizon. Can take paid VA call, non-ACGME. The thought from the current residents is that this will be a strong program in the coming years. 1 day per week of hip preservation with scopes and PAOs by the PD but can opt to scrub other cases.

OrthoCincy: a new program without a current fellow. Private practice fellowship. Very heavy outpatient experience. PD is young and nice trained at MGH. Primarily DA experience with robotoic TKAs as another big facet of the program. They're shaping the fellowship so some questions remain. Only one other attending at the interview. Sign a non-compete. Questions about autonomy and exposure to revision remain unanswered.

FOI: 4 fellows per year. Currently a very disgruntled fellow that was at the interviews and overall wasn't pleased.Mentorship style but with 4-5 attendings. My impression is that you spend a lot of time learning different ways to do everything. See all the approaches to the hip, use many different implant companies, robotic TKA and non. The fellows felt that they would graduate and be able to do DA hips but that there would still be a significant learning curve. To me, seems more like a resident joints rotation than a fellowship. Not sure you graduate and are a master of anything. 15-20% revision rate per the fellows. Autonomy varies. Mandatory trauma call. One fellow was doing hand cases and a peds femur hip spica...do get paid some though. Overall I think the vibe is negative. Too many fellows, 2.5-3 office days per week.

Lennox Hill: 5 Fellows per year. Another mentorship model. Fellows were happy with no scut work. Autonomy varies. Do drive a lot out to Long island from NYC on some rotations but fellows thought it worth it. Revision experience seems to vary, though a referral center the revision, particularly on the hip side were lacking it seems. No trauma call. ACGME accredited. Doesn't seem like trauma cases would be available even if interested. Described by one attending as "White Collar" program. Come out comfortable with revisions. DA exposure seems questionable. Autonomy varies by attending. Fellows are well taken care of thought. Mont addition to the program is huge and addresses the lack of meaningful hip experience or complex primaries. 5 fellows is a lot however, cover a lot of attenidngs.

Updates to follow. Hopefully others can chime in.

Hey guys, I’m finally getting around to posting my impressions of some of the programs I interviewed at. This is just what I thought. Take it for what it’s worth.

New England Baptist: high-volume, lots of attending‘s, lots of different hip approaches including the superior/supercap Approach. Do use lots of different implant systems, white collar program. You get to flip rooms and there are PAs to help close. No orders. No scut. Very high case logs 800-900. Lots of primaries. 10% revision. Buying a robot. Could get you ready for a super efficient practice. ~100 revisions per fellow (some poly swaps considered revision) some are double scrubbed with other fellows. New attending brought to the hospital to mainly do revisions - will likely improve volume and experience. Attendings are great and down to earth.

MGH: much better than what I had previously heard. 4 fellows, 350-500 cases. Good mix of primaries and about 20% real revision cases. Two newer attendings do lots of complex stuff. Some PFR/DFR, total femurs/endo experience. Runs more like private practice as MGH isn't unionized. Limited anterior experience right now. Tons of Unis. Good research set up. Good mix of attendings with various backgrounds. Able to take additional call for moonlighting money. Limited anterior hip experience, but may change with new recruits.

Rothman: super efficient. An attending can get 10 or so cases done by 3pm. Every hip approach. Lots of implant choices. Lots of big name attendings. “Blue collar” in that everyone works really hard, but it’s highly academic. Most research projects/papers of any fellowship due by the end, but it’s a research powerhouse and is a well oiled machine. Seem to have a good revision experience too, 125 cases or so. Down sides - have to drive 20-30 mins for many rotations depending on where you live.

UCLA - I would ask to talk to former fellows, offline…. 

Hoag - volume volume volume, fellows clocking in around ~1000-1100 cases, 95% anterior hips and you get very comfortable and over the learning curve early, 100-150 revisions (including poly-swaps), learn the business of ortho - all ortho hospital, run mostly by surgeons, research coordinators to help with projects, able to do database research easily. Negatives - almost all anterior hips except revisions, call is half the year split between the two fellows - mostly patient phone calls, 2 weeks at a time. No trauma, not many periprosthetics, minimal infections.

Northwester - attendings are down to earth, work a lot with Manning who is really skilled, solid revision experience, good revisions and complex primaries, appropriate autonomy, about 450 cases per fellow, not a ton of uni's, mostly Medacta knees. Overall seemed like a very solid place.

