Zimmer Biomet sponsored travelling fellowship

Lt Col Sushmith Gowda

I am extremely grateful to the BOA Committee and Zimmer Biomet for the travelling fellowship awarded in 2022. My primary learning objectives for the fellowship were to observe and learn about day-case arthroplasