Adult Reconstruction Fellowship Review 2021-22

Wanted to share my thoughts to offer recent information. Similar sentiments to the past: most places would train you well otherwise they wouldn't have a fellowship! Things to look for: complexity/revisions, volume, approaches, outpatient, robotics, research, mentorship, name etc.  Previous posts are badmouthing some programs, but most places have improved. 

"ELITE ORTHO" PLACES INTERVIEWED: 

HSS: Just an amazing place, top tier attendings pushing the needle in total joints. You will come out well connected, likely end up indoctrinated with arthroplasty history as well as training. Al implants. All approaches. Robot savvy. Most of the guys designed the robot.  Cement techniques. Questionable autonomy, but you see some excellent complexity w/ access to tremendous resources.

MAYO: Revision gurus. Low case volume, but excellent experience w/ regards to what you can do. Amazing staff, written most textbooks. Can’t go wrong. You will come out of here seeing the most complex cases of the country and they actually do really well post op.

RUSH: Strong didactics. Questionable autonomy w/ certain attendings. You have to drive to Indiana for some rotations, but they comp it. Learn distraction osteogenesis w/ Paprosky for tabs. The attendings are all top gun pilots, approaching optimal efficiency taking on everything. You will come out with a cookbook for outpatient total joints. 

EXCELLENT TRAINING UPPER TIER: 

HARVARD/MGH: Kwon seems to generally care about his fellows personal lives and career trajectories. 500 cases. 20% Real revisions. outpatient experience.  Autonomy. w/ attending in room. Robotics MAKO CORI. Robotic Uni and Revision.  Mainly posterior approach, but you get anterior w/ 1 or 2 docs. This fellowship is on upswing will be an amazing place to train if you’re fortunate enough to land it. All call issues were sorted out by 2021-22 fellowship class. Kudos to them. Can't go wrong w/ Harvard. 

UCSF: Amazing didactics. All approaches. Some of the best teachers in the business. The UCSF program is an amazing place to train. Some drawbacks would be of an academic system. 

USC: All posterior. Oakes seemed like he sets up his fellows to be successful. Amazing staff retention. Amazing facilities. No call. High complexity of cases. Only fellow. Lifelong mentor. Decent revisions. 

UTAH: Anterior based revisions. Amazing staff. Won’t go wrong, will come out a capable surgeon w/ ability to be marketable. Peters is very well known in the academic community.

SLEEPERS PROGRAMS: 

YALE: Anterior approach gurus. Dr. Rubin is super nice and approachable. Great case volume and mix. Hip fracture call is amazing. You would learn a lot, and do a lot.

UT HOUSTON: No scut. OR heavy. Amazing staff. Down-to-earth docs. All approaches. No weaknesses. 1 house. Free breakfast everyday. Lifestyle fellowship. UT AUSTIN: Bozic is going to be AAOS president. Nuanced arthroplasty care. Perioperative home experience. All approaches. Koenig would be an amazing mentor. Fortunate if you match here. Tremendous autonomy. 

MAYO FLORIDA: Cam ledford is truly the man. He will set you up with the appropriate skills to succeed in the real world. It’s an amazing fellowship, strong didactics. A mix of tumor trained and arthroplasty trained docs. It’s truly going to be one of the most sought after fellowships in the country within the next 5 years.

CC FLORIDA: The sexiest program on the trail. Miami. Cool doctors. Anterior approach. Anterior revisions. High volume. Attendings challenging dogma of ortho.REVISION

HEAVY REVISIONS:

UofC: Finn isn’t going anywhere. He’s the man, and he’s going to do a ton of revisions. Arthrofibrosis: Strip the collaterals drop an OSS Hinge type fellowship. Just fine for me.

BIG NAME w/ LOW REVISION:

NYU: Fellows seemed happy, but 5-10% revision rate. Seems like they use a lot of tech. Davidovitch would be one of the best guys to learn the anterior approach. Prolly one of the cleanest approaches in NYC.It all depends on what you are looking for.



Some will agree and some will disagree. Don't think about it too much.

In General, agree with previous post. Will add my own thoughts from this past interview cycle. Thought that virtually every place would provide great Joints training, just have to figure out what matters most to you. Name? Revisions? Anterior approach? Robotics? Location? Mentorship model? etc etc etc. I'll provide a short version of my own 2 cents based on some notable places I interviewed, this list isn't meant to be comprehensive.