Rush - very seasoned faculty, broad experience, many fellows, very efficient, variable hands on experience depending on the service. The academic conferences seemed to be a major highlight, lots of thinking and planning involved, fellows seemed happy. Hard to really gauge since I had an online COVID interview, but clearly excellent reputation.

Wanted to share my thoughts as well since there was so little recent information. I think in general that there are no bad joints programs and that almost all places would train you well otherwise they wouldn't have a fellowship! Saying whats is the ideal fellowship depends so much on what the individual applicant is looking for - complexity/revisions, volume, anterior, outpatient, robotics, research, mentorship, name etc. That said, I do think there are some names that most people would agree are the most prestigious few and they have probably remained pretty consistent over the years

In my opinion and in alphabetical (e.g. no particular) order: HSS, Mayo, OrthoCarolina, Rothman/Jefferson

Some other highly regarded places this year (places I interviewed at or heard about, again in alphabetical order): Anderson Clinic, Brigham and Women's, Cleveland Clinic, Duke, Hoag, Rocky Mountain, Rush, Utah, Wash U

Personal and brief opinions on a few of them. Note that specific info on rotations, approaches, salaries etc can all be found on interview day so I'll keep it brief. I think this reinforces that there are a lot of terrific programs out there, including many I didn't get to see

Anderson Clinic: historically a big player in the recon world with the Engh family. Still an outstanding fellowship, though I don't think its on the same level as some of the other premiere places listed above. Hamilton would be a great mentor and I got a very collegial and positive vibe from here. Strong volume (650 cases), very strong anterior and uni experience and great autonomy from what I see on interview day (we went into the OR). Less revisions than some other places. Less academic than some other places but you would walk out on an outstanding surgeon ready for private practice and well regarded with this name. I was very impressed with the grads from here that I worked with.

Baptist: another program that was historically a big player in joints, but I think this one has slipped a little bit from the glory days of Scott. Similar to Anderson with high volume (800+ cases), strong anterior experience, and private practice style. Big focus on efficiency and I got the sense that autonomy is somewhat variable but still fellows were comfortable and walked out happy. Wined and dined prior to interview here. Of note, revisions here have improved significantly with bringing in Smith from BU/Tufts. Overall would be a great fellowship.

Brigham: historically an upper tier program that I think is now knocking on the door of the other premiere programs. Estok has been FD for some time and is dedicated to training fellows. Iorio is now at the helm of division chief with a lot of new hires including Chen from Rothman. Seems like all aspects of joints covered: revisions, all approaches including about 60% anterior, solid volume for a university and solid autonomy according to their fellows. Strong research and academics with Chen, Iorio. Also can't forget the Harvard name! Overall, a place that offers an extremely well rounded joints experience.

Cleveland Clinic: another fantastic fellowship that is knocking on the door of top tier places. Huge emphasis on fellow autonomy and case complexity with a strong revision experience. The faculty seemed like great guys and their pre-interview dinner really sold the program. The FD Krebs also sold the robotics experience here as well, and Kamath does hip preservation for some but not excessive exposure. Really seems like all aspects of adult reconstruction are covered. My concern was that there seemed to be less anterior than some other places but overall thought this was an incredible place.

HSS: one of the premiere places historically and still today in my opinion. Seems like some of the old guard is gone but Bostrom and Su are dedicated to creating an excellent fellow experience here. Lots of perks to be being at HSS including affordable housing and comfortable and well compensated call. Strong case numbers with appropriately varying autonomy between the faculty. Seems like all aspects of recon are covered, though I think less anterior than some other places. Big emphasis on robotics where it seems these guys are at the forefront. Awesome preinterview dinner. The caveat is that there are a lot attendings that train fellows (~20). Just fine for me, but some folks may prefer to work with a smaller group more frequently. Issues with schedules being set by residents rather than fellows seem to have been resolved. Overall, an elite fellowship that would prepare you very well. Can't go wrong here.

