Curriculum

The Orthopedic Adult Reconstructive Surgery Fellowship offered at Houston Methodist is designed to provide the fellow with a well-rounded clinical and high-level research fellowship experience in total hip and knee replacement. The fellow will receive exposure to different surgical approaches and different types of arthroplasties.

Houston Methodist serves as a regional referral area for complex cases, which will broaden the fellow’s experience. In addition to traditional hip and knee replacement surgery, the arthroplasty surgeons perform uni-compartmental knee arthroplasty, osteotomies of the knee, and surface-replacement arthroplasty of the hip. The fellow will participate in a large revision surgery practice and will assist in the operative treatment of patients with infected joint replacement and concomitant severe bone loss. Both modular and non-modular prostheses are used for revision hip surgery.

Fellows will develop an understanding of ethical, socioeconomic and medical/legal issues that affect patient care. They will also learn how to apply appropriate utilization management and cost containment measures, while providing quality patient care.

Houston Methodist provides many didactic activities, including non-orthopedic conferences involving active clinical and research divisions, and 17 other Accreditation Council for Graduate Medical Education (ACGME)-accredited residency programs. The fellows will participate in various educational activities at Houston Methodist. Participation in institutional orientation, education programs and other activities involving medical center faculty is required. Didactic activities of the fellowship will include a weekly total joint replacement teaching conference with a defined syllabus designed to cover the field of hip and knee surgery.

The weekly teaching conference will be the responsibility of the supervising attending physician, but the fellow will be expected to prepare and present some of these sessions over the course of the year. At the completion of the academic year, the successful fellow will have accumulated a library of didactic presentations. In addition to providing comprehensive general orthopedic care, the orthopedic surgery service maintains a strong research effort that further enhances its clinical services.

The Institute of Orthopedic Research and Education (IORE), which includes laboratory space and office facilities, is directed by Phillip Noble, PhD, a nationally and internationally recognized expert in joint replacement research. The productivity of the research in recent years has been very impressive and the staff includes 15 research personnel. In the last five years, there have been over 50 presentations from this lab at the annual Orthopaedic Research Society (ORS) and American Academy of Orthopaedic Surgeons (AAOS) meetings. The IORE offers a unique opportunity for fellows to be engaged with researchers from Houston Methodist, local, national and international arenas.

The fellow will have a designated research day every week to devote the necessary time and attention to the study and completion of the research topic or topics. The goal of the fellowship year is to enable the fellow to practice adult reconstructive surgery at the highest clinical level and to equip the fellow for a possible academic career.

Block Rotation Schedule
Each fellow will rotate for three months at a time in each rotation, there are two rotations. Dr. Stephen Incavo is one rotation and Dr. Terry Clyburn and Dr. William Bryan is another rotation. In general, one fellow will rotate with a faculty member. The surgical case mix of hip and knee surgery is approximately split with 30 percent of the cases categorized as revision surgical cases.

The following schedule best describes the rotation:

Day AM PM
1 OR (Surgery) OR (Surgery)
2 OR (Surgery) OR (Surgery)
3 Office (Outpatient) Office (Outpatient)
4 Office (Outpatient) Office (Outpatient)
5 Didactics/Research Research

Rotation with Stephen Incavo, MD
Fellows will be exposed to hip replacement surgery performed via the antero-lateral approach to the hip joint. In revision surgery, the fellow will become experienced with femoral augments, acetabular cages, extended trochanteric osteotomy and allograft augmentation. Both modular and non-modular prostheses are used for primary and revision hip surgery. Dr. Incavo performs osteotomies on the knee, as well as uni-compartmental arthroplasty. In knee replacement surgery, Dr. Incavo uses PCL retaining, sacrificing and substituting designs. Periprosthetic fracture treatment will also be included the fellowship year.

Rotation with Terry A. Clyburn, MD and William Bryan, MD
Fellows will be exposed to hip and knee replacement surgery. Fellows will be exposed to total hip replacement preformed via the posterior approach to the hip joint. Dr. Bryan specializes in primary joint replacements with advanced pain management, rapid recovery and anticipated discharge at 24 hours. His priority is total knee replacements and it constitutes 75% of his surgical cases.


Research collaboration with Philip Noble, PhD
A research experience, under the direction of the surgeons and Philip Noble, PhD, is embedded within the rotation throughout the year. The fellow will devote at least one day each week to research and didactic. The goal of the research experience for fellows is to produce scholarly work accepted for podium presentation at a national meeting and accepted for publication in a leading journal. Fellows will also develop knowledge in research design, to include conducting a literature review, developing hypotheses, collecting data and analyzing results. Fellows will be expected to evaluate epidemiology as it relates to joint replacement surgery.
Fellows will work closely with Research Coordinator Domenica Delgado. She can be reached at ddelgado@houstonmethodist.org.