Top Tier: 
 Usual players. These programs have the combination of well known names, academic prestige, and connected attendings. 

HSS: those that are lucky enough to score an interview here understand: the resources are unparalleled. Big name attendings. New York City. Robots, revisions, and research. If you don't mind training with 18 attendings and want to go into academics, this is the place for you. 

Mayo: The only place that could rival the resources of HSS is Mayo. Yes... its in Rochester Minnesota. If you can get over that, want to go into academics, and prefer the mentorship model, this place is it. Autonomy probably less than most other places, and case volume certainly lower, but that's what you get when you have famous Joints attendings doing the most complex cases you will ever come across


2nd tier:
These "2nd tier" places could easily be the best program in the country, depending on what you want out of a fellowship. 

CCF: Got the feeling this fellowship is a ton of fun. Great culture. Junior attending, revisions, robot. All approaches. Minimal research requirements. 5 fellows. Krebs seemed awesome

Duke: Bolo is the man, plain and simple. Felt like a family, very collegial atmosphere. Duke name, if that interests you. Minimal robot, and minimal DA experience where some notable drawbacks, though they did just hire a DA guy 

UTAH: Great culture, emphasis on anterior approach. Felt like after training here, could go anywhere and do anything. Attendings well connected in academic community


Up and Comers:
I picked 3 programs that may not be "tip of the tongue" names when it comes to Joints fellowships, but easily could jump to the above tier in near future. 

UVA: Got the sense from the interview that Browne is as good as it gets when it comes to a mentor. Complex cases, all approaches. Doesn't have the fellowship history like some of the other places, but as long as Browne stays, this will be a great place to train


U of Chicago: Surprised that this place isn't talked about more. You can live in downtown Chicago for a year. Tons of autonomy with good case numbers. Big time revisions with Finn who is 50% revisions and the revision master (cup cages, hinges, triflanges). Great anterior hip exposure and tons of Mako hip and knee with Luu, who seems like the man. Wallace is young but getting more well known. 2 fellows, Mentorship model, seemed like they would be genuinely invested in your training 


USC: Liebermann is a big time name and is as connected as it gets. Again, geography isn't everything, but LA ain't a bad place to be for one year. Heckmann seems like the man, and no doubt is doing complex cases. Smaller program with 1 fellow, but that's not necessarily a bad thing. My only critique would be its a posterior-only program, and they seemed to be a bit anti-robot, but depending on what you want that may not be a bad thing either. 

I share similar sentiments to the folks above. After having gone through the cycle 21-22 I think theres a lot of things to be learned. 1. Find what fellowship works for you 2. the name/prestige factor is a must when considering the job market 3. there are some places that treat you like a glorified PA (don't go there and find out those programs quickly, chances are they went unmatched this past cycle). 

TIER1: 
Best programs interviewed (self-explanatory)
1. HSS 
2. Rothman
3. Mayo

Tier 1A: 
1. Cleveland Clinic (Cleveland): Krebs is amazing. Great staff. Truly epic training with sound technique. Great fellow autonomy and comradery. Fellows are respected. All approaches. All the things you want: name, academia, approach, skill, everything in one package. 
2. Harvard / MGH: autonomy, excellent revision volume, all approaches (less anterior) excellent research opportunities. Amazing outpatient experience. Probably one of the best fellowships in the country for honing your skills, and becoming a leader in your practice setting of choice. 
3. Utah: autonomy, anterior approach, excellent AAHKS connections, great revision volume
4. Rocky Mountain: Doug Dennis is amazing. probably the best conceptual knee fellowship in the country
5. UCSF: just fantastic autonomy, pathology, and revisions. Amazing balance of teaching. The location is perfect. You would be an excellent surgeon graduating from here. 


Tier 2
1. Brigham: Great experience and autonomy. Low case volume. All approaches. Questionable revision experience. OR turnover times are long. Great AAHKS connections. 
2. UT Houston: no weaknesses, just doesn't have that academic name
3. UT Austin: Bozic is chair. Koenig is an excellent teacher. Agree with earlier sentiments. 
4. Rush: Big names. Mainly posterior approach. The didactics are amazing. Driving a lot to Indiana. Just didn't mesh in the interview. But it's definitely tier 1a, just doesn't seem like it has the allure as it used to. 
5. Baptist: high volume, cog in the wheel. Gentlemen's fellowship, but you are really just trained on efficiency. 