Mayo: another one of the premiere joints meccas. Many faculty who have authored your textbooks (Berry, Trousdale, Lewallen, Sierra, Pagnano, Taunton) and educated you on how to manage revisions and periprosthetic fxs. Rochester MN is what it is and was an experience to see for the first time. For a year anything seems doable but everyone has different life priorities. In terms of training, covers any and all aspects of recon including approaches. Unlike the HSS/Rush/Rothmans of the world, there is less an emphasis on volume but on complexity and quality of cases. Case number was around 350 which was lower than most, but the spectrum of revisions and hip preservation was at the top. Fellows seemed happy with a huge emphasis on didactics and teaching. Some concerns about "PGY6" with floor responsibilities and volume persist. Overall, a premiere fellowship that covers everything.

Mass Gen: historically MGH was one of the names in arthroplasty though I think with some deficits in modern day arthroplasty. Interview day was a little bit disorganized and one of the fellows seemed disgruntled, which may have affected some peoples' perception. Harvard name and solid training is there but concerns about volume, autonomy, and amount of scut work. There also are deficiencies with no real anterior experience. Overall, would be a good year but I think it is not quite what it was in the past and wasn't so popular on the trail this year.

Rothman/Jefferson: one of the premiere recon fellowships and joints meccas that offers the complete package for fellowship training. Privademics to its core. Huge names in the joints world. Covers all exposures (anterior, AL, DL, posterior) and all implant types. Great fellow autonomy where you are really expected to operate from day one. Work hard program surgically, but minimal scut with an army of ancillary staff for clinic. Strong revision experience with some of their new hires. 600 cases, 25% revision. Busy schedule daily with early morning ORs ending in the early afternoon. Strong didactics and journal club. Of course research apparatus here is a well-oiled machine and impactful with guys like Parvizi and Austin. Fellows go into both academics and private practice with great connections all over the country from here and extremely well prepared both in terms of academic prowess and in how to run a business. Very nice and fun dinner at Austin's house after the interview. Overall, seemed to be an outstanding fellowship choice and again you'd be lucky to match here

Rocky Mountain: a hidden gem of a fellowship here. Not the name recognition that Mayo/HSS/Rothman have but still well regarded in the joints world and among applicants over the years. Run like a true private practice with minimal scut work for the fellow. Dennis and Jennings would be incredible mentors and truly dedicate themselves to their fellows. No residents. All approaches, unis, and revisions abound. stronger research infrastructure and expectations than I would have thought coming in. Overall a strong private practice fellowship without the traditional big name but would be a great choice.

Rush: another big name privademic place. We did not visit Rush as interviews were all online due to COVID19. I agree with the sentiments previously described: great didactics, big name, and a well run practice. I do think Rush joints has slipped just a bit from the top tier ranks but that's just my opinion. This is definitely a premiere place but some deficits with lack of exposure to anterior hips and questionable autonomy with some of the faculty. Della Valle would be an amazing mentor but it seemed like some others may view fellows as more of a cog in the wheel. Gerlinger, the program director, seemed like an all around great guy. Strong revision experience among the privademic places. Again, they did an excellent job and presented the program very well as best they could but I feel like it was hard to dispel some of the rumblings from recent fellows. Chicago would be a great place to live for the year and overall a very strong fellowship that would take you far.

Stanford: in the past was considered one of the best joints spots on the West coast, though I think some other places have leap-frogged (see below). Overall, my sentiments are similar to MGH on this one: all posterior, relatively lower volume, and university pace in exchange for a big household name. Goodman seems like a great guy and Huddleston and Maloney are heavy hitters in the joints world but autonomy does seem to be questionable. The VA seems to be the gem here where fellows eventually get autonomy and attending level privileges for cases but only about half the year. Approximately 300 cases, 20% revisions. Overall, would be a solid fellowship.

Utah: another hidden gem of a program that has come to prominence among applicants on the trail (but not on this forum yet). An outstanding program with Peters at the helm. Strong anterior exposure and a huge catchment area for revisions makes this arguably the best West coast (though a little far from the ocean) program. Autonomy is outstanding at the VA where the fellows function independently in arthroplasty. Approximately 500 cases, 35% revisions. One things they seemed to address on interview day is resident overlap, as the attending to fellow ratio is 5:3. According to them it has been balanced, though it seems like talking to one fellow that there is some concern at the university hospital. Not a big problem, but something to be aware of I think. Overall, an outstanding program knocking on the door of the other elite spots.

