The NorCal Hip and Knee Fellowship is a developing program with foundational support from Hipster Inc. It comprises a clinical experience involving multiple high-volume private practice surgeons in the San Francisco Bay Area. Under Fellowship Directors Dr. Nicholas Mast and Dr. Stephen Howell, the fellowship candidates will be exposed to the latest in minimally invasive arthroplasty of the hip and knee. The fellowship will instruct techniques of Kinematically aligned primary and revision knee arthroplasty, Unicompartmental knee arthroplasty, Arthroscopic and open knee ligamentous reconstruction, Arthroscopic and Open Hip Preservation, Hip Fracture management, Anterior Approach Hip Arthroplasty, Resurfacing hip arthroplasty, Revision Anterior Approach Hip Arthroplasty, and related procedures.
Our two-center fellowship program is split into a 6-month placement in San Francisco/ Marin to focus on surgeries of the hip and pelvis working with Dr. Mast, and 6 months focused on Kinematically aligned knee replacements in Lodi/ Sacramento working with Dr. Howell.
Fellows are involved in all facets of patient care, including in-clinic consultations, pre-operative and peri-operative management of patients, in addition to gaining high-volume surgical experience. This will equip Fellows to diagnose and treat a wide range of knee and hip pathologies including complex revision cases.
The Surgeon Trainee is expected to benefit from truly the “cutting edge” of arthroplasty training. Over the past decade, two techniques of lower extremity arthroplasty have emerged as truly minimally invasive. In the hip, the technique of anterior approach for hip replacement has emerged as providing advantages to the patient including less pain, an easier recovery, and reduction of certain complications related to hip replacement. Similarly, in the knee, the technique of kinematically aligned total knee arthroplasty has emerged as soft tissue friendly, resulting in less pain, swelling, and benefiting the patient in terms of early postoperative recovery and reducing physical therapy requirements. The technique has worked to reduce the well-documented 20% dissatisfaction rate when total knee replacement is performed via traditional or mechanical alignment techniques.
Over the past 15 years, Dr. Mast has participated in the growth and development of the Anterior Approach technique for Hip Replacement. He has participated in numerous teaching opportunities, authored many articles, and helped further develop novel techniques to deal with problems of the hip. As head of the hip curriculum, the surgeon will have an unparalleled experience in hip arthroplasty.
One cannot write the book on kinematically aligned total knee arthroplasty without referencing Dr. Stephen Howell. In fact, Dr. Howell literally wrote that book. Dr. Howell’s experience covers nearly 3 decades of study of the problems around the knee.
The emphasis of the fellowship is to develop a “hands-on” skillset of current minimally invasive techniques in the trainee surgeon. A broader education in critical thinking as it relates to the diagnosis and management of complex arthroplasty problems will be taught. A robust annual exposure with over 1000+ annual arthroplasty cases performed by clinical faculty annually will ensure ample opportunity for the fellow to experience the breadth of arthroplasty cases.
Unlike most arthroplasty fellowships that are focused on a hospital environment, the NorCal Arthroplasty Fellowship provides invaluable private practice context encompassing first-hand experience of all aspects of the procedures – from patient optimization to effective outpatient procedures and post-operative care.
Standing on the shoulders of giants
Education and mentorship is about creating a bridge between generations of surgeons – by taking what has been learned by one generation and passing it to the next to build on it. The NorCal Arthroplasty fellowship program is designed to share best practices in joint replacement surgery with the next generation of surgeons.
“Having mentors in surgery shapes you, it ends up to be your surgical DNA, it’s unique to you but you have inherited it from your mentors”James Church MD
Method of Formal Evaluation
The fellow on intake to the program will develop in conjunction with the Program Director an Individual Learning Plan (ILP) to adequately assess the fellow’s long-term and short-term goals, specific objectives, career plans, self-identified strengths and weaknesses, development of strategies to achieve the goal and objectives, assessment of progress on goal and objectives, and incorporate feedback from faculty/mentor/advisor.
Assessments will be made by faculty-guided direct observation of clinical care. Formative guidance will be offered on a quarterly basis. Growth and development of relevant Knowledge Base, Technical skills, and Professionalism will be guided by input from Faculty and staff.
Dr. Nicholas Mast
After completing his orthopedic residency, Dr. Mast undertook extensive additional surgical training in the form of international Fellowships and that allowed him to learn from international leaders in the field of hip and pelvis surgery – including:
- Dr. Reinhold Ganz (whose countless achievements include developing the peri-acetabular osteotomy (PAO) procedure for hip preservation),
- Dr. Michael Leunig (a foremost authority in hip preservation and pelvic surgeries)
- Dr. Frédéric Laude (one of the most influential surgeons in the development of the anterior approach worldwide),
- Dr. Joel Matta (a leader in the field for evaluating, diagnosing, and treating complex orthopaedic hip disorders and the godfather of the anterior approach in the US)
- and of course, his father Dr. Jeffery Mast who collaborated with Dr. Ganz on the PAO technique to treat developmental dysplasia of the hip.
Read more about Dr. Mast’s own training.
Dr. Stephen Howell
The Fellowship distills this expertise in anterior hip surgeries and combines it with an opportunity to learn from a pioneer in knee replacements – Dr. Stephen Howell.
Dr. Howell developed a revolutionary new approach to knee replacement in 2005 – known as kinematic alignment, this innovative technique improves the placement of the orthopedic implants that form the new knee, resulting in more consistency and reliability in patient outcomes. The approach enables shorter lengths of stay and quicker return to prior function. According to ProPublica, Dr. Howell’s readmission, complication and infection rates after total knee replacement are among the lowest in the nation and he is considered among the Top 3% of California knee replacement surgeons.
Dr. Howell has published more than 140 scientific articles in peer-reviewed journals and frequently shares his clinical experiences and research findings as a presenter and invited speaker at national and international meetings and at universities worldwide. He regularly hosts experienced orthopedic surgeons from around the world who seek education in his techniques by observing patient care in the office, hospital, and operating room.
Dr. Alexander Nedopil and Dr. Robert Mayle.
Research Initiatives and Innovation
The aim of the fellowship is to further educational goals in training and application of minimally invasive techniques of primary and revision arthroplasty.
Current studies include:
- Outcomes following anterior approach total hip arthroplasty
- Outcomes following kinematically aligned total knee arthroplasty
- Anterior Approach for Revision Total Hip Arthroplasty
- Outcomes following simultaneous bilateral knee and hip arthroplasty
- Reduction of infection in total knee and total hip arthroplasty
- Cost and Value as they relate to primary joint arthroplasty
- Improving safety and access for arthroplasty in the ASC setting.
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