Tier 3
1. Montefiore: low-key one of the better new york programs. Kamara seems like he really cares about you.  Pope is the revision guy. Both guys are probably handling all the rejected patients from HSS and NYU. 
2. Houston methodist: excellent training. Seems like incavo is stepping down. Better overall for the program. Will definitely be premier in the next couple of years.
3. Orlando: probably one of the best experiences for "trauma-plasty" with Haidekwhc. 

Just my experience and opinions. 

I interviewed during the 2021-2022 cycle and agree with the comments above. There are so many great programs that will train you well so you have to decide what is important to you. Factors I considered were: Name/prestige, anterior hip experience, autonomy,  culture/mentorship, revision experience, and amount of scut work. 

Tier 1:  
1. OC 
2. HSS
3. Rothman
4. Mayo 

Tier 2: 
5. Utah: mostly DAA including revisions, great attendings/culture, great autonomy (independent cases at VA), unmatched revisions, high volume (~600 cases), academic setting but efficient (low turnover time, 90% outpatient primaries) 
6. Cleveland clinic: all approaches, great attendings/autonomy, good revision experience, living in cleveland?  
7. Duke: 15% DAA, 60% ABMS, great attendings and big name, minimal call/scut, durham is sleepy
8. Rush: mostly AL/PL (1 new attending does DAA), big name/great connections, cool city but lots of driving 
9. WashU: 70% DAA, perhaps the best autonomy (20% cases are solo), great revisions, big name/great attendings, living in st. louis? 

Tier 3: 
10. MGH: improving, less scut from prior although got the sense that residents don't help much with floor stuff. mostly PL (1-2 attendings do DAA), never alone in OR but good autonomy. harvard name and cool city. 
11. CJR: Dennis is a legend, all approaches, fridays off for research, questionable autonomy with some attendings, some scut during call (patient phone calls, etc)
12. UCSF: all approaches (30% DAA), lower volume (~450 cases), high revision volume (~35%), cool city with subsidized housing, on call 1 wk per month with some independent cases 
13. Yale: 60% DAA, only fellow, attendings seemed very approachable, hip fracture call, international opportunities, big name, living in new haven? 
14. Brigham: good DAA experience, questionable autonomy, harvard name and cool city.
15. Hoag: unmatched volume (~1000 cases), mostly DAA, low revisions, great location with cool attendings, if you want to work in socal would be great for networking 
 

My experiences. Landed a nice spot mentioned by some folks above. Go get it.

Grand Master programs I interviewed at: 
1. Orthocarolina: unparalleled. 
2. HSS: best city, best mix, best connections -->sets you up for life. 30 attendings. Felt like the Complex Fellow does the revisions w/ sculcos though. 
3. Rothman: max courtney will show you things. 

Master programs
1. Cleveland Clinic: all approaches, minimal scut, great revision volume. Honestly one of the best places to train in the country. 
2. Duke: flat out an amazing place, decent autonomy, can get yourself into hip pres scenarios, nice exposures. 
3. Harvard/MGH: Autonomy, volume, revisions. Puts other Boston programs to shame.  Amazing research lab for paper junkies. Birthplace of modern knee replacement. 
4. Utah: only program I interviewed at that offers DA revisions. Amazing autonomy. Great for future practice set up on the west coast if desired.
5.  UCSF: erik hanson is pound for pound the best teacher in all of these fellowship interviews. tremendous autonomy and exposure for all fellows. 

Expert
1. USC: all posterior. good pathology, good education. 
2. BrighamandWomen's: low volume, questionable autonomy, low revisions. Attest to the guy above. 
3. Baptist: cog in the wheel, gentleman's fellowship, if you want to be a plug and play surgeon for a year and have a fun time, go for it. 
4. NYU: great DA observation. No revisions, major flaw.  

Class A
I didn't apply to any Texas programs, but from what I hear they are all legit and handle their business and fellows well. 


 

 Places I interviewed at. Top 10 program list from my perspective. All elite. Each of these programs is a "tier 1" place, with some of the best teachers and resources in academia. Each place will give you the pedigree and network to accel in our field. All of these programs are amazing, that said, I encourage you to rank based on interview feel, case mix, and career goals. You are fortunate if you land any of these. All big time players to me. 

1. Orthocarolina
2. Rothman
3. HSS
4. Mayo
5. Utah
6. Harvard MGH
7. UCSF
8. Cleveland Clinic
9. Duke
10. Baptist