Did not interview at but wish I did: OrthoCarolina, Hoag, SJRI, Duke

As the others alluded to above, I wanted to share my thoughts on the programs I interviewed at or heard about to help prepare applicants. Going in, everything I had was hearsay from an upperlevel who applied last year and there was minimal information on this forum. So hopefully we can change that so people can make more informed decisions and apply selectively.

First off, there really are no “bad” programs. All of the fellowships I interviewed at were going to prepare me in some way, shape, or form to be a better arthroplasty surgeon.

I was lucky enough to have interviewed at most of the "top" programs in the country. While I received invites at others, I will refrain from commenting on them if I did not actually interview there or have some extensive experience there (will note this as to try to minimize bias).

That being said, take this with a grain of salt. Everyone looks for something different in a fellowship, interviews could give a different "vibe" to each applicant and cause subconscious bias, and an interview at a program only gives us a glimpse of the fellowship but only the fellows at those programs know the true experience. I was looking for an academic place with high complexity/volume of revisions. But I know others were looking for high volume primary joints, privademics, private practice, location mattered to some more, etc. So before you go in, I urge you to look at your priorities prior to applying and weigh/rank your priorities. Keep that somewhere and score each program based on those priorities as you interview (like 1-2 days after the interview while it’s fresh in your head). This made my final ranking a bit easier. And lastly, ask your significant other (make sure he or she is going to be happy with your list), ask mentors for their opinions, ask upperlevels who applied the year before, and ask other interviewees who you’ve gotten close to on the trail. I felt that despite the extensive notes I took on each location, it was fruitful to have these conversations to get other peoples’ opinions.

Anyways, that’s that. Here’s my brief summary of the programs below.

As said above by another applicant, there are a couple programs that most would agree are consistently considered premiere programs. In my opinion, these are: HSS and Mayo historically, and OrthoCarolina has been considered a premiere program in relatively more recent years.

The other top tier programs (or at least were highly regarded by myself or other applicants this year) were (in alphabetical order): Anderson, Brigham and Women’s, Cleveland clinic, Duke, Indiana, Rocky Mountain, Rothman, Rush, UCSF, Utah, UVA, WashU.

Here are my notes on places I went to:

Anderson: 4 fellows. Great case volume (600-650). Great autonomy. Fellow was doing case when I interviewed there. All approaches, they do outpatient joints. 15% unis. Great location. Goyal has slowed down since he is working on a startup company. Lowish revision experience (around 10%). They do both gap balancing and measured resection. They do cementless knees. Has robot/nav. OR to clinic ratio is 2.5:2. Great safe location to live in, can be expensive.

Cleveland Clinic: 5 fellows. the hospital has a strong name of course, the department is mostly younger faculty. Lots of autonomy and great revision experience. All approaches. Lower case volume than many programs (300-400). The fellows seemed to love this program and the incredible complexity and autonomy that they receive. OR to clinic ratio is equal. Some hip preservation with Kamath. Has robot. Few UKAs. No outpatient yet.

Duke: 3 fellows (2 nonACGME, 1 ACGME). strong academic name, well-known faculty but young. All approaches (although anterior is minimal in comparison to posterior – they have one DA guy who does it off table). Great case volume (500-600). Very good autonomy. Great location. OR to clinic ratio is 3:1. Interact with residents. PA/NP support available. Bolognesi is a great fellowship director. Jiranek does complex revision cases. Thorston is their research guy and was a little odd.

Hospital for Special Surgery (HSS): 6 fellows. Tied for best academic name. Master surgeons. All approaches. Great case volume (around 600) including lots of primaries and complex revisions, hip resurfacing. Great autonomy (fellows do all of cases, except with Salvati when doing hips – he demonstrates cementation technique). NYC is expensive but subsidized housing helps. Very little clinic time in year. Revisions are mostly with Bostrom. Lots of PA/NP support. No resident interaction. Lots of attendings to work with over the year (around 15), so lots of opportunity to learn different techniques, but can be intimidating to some applicants.

Houston Methodist: 2 fellows. Good case volume (650). Beautiful facility. Great autonomy. Great complex revision experience. OR to clinic ratio 2:1.5 (1 day of dedicated research). Lots of periprosthetic fractures, few PAO. Has posterior and DA approach. Buying robot, has nav. Good UKA experience. Some outpatient experience. Has NP/PA support. I really liked this program and think it’s up and coming.

