Knee Surgeons gaining expertise via Travelling Fellowships

As an option during their higher surgical training, aspiring knee surgeons may undertake 'Fellowships', where they spend time with more experienced colleagues.

A special fellowship - a sort of 'prize' for which such aspiring knee surgeons compete, is called a 'Travelling Fellowship', where the travel is funded by sponsors, an educational travel programme is assembled by a mentor and the 'Fellows' then travel around the world visiting expert colleagues, who host them with a certain amount of pride.

This is a report by Drs Akash Patel and Mihai Vioreanu who won the 2017 ESSKA Osteotomy Traveling Fellowship, which was supported by an industry partner, Arthrex. They travelled to Munich, Germany, Arhem, Holland, Lyon, France and London, UK and this is the report they forwarded to me of their travels. I thought KNEEguru Readers might find their experiences interesting...

The Osteotomy Traveling Fellowship.

ESSKA, through its educational committee, is supporting a number of traveling fellowship programs to promote international scientific and cultural exchange for promising young orthopaedic surgeons. This is an inaugural unique programme that gives surgeons great opportunity to experience primarily osteotomy procedures at leading European centres. It allows Fellows to exchange scientific information, stimulate research and collaborate on an international scale.

The ESSKA Traveling Fellowship concept was conceived by Dr. John Feagin and Dr. Werner Muller more than 30 years ago and since then has become a prestigious academic award, with multiple knee subspeciality programmes. It has allowed orthopaedic Fellows to travel throughout the world, with many previous Fellows now constituting leadership of ESSKA, APKASS, AOSSM and SLARD.

Traveling Fellow: Mr. Akash Patel (London, UK)

Mr. Patel undertook his undergraduate training at University College London Medical School (U.K.), with an orthopaedic attachment in Sydney (Australia). He completed orthopaedic registrar training at Imperial (London, U.K.), with further sub-speciality Fellowship training in Johannesberg (South Africa) and currently Royal Berkshire Hospital (U.K.).

He has a speciality interest in knee, hip and trauma surgery.

Travelling Fellow: Mr. Mihai Vioreanu (Dublin, Ireland)

Originally from Romania, Mr. Vioreanu completed his orthopaedic training in Ireland. He further sub-specialised in primary, complex and revision hip and knee arthroplasty in Vancouver (Canada) and in sports knee surgery in Sydney (Australia). Mihai undertook the 2014 ESSKA / APKASS Global Travelling Fellowship in Asia-Pacific.

Mihai now practises in Dublin (Ireland) at Sports Surgery Clinic.

...with Prof Andreas Imhoff - Munich, Germany

We were both delighted to finally meet each other and excited about the two weeks ahead. We were conscious that this would be an intense two weeks where we would have the chance to interact with and delve into the work of some of the higher volume osteotomy surgery in Europe.

Chatting over a large Bavarian beer in historical centre of Munich was no better way to begin our journey. We both shared our different backgrounds and family lives and found it difficult to settle over defining this trip as a work, academic, business or adventure trip.

It was overwhelming to meet with the entire surgical team led by Prof Imhoff early in the morning during the daily surgical rounds. We both knew how productive in terms of research Prof Imhoff is, so it was no surprise to observe how efficient his team was. Planning of the surgery was concise but exact, with cases reaching great level of complexity.

Our theatre visits included excellent opportunity to observe and assist with procedures including OATS/mosaicplasty, mega-OATS, HTO with ACL reconstruction and HTO to reduce tibial slope. Attending the morning surgical list planning meetings also gave us a great useful insight into the decision-making processes and opportunity to discuss cases.

A high standard, evidence-based academic meeting was arranged by Professor Imhoff and his team. This included research presentations which allowed interesting discussions regarding knee osteotomy planning, knee instability, ACL reconstruction with combined osteotomy and knee joint preservation versus replacement.

In the evenings we visited the world famous beer gardens to sample German delicacies and had a lovely dinner with Professor Andreas Imhoff and the team. This facilitated further discussions and networking. After only two days it became clear to both of us that we were in for a treat for the remaining of our travels. Having experienced the German precision in both planning and application of surgeries we were looking forward to travel north to our Dutch friends.

...with Prof Ronald van Heerwaarden - Arnhem , Holland

After a short plane and train trip we were greeted by great weather and the warmth of another beautiful European nation.

Prof Ronald van Heerwarden welcomed us upon arrival in our hotel and treated us to a nice, friendly dinner at De Palatjin restaurant based in the jovial surroundings of Sonsbeek park.

