Jason Webb – Rothman Ranawat Travelling Fellowship adventure

Jason Webb – Rothman Ranawat Travelling Fellowship adventure

Jason Webb – Rothman Ranawat Travelling Fellowship adventure

Earlier this year a group of aspiring surgeons travelled to some of the top orthopaedic centres in the USA as part of the Rothman-Ranawat Travelling Fellowship. Jason Webb talks to OPN about experience.

Six weeks, 15 flights and 11 hotels later, the lives of four young aspiring orthopaedic surgeons changed forever. In March 2015, I set out alongside Eoin Sheehan from Ireland, Daniel Oakes from Los Angeles and Brian Curtin from Charlotte, North Carolina, on a journey that would begin at the American Academy of Orthopedic Surgeons Annual Meeting in Las Vegas, before taking in 10 of the best total joint centres around the United States and Canada.

Arranged under the auspices of the Hip Society’s 2015 Rothman-Ranawat Travelling Fellowship, our trip promised to be an inspirational tour of state-of-the-art facilities offering exemplary surgical care of the hip joint throughout North America, and would include personal interactions with some of the world’s most prominent specialists in adult joint reconstruction, as well as scientific conferences, surgical observations, and much more.

After leaving the neon excesses of Las Vegas, we headed west to San Francisco then criss-crossed our way across the USA visiting, among others, Pasadena, Philadelphia, New York, Chicago and Boston, before heading up into Canada to conclude our trip.

Highlights

The Fellowship proper began at Stanford University in San Francisco, where we were hosted by Bill Maloney and colleagues. We observed complex hip surgeries in the operating rooms of the university hospital and this was followed by lively interactive grand rounds with residents and fellows. We were also treated to the first of many excellent steak dinners, and enjoyed interesting debate on various facets of arthroplasty surgery.

Keck Medical Centre is part of the University of Southern California and is nestled in the leafy suburbs of Pasadena. Here we were treated royally as guests of ‘the great man from Iowa’ Larry Dorr, and got to observe Paul Gilbert and Larry Dorr demonstrating a master class in robotic arthroplasty surgery. Jay Lieberman hosted an interactive and stimulating academic session where we discussed many of the current issues facing arthroplasty practice, and we were joined by Dr Ebramzadeh who enlightened us on modern biomechanics.

A red-eye flight took us across to the east coast, and Philadelphia, where we were immediately immersed in the efficiencies of the Rothman Institute in the operating rooms of Thomas Jefferson University Hospital. And thence to New York City and the Hospital for Special Surgery (HSS), where we were given open access to all the arthroplasty cases for the day and participated in full and educational grand rounds with all the residents and fellows the following morning. The scientific research at HSS was impressive and under the guidance of Timothy Wright we were shown all the simulator and retrieval work currently ongoing, as well as being treated to a ‘tour-de-force of MRI and Mavric sequencing’ by Holles Potter.

In New Albany, Ohio, we witnessed a variety of direct anterior approaches as well as revisions, conversions and difficult primaries, and then at the Anderson Clinic in Alexandria, Virginia, we were given a tour of the implant retrieval laboratory and participated in an academic conference where the Anderson Clinic and their neighbours presented papers on subjects including ‘day case’ hip arthroplasty.

Next to the windy city and we were given further opportunities to observe the work of top surgeons – in this case Della Valle, Berger and Rosenburg – at Rush University. On our second day in Chicago there was a faculty conference that included discussions on the treatment of periprosthetic joint infection and metal ion monitoring. At OrthoCarolina, in Charlotte, NC, we experienced southern hospitality at its best and saw the benefits of working in a unit where team-working has been perfected.

There was no slowing in our pace as our tour drew to a conclusion with a visit to Massachusetts General Hospital in Boston that can only be described as an educational revelation – including an academic conference and tour of the university department, all hosted by Drs Rubash and Harris – before we headed to the London Health Sciences Center in the Canadian province of Ontario to conclude the fellowship with two fascinating days of clinical activity followed by observation of revision hip cases selected for our visit.

Reflections

We each headed out with individual goals and hopes for what we gain from participating in the Rothman-Ranawat Travelling Fellowship, and as the tour progressed we all realised that we were gaining a totally different perspective on many of the practices that we would return to at the end of our travels. Previous participants had told me I would make lifelong relationships with my travelling companions. They also assured me that each site visit would give me numerous tips and tricks that I could integrate into my own practice when I returned to the UK. These aspects of the Fellowship were easily accomplished and in themselves were probably sufficient to make this the experience of a lifetime.

What I hadn’t quite realised, however, was just how important our vantage point would prove to be with regards to changing our practice, and for me this came as a blinding revelation when we reached the Rothman Institute in Philadelphia – the third destination on our itinerary. As surgeons in the operating room, our everyday responsibility focuses on patient care and working as efficiently as possible. As travelling fellows our interaction with the host surgeons was often limited to observation. The opportunity to take a step back and be able to observe the operating room environment in its entirety, including staff interactions, was an incredible privilege and gave a remarkable insight into how much goes on outside the surgeon’s immediate circle – and the consequent potential for new efficiencies.

Every place that we visited provided at least one day of theatre observation, and the variety of cases that we were able to witness – ranging from primary joints to hip scopes to very complex hip revisions – confirmed that there is often more than one way to achieve the same end-result in arthroplasty. It was pleasing to reassure ourselves that our current practices in patient care are in line with those of the top joint centres, but we were also enlightened by new and interesting ways to improve our current protocols across the entire patient experience.

Personally speaking, I found it a wonderful experience to visit 10 great cities, and typically at least one social activity was arranged at each port of call; we were lucky enough to enjoy baseball games, numerous steak dinners, whitewater rafting, a Broadway show and brewery tours, just to name a few. We enjoyed stimulating and thought-provoking interactions at each site and I truly believe I have established what will be career-long professional relationships. Many of the centres we visited included their fellows and residents in the experience, adding additional interactions with a number of talented, up-and-coming surgeons in the field of arthroplasty.

The whole experience was a professional revelation for all four of us, and witnessing the benefits of team work, organisation and the application of sound scientific principles to improve the outcome of hip arthroplasty surgery has fuelled us to improve the practices in our own units and countries. Forming such professional and friendly ties can (we hope) only prove beneficial for the future of hip surgery.

Without a doubt, for me this was an unbelievable experience and well worth the difficulties of spending time away from family and practice. To anyone considering the opportunity, all I can say is you will not regret the experience and your practice will benefit greatly from the knowledge, professional relationships and new perspectives gained.

Acknowledgements

The Rothman-Ranawat Travelling Fellowship takes a great deal of time and effort to plan and arrange. This could not be done without the unbelievable talents of Lisa Dushane and Olga Foley from the Hip Society. My journey would not have been possible without the financial support of the Hip Society, Drs Ranawat and Rothman, and the stewardship of Dr Adolph Lombardi.

Jason Webb

Jason Webb is a consultant orthopaedic hip surgeon at the Avon Orthopaedic Centre at North Bristol NHS Trust. He has a sub-specialty interest in prosthetic joint infection.

Brian Curtin

Brian Curtin is a consultant orthopaedic surgeon at OrthoCarolina in Charlotte, North Carolina. He won one of the 2015 Rothman-Ranawat fellows.

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