total joints

[studyinghard]

Anyone in here interested in total joints fellowships? It seems like it would get repetitive after a while. Any attendings in here wish to give their two cents about such a focused practice of medicine and the pros and cons of sub-specializing?

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[moquito_17]

Anyone in here interested in total joints fellowships? It seems like it would get repetitive after a while. Any attendings in here wish to give their two cents about such a focused practice of medicine and the pros and cons of sub-specializing?

I'm not a Total Joints fellow, but I know enough to answer this question.

1) Extremely satisfying for primary THA/TKA. Over 90% of the patients love you. Being appreciated never gets old
2) Not every knee and hip is the same. Varus/Valgus, compartmental disease, age, OA/RA/TA, LLD, etc. all make a difference in operation, prosthesis choice etc. To the untrained eye, it looks like a lot of total joints, but there is a lot of meticulous decision-making and planning that go into primary THA/TKA.
3) Six sigma. Joint surgeons are perfectionists. They want 100% perfection, not 95% and are ‘hard-wired’ to seek that 5%
4) Revisions. Very interesting collage of failures, problems and revision strategies. Each revision is puzzle that requires a tremendous amount of skill, planning and knowledge.
5) Fancy osteotomies that no one else does. (PAO, etc.)

Hope this helps,

P.S.:

THA: Total hip arthroplasty
TKA: Total knee arthroplaty
OA: oseteoarthritis
RA: rheumatiod
TA: Traumatic arthritis
LLD: Leg length dicrepency
PAO: Periacetabular osteotomy

 

[dawg44]

I'm not a Total Joints fellow, but I know enough to answer this question.

1) Extremely satisfying for primary THA/TKA. Over 90% of the patients love you. Being appreciated never gets old
2) Not every knee and hip is the same. Varus/Valgus, compartmental disease, age, OA/RA/TA, LLD, etc. all make a difference in operation, prosthesis choice etc. To the untrained eye, it looks like a lot of total joints, but there is a lot of meticulous decision-making and planning that go into primary THA/TKA.
3) Six sigma. Joint surgeons are perfectionists. They want 100% perfection, not 95% and are ‘hard-wired’ to seek that 5%
4) Revisions. Very interesting collage of failures, problems and revision strategies. Each revision is puzzle that requires a tremendous amount of skill, planning and knowledge.
5) Fancy osteotomies that no one else does. (PAO, etc.)

Hope this helps,

P.S.:

THA: Total hip arthroplasty
TKA: Total knee arthroplaty
OA: oseteoarthritis
RA: rheumatiod
TA: Traumatic arthritis
LLD: Leg length dicrepency
PAO: Periacetabular osteotomy

Very accurate, I agree. There is the disadvantage of having to do other peoples revisions as you build your name. Revisions don't pay much extra for all of the extra work. I guess you don't have to do other peoples revisions, but thats how most joint guys build their name in a community.

 

[Pin-Lag-Lock]

moquito_17 - great response
dawg44 - makes a strong point
Anyone considering Adult Reconstruction (AR) needs to investigate the area before entering a fellowship. IMO:

Advantages:
high paying field (most surveys it is #2 to spine).

big exposures with lots of orthopedics (hammers, saws, and drills).

lots of thinking and problem solving

Disadvantages:
all inpatient surgeries - revision patients are older with more medical problems, when complications arise the patient may end up staying in the hospital for weeks. In addition, rounding can be long and painful because it not the orthopedic problems but the medical issues that keep the patient in the hospital. Also dealing with patient's family can be a source of fustration (similar to peds).

payment for revisions - orthopedics today, a sugeon needs to be fast and efficient with a high volume practice.

primaries do great, revisions the results are not as good.

Most of the fellowship trained joint surgeons in the community have high volume primary practices. Most of the joints are being performed by the general orthopedist, however, if one wants a high volume primary joint practice an AR fellowship will help but is not necessary.

 

[dawg44]

Disadvantages:
all inpatient surgeries - revision patients are older with more medical problems, when complications arise the patient may end up staying in the hospital for weeks. In addition, rounding can be long and painful because it not the orthopedic problems but the medical issues that keep the patient in the hospital. Also dealing with patient's family can be a source of fustration (similar to peds).

Inpatient surgery is what kills me. I can't stand rounding not to mention the inefficiencies that are apparent in most hospitals. Do these statements sound familiar: How long does it take to turn over a room? When can I take my case back? When can I do my add on case?
As far as rounding goes I guess you could have a PA do it, but I with that being said I'd just rather have primarily an outpatient practice.