Lower extremity total joint arthroplasty (TJA) volumes at Dartmouth Hitchcock Medical Center have increased steadily over the past decade, with particular growth in revision joint replacement.
The Orthopaedics’ Hip and Knee Arthroplasty Division boasts a core faculty with national prominence and a clinical practice that performs high volumes of primary and complex revision hip and knee arthroplasty, with an emphasis on direct anterior hip replacement that is becoming the new standard of care.
This unique environment, coupled with the academic opportunities presented by Dartmouth College's Thayer School of Engineering’s Biomedical Engineering Center and the Dartmouth Orthopaedic Registry, provides the critical elements to establish a top-tier adult reconstruction fellowship that will improve the training appropriateness of our residents’ experience and yield highly trained, judicious arthroplasty surgeons who will meet the looming arthroplasty needs of our aging population.
The Adult Reconstructive Surgery Division seeks to train our fellows to independently perform primary hip and knee arthroplasty and complex revision procedures.
Arthroplasty fellows will participate actively in a high-volume TJA practice with a strong emphasis on the direct anterior approach for primary total hip arthroplasty, complex hip and knee revision surgery, arthroplasty-related trauma—including peri-prosthetic fractures and infections—and practice management duties to aid in her or his transition into practice.
Arthroplasty fellows will:
- Participate actively—commensurate with their intended professional goals of a career adult reconstruction—in the clinical and surgical management of patients with advanced degenerative hip and knee problems, with a focus on failed arthroplasties.
- Be expected to have a minimum of two research projects suitable for publication/presentation by completion of the fellowship.
- Have the opportunity to engage with the Thayer Biomedical Retrieval Lab.
- Be board-eligible, credentialed as faculty, and be expected to transition into a junior attending role during their fellowship year, taking on increasing independence.
- During call, be expected to mentor residents in their role as junior faculty.
- Take general trauma (two weeknights/month, four weekends/year, and one holiday at minimum).
- Have the opportunity to cover the trauma room and manage basic fractures if they desire.
- May scrub megaprosthesis cases on the tumor service.
- May get credentialed and participate in arthroplasty cases at Dartmouth Health members.
- Must demonstrate proficiency in primary and complex revision TJA upon graduation.
- Will have the opportunity to run a solo arthroplasty clinic with attending oversight.
I can’t sing enough praises for the arthroplasty group and the adult reconstruction fellowship at Dartmouth Hitchcock Medical Center. This program was presented to me as one with significant autonomy and, in general, expectations consistent with more of a junior faculty role as opposed to that of a traditional fellowship – which couldn’t be more accurate. While opportunities for research, resident education, and traditional fellow-attending experiences abound, I was exceedingly pleased with the expectation for growth as an orthopaedic surgeon, an attending and as a person. During my year, this growth was felt most when running the fellow’s clinic, booking cases truly as the attending surgeon and taking level 1 trauma call. Of course this was fostered with advice and oversight (to an appropriate degree) from the faculty and performing hundreds of cases one on one with them otherwise, but in discussion with my peers, this level of autonomy and experience available the rest of the time is uncommon and something I truly enjoyed. On another, but equally important note, the attending surgeons there quickly became some of my closest friends and individuals that I can feel confident will be there for me if/when I need advice or assistance in the future. In retrospect, I feel incredibly fortunate to have matched at Dartmouth and if I had to repeat the process, I wouldn’t change a thing.Will Rainer, DO
In summary: Highly recommend, 5/5 stars, would definitely go here again.
Arthroplasty Fellow, 2021-2022
Looking back at the past year I can truly say there is nothing more that I could have asked for from a fellowship. In the most simple sense, my goal for fellowship was to complete my training feeling comfortable with my skills in primary, complex primary and revision arthroplasty. I feel those goals were exceeded in every aspect. I gained knowledge in a diversity of techniques and approaches to primary arthroplasty. I experienced a variety of complex primary and revision cases that I think is unparalleled. Having completed over 550 cases with approximately 30% revision for both hip and knee, I feel comfortable handling just about anything I can expect to see in practice. In addition to this, I covered level 1 trauma call and our dedicated orthopaedic trauma OR and gained experience covering a wide range of arthroplasty and non-arthroplasty related trauma as an attending. Nearly 20% of my logged cases were “independent”, with me as the attending. The amount of confidence that gives me as I head out into independent practice is absolutely invaluable. Lastly, and most importantly, the key feature of the fellowship is the people. There is not a single attending with the program that I didn’t love to work with, and that I don’t feel adds something extremely valuable to the educational experience. These are people that for me simultaneously embody the roles of mentor, teacher, colleague, and friend. And I cannot express how grateful I am to have had the opportunity to have spent the past year with this group. I look forward to staying in touch with all of them as I move forward in my own career.Samuel Kunkel, MD, MS
Arthroplasty Fellow, 2020-2021
Joining a new fellowship carries risks that an established program may not, however with the right leadership in a hospitable environment it can be a great experience. I decided to join the Dartmouth arthroplasty fellowship after extensively investigating the departments' reputation. Dr. Moschetti and his team of colleagues demonstrated a truly collegial working environment and were fully invested in my professional development. The high case volume allowed me to be easily integrated into the arthroplasty team without having to squabble over cases with residents. Despite the COVID19 pandemic, I completed 425 cases with 35% being revisions. Being licensed as a junior faculty member allowed me to take on additional clinical responsibilities, run my own clinic, cover the trauma room at a level I trauma center, and develop my own intraoperative leadership style. Although my current career plans are non-academic, with the help of the departments' stellar research staff I was able to complete 4 research projects and help secure grant funding for an upcoming randomized control trial. I would very strongly recommend this fellowship to any applicant who is interested in a hands-on transition-to-practice arthroplasty fellowship with an emphasis on revision surgery and anterior approach total hip arthroplasty.David Christensen, MD
Arthroplasty Fellow, 2019-2020