Indiana University: 3 fellows. Strong academic name. great revision experience. Great case volume (around 500). Very good autonomy. All approaches (hired Buller who does DA). Meneghini and Warth run the hip and knee center at Saxony, with a good mix of primary and complex cases. But you also work with Dr. Parr downtown who does complex cases. Definitely sounds like a great revision experience overall here since they are a large referral center for the state. Has outpatient surgery, UKAs, cementless knees, and navigation. Great NP/PA support. OR:clinic ratio is pretty equal.

Mayo: 3 fellows. Tied for best academic name. Complex revision cases and primaries. Preservation with Sierra. Master surgeons. All approaches (Taunton is the DA guy). Mayo resources. Lower case volume (300-400 cases) than many programs. Possibly less autonomy depending on who you work with. Cadaver lab available at all times. Great mentorshp model. OR to clinic time is equal. Not much PA/NP support. No outpatient joints. Interact with residents. The location in Rochester is one of the downsides that everyone talks about. If you can stomach it for a year, you will absolutely love this place.

NEBH: 5 fellows (maybe 6 in future). High case volume (800). DA and posterior approaches. Good autonomy. Lots of UKAs. Little revision (10-15%), including liner exchanges. Buying a robot soon. Knee gap balancing and measured resection. Mostly all OR, very little clinic time. Has NP/PA support. Interact with residents.

OC: 4 fellows. Very strong academic name, high case volume (800-1000). Great surgeons. All approaches. Lots of trauma cases. Great case volume. Great autonomy. Very little clinic time in year (around 1 day/month). Call is “voluntary” but everyone does it. There is a lot of call, but the fellows seem to enjoy it since it gives them autonomy with periprosthetic fractures, and they get paid well. Not much preservation or UKA. Not much robot/nav either. Awesome city to live in.

Rocky Mountain: 2 fellows. Doug Dennis is a legend. Great operative experience including complex revisions. Great mentorship. Great case volume (600-700). All approaches. Knee gap balancing. Fellows go on Operation Walk. Denver is awesome. They do knee gap balancing only. OR to clinic ratio is 3.5:1. Low salary and high cost of living. Has PA/NP support. Has robot/nav. Few UKAs. They do 15% outpatient joints.

Rothman: 4 fellows. Strong academic name. great revision experience. Great case volume (600). All approaches. Good autonomy, possibly less depending on who you work with. Parvizi is getting pretty involved with his company, so not sure if he has cut down on operative time. Philly is a fantastic city to live in. The fellows do have to go in between different hospital sites during the year.

Rush: 6 fellows. strong academic name, only posterior approach right now, although hiring DA guy. Berger does a great anterolateral approach. Great case volume (500-700). Good autonomy but varies with staff quite a bit. A lot of outpatient surgery. Paprosky does revision cases but has slowed down. OR to clinic ratio is 3.5:1.5. Service depends on fellows and difficult to ask for vacation.

Stanford: 3 fellows. Stanford name. Well-known faculty. I got the vibe that there was not as much autonomy in general, however there was significant autonomy at the VA. Only posterior approach (no DA). Low case volume (350-400). Revision 20% of cases. Has robot/nav. Few UKA, few trauma. OR to clinic time is equal. Beautiful location.

UCLA: 1 fellow (planning to expand to 2). They are a new program (1 year old). Good case volume (500). Great autonomy. Lots of super complex revisions, especially with McPherson (this sounds like one of the best revision experiences in the country). Some periprosthetic and some hip preservation (Sassoon). Anterior and posterior approaches. OR to clinic ration is 2.5:2. Has UKA experience. Buying robot. Beautiful location. Definitely an Up and coming program.

WashU: 3 fellows. strong academic name. Great case volume. Great autonomy, VA experience sounds incredible. Lots of hip preservation (20-30%). Great variety in cases. All approaches, robot, UKAs. Lots of call but you get paid for it. OR:clinic ration is 3:2. Fellows feel they can handle anything leaving this fellowship. The interview experience was a bit odd in a couple of the rooms where you interview with the 3 staff other than the main fellowship ones (these are staff you work with on off days) and the nursing interview room as well.