We spent a day in theatre with Prof van Heerwaarden and had the pleasure of observing, as well as assisting, complex osteotomy cases. These included an intra-articular hemi-plateau tibial osteotomy for a post-traumatic severe tibial deformity, a double osteotomy in a patient with a severe varus knee (distal femoral closing wedge and proximal tibial opening wedge), and a supramalleolar tibial osteotomy for malunited Salter Harris type 2 fracture. We were extremely impressed by the simplicity of application of complex surgical deformity correction deformity by Prof van Heerwarden.

In contrast with our German experience this was a ‘one man show’ where Prof van Heerwarden performed all these very complex deformity cases while clearly discussing the theoretical principles of all his surgical gestures. This made it look so easy but we wondered if these surgeries came with the disclosure: “ don’t do this at home “.

The following day we were warmly invited to Prof van Heerwaardens house for coffee in the morning. This was followed by a wonderful trip to visit the Kroller-Muller museum, with one of the largest Vincent van Gogh collections in Holland, a 25km bike ride through the pristine beauty of De Hoge Veluwe national park and a visit to the Arnhem Olympic training complex.

Throughout this excellent experience we discussed the complexities of osteotomy and had ample opportunity to ask questions about various techniques. It was the best and the most personal outdoors research meeting we have ever attended. To mark the special occasion Ronald offered both of us a very kind and special gift: “Osteotomies for Posttraumatic Deformities” authored by Rene Marti and Ronald himself.

Prof van Heerwaarden was an absolute gentleman, fantastic host and supportive teacher. We are very grateful for all his time and effort for us. We were only half way through our journey and really understood how instrumental traveling is for complex learning.

...with Prof David Dejour - Lyon, France

We arrived in Lyon on the weekend to continue our adventure in exploring the complexities of knee surgery around Europe. We stayed in vieux ville of Lyon and were inspired by its culture, heritage and innovative spirit. We were both looking forward to discovering the prestigious and world renowned ‘ecole du genou Lyonnaise’.

During the free days in Lyon we were spoiled with excellent weather, world class cuisine and wine.

We met Dr David Dejour and his team on Monday and enjoyed the opportunity to observe, assist and discuss complex cases in theatre.

These included total knee replacements, knee arthroscopy and ACL reconstructions using patella tendon/hamstrings autograft. Observing the ‘Maestro’ at work , which culminated with a case of trocheoplasty combined with patella osteotomy and MPFL reconstruction all performed in one setting in a 15 years old girl with complex patellofemoral pathology. This was most definitely the highlight of our trip to Lyon. We were all awed by the smoothness and precision of both the decision making and execution of this complex surgical procedure.

Later that evening, we were joined by the Italian and Argentinian knee fellows for dinner and drinks. We continued to exchange ideas and practice our French until early hours. After a busy few days, we continued our European journey to the UK.

...with Prof Adrian Wilson - Basingstoke, UK

A short flight from France to U.K., straight into operating theatre with Prof. Adrian Wilson, a great surgeon and academic.

Prof Wilson performed a high tibial osteotomy and gave very good tips for improving surgical technique.

In the evening, we were treated to a lovely British pub dinner. We had the pleasure of meeting Mrs Wilson and the team, including Raghbir Khakha and Bhushan Sabnis.

Thursday started with a constructive team meeting and coffee. This was followed by further session in theatre with Mike Risebury, Sam Yasen, Bhushan Sabnis and Raghbir Khakha. We observed and assisted in further interesting cases including high tibial osteotomy to correct rickets deformity and combined ACL/LCL/ Laprade procedure.

The day also included a useful osteotomy planning session with useful combined teaching with Mike Risebury, Dave Howard and Sam Yasen. In the evening, we were treated to a lovely dinner cooked by Prof Wilson’s wife at his house for the whole team. This was an excellent personal touch to add to our hospitable and educational experience in Basingstoke. We were able to discuss and exchange many surgical ideas over dinner, as well as build strong international relationships for the future. It was the perfect way to end our educational experience.

It has been an extremely insightful, personal and educational experience for both of us. We are both convinced that this Osteotomy Traveling fellowship will become one very popular and sought after fellowship in Europe. We are happy to have been the first to experience it and will wholeheartedly recommend it to our European colleagues. We are extremely thankful to ESSKA, Arthrex and our great hosts throughout this wonderful journey.