The Orthopedic Adult Reconstructive Surgery Fellowship at Houston Methodist is designed to provide the fellows with a well-rounded clinical and high-level research experience in total hip and knee replacement.
Houston Methodist is recognized by U.S. News and World Report as the #1 hospital in Texas and our Department of Orthopedics and Sports Medicine is nationally recognized as #12 in the United States. Houston Methodist Hospital is located in the largest medical center in the world and serves as a regional referral center for complex cases. In addition to primary hip and knee replacement surgery, the arthroplasty surgeons perform unicompartmental knee arthroplasty, osteotomies around the hip and knee, and revision hip and knee replacement for all indications. The fellow will participate in all aspects of clinical care and will be exposed to a wide range of surgical cases, approaches, implants, and leading-edge technologies.
Fellows will also develop an understanding of ethical, socioeconomic, and medicolegal issues that affect patient care. They will learn how to apply appropriate utilization management and cost containment measures while providing quality patient care. Houston Methodist has an outpatient program for primary hip and knee arthroplasty and we will strive to teach the fellows how to be successful in practice with outpatient TJA.
The Houston Methodist fellowship is Accreditation Council for Graduate Medical Education (ACGME)-accredited, and provides many didactic activities - including weekly orthopedic conferences involving active clinical and research divisions and the orthopedic surgery residents. Participation in institutional orientation, education programs, and other activities involving medical center faculty is required.
Didactic activities of the fellowship include a weekly total joint replacement teaching conference with a defined syllabus designed to cover the field of hip and knee surgery. At the completion of the academic year, the 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 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. The surgical case mix between hip and knee surgery is evenly split. Around 30 percent of the cases logged by fellows each year are revision surgical cases.
Our primary hip replacement practice will expose the fellows to both simple and complex diagnoses, and to a range of exposures including direct anterior approach (DAA) and mini posterior. Revision hip surgery experience will teach extensile approaches, trochanteric osteotomies, a range of complex acetabular reconstruction techniques including jumbo cups +/- augments, acetabular cup-cage constructs, custom triflange acetabular reconstruction, and articulating spacer placement. Both modular and non-modular femoral stems are used for primary and revision hip surgeries. Periprosthetic fractures, geriatric hip fractures, and periprosthetic joint infection treatment will also be included during the fellowship year. Although the fellowship is predominantly focused on reconstruction, fellows will have the opportunity to learn hip preservation with PAO and femoral osteotomies with Dr. Park. Hip arthroscopy cases with Dr. Josh Harris will also be available for those fellows interested in a comprehensive hip practice.
The knee experience at Houston Methodist starts with osteotomies around the knee and continues through unicompartmental knee arthroplasty (UKA), total knee arthroplasty (TKA), and revision knee arthroplasty. Primary TKA will expose the fellows to both conventional and robot-assisted techniques, as well as to complex diagnoses. TKA revision experience will expose the fellows to extensile exposures (quadriceps-snip, tibial tubercle osteotomy, rare V-Y turndown) and a variety of safe techniques for implant removal. A wide range of preoperative diagnoses will introduce the fellows to complex procedures including bone defect management with porous cones/sleeves, standard augments, cemented and press-fit stems, hinged prostheses, megaprostheses, extensor mechanism reconstruction with mesh, articulating and static spacer placement, and periprosthetic fracture management around the knee.
The teaching faculty use a variety of implant brands and designs for primary and revision hip and knee surgery. The fellows will be exposed to many different implants from the following companies: Zimmer-Biomet, Microport, DePuy, Smith & Nephew, Stryker, Conformis.
Block Rotation Schedule
We have three rotations in our adult reconstructive surgery fellowship training. Each fellow will rotate for four total months in each rotation.
Rotation with Stephen Incavo, MD, Kevin J. Park, MD, and Timothy S. Brown, MD
Fellows will be exposed to hip preservation surgery with Dr. Park (PAO, femoral osteotomies), and hip replacement surgery performed via the posterior approach (Incavo, Brown) and the direct anterior approach (Park). Dr. Brown will occasionally perform anterolateral approaches for certain indications (excessive femoral bow, prior anterolateral approach) and for teaching (hip fractures).
Dr. Incavo performs osteotomies around the knee, as well as UKA. In knee replacement surgery, Dr. Incavo uses PCL-substituting designs.
Dr. Park performs UKA, robotic TKA, and uses medial-stabilized design knee prosthesis.
Dr. Brown performs robotic-assisted UKA through mid vastus approach, and robotic-assisted TKA through medial parapatellar approach. He uses a range of implant designs depending on the patient and pathology (cemented and cementless TKA, CR and PS).
Rotation with Robert S. Neff, MD and Brian S. Parsley, MD
Fellows will be exposed to hip replacement surgery performed via the posterior approach (Parsley) and the DAA (Neff).
Dr. Neff performs unicompartmental arthroplasty, robotic knee arthroplasty, and uses PCL substituting design knee prosthesis.
Dr. Parsley uses a mobile-bearing partial knee replacement. He uses a variety of implants and designs for total knee replacement, including CR and PS designs, and rotating platform designs.
Rotation with William Bryan, MD and Terry Clyburn, MD
Fellows will be exposed to 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 focus is in total knee replacement and it constitutes 75% of his surgical cases.
Dr. Clyburn specializes in primary and complex revision hip and knee joint replacements. Dr. Clyburn also specializes in patient specific design total knee and hip replacements.