Wish I interviewed at UCSF, Brigham and Women's, Hoag, and Beaumont.

Applied last cycle but here are some opinions of the top programs. Generally agree with reviews posted on here. Lots of good places to choose from in arthroplasty these days. I personally didn't care too much about robotics since I had a strong residency experience at a mid volume joints program, but I did care about anterior and revision experience.

Top tier:
OrthoCarolina: ~500 cases/year; strong anterior, privademic model, huge names; solid revisions, no weaknesses; paid call
Rothman: ~600 cases/year; strong anterior (off table), business and academics well represented, huge name, solid revisions, no weaknesses
HSS: ~600 cases/year; huge name, great volume, solid revisions; concern about mentorship and anterior experience
Mayo: ~350 cases/year; huge academic name, lower volume, lower autonomy, highest revision volume, limited anterior, great research; hip presi if that's your thing

Very good:
Rush: huge academic name, questionable autonomy, great revisions, limited anterior
Cleveland Clinic (main campus): outstanding autonomy and revision experience, limited anterior is the only negative for me
Anderson Orthopedic Research Institute: lower revision volume but great practice
Utah: top notch anterior and revisions; questionable interference from residents
Duke: big names, great atmosphere, less anterior
Rocky Mountain: high volume, great mentorship

Others:
New England Baptist: low revision volume but solid and highest volume place I interviewed at
Stanford: no anterior
MGH: high scut work, no anterior, low volume
Southern Joint: wasn't my vibe
Scripps: high scut (PA status), no anterior; great location!

Was in recent cycle, learned that there are a ton of great programs but everywhere offering a little bit different. In my opinion, tiers only make so much sense because different places offer different things. Any of the below will set you up for either an academic career or private practice, with the exception of Mayo (they want academics). Here are some thoughts on the ones that stood out, in no particular order.

Mayo -- pros: top tier academic fellowship, excellent conferences, complex cases, great cordial group of attendings, most personal interview day. All approaches covered. they train academic surgeons, and they state that is their goal. cons: lower volume (350) and autonomy, no PA support, run inpatient service. location

OC -- pros: high volume, great operative experience, make a lot of money via call, operate with co-fellow, big names with diverse training backgrounds. cons: none really

HSS -- pros: tons of big name attendings, about 1/3 hands on, 1/3 wander in, 1/3 autonomy. 700 cases. robotics, research opportunities, great pay and location. cons: large group of attendings so may not learn one style well, assigned 2 research projects before you come, maybe 25-30% anterior, questionable revision experience

Rothman -- pros: privademic model, can publish a ton if you want, lots of anterior, excellent operative experience, super efficient. cons: lots of driving, some interesting personalities to deal with. if they are running late on interview day, you might not finish all your interviews and still get ranked

Brigham -- pros: Harvard name and network, lots of anterior, relatively high volume for academic place (500-600?), good autonomy and location. fellows very happy. not much call or rounding responsibilities. cons: resident interaction can be hit or miss (often a miss). very nice but expensive area in boston, but some moonlighting opportunity to help offset cost

Rush -- pros: high volume, big academic name, "MIS" techniques. paprosky still operating. cons: no anterior hips (hired someone new but dont think fellow work with much), lots of driving, autonomy concerns

Anderson -- pros: privademic model, watched fellows operate while attending was in office (attached), no question of autonomy. anterior hips, unis, all the sleek stuff. great attendings. cons: somewhat boring area, but no real concerns as a surgeon. some floor work but seems minimal (no PAs), lower revision volume.

Duke -- pros: most organized interview day, collegial and skilled attendings. beautiful new buildings and expanding more. good primary and revision mix. solid network within world of arthroplasty. cons: minimal anterior, durham is hit or miss though supposedly improving, some driving to other sites.

Cleveland Clinic -- pros: great name, fun attendings, their focus is to make you a good surgeon and they state that above all else. lots of autonomy, navigation, robotics. cons: location for some may not be ideal, some driving to different sites

Western Ontario -- pros: all approaches, attending in room but you do case, very connected in world of academic ortho, as American you cannot take call so you operate M-F and thats it. PD is a great guy. tons of revisions: cons: not paid much, occasionally have to deal with a trauma attendings

If you end up any of these I can't imagine you'd have trouble finding a good job or being set up to crush it in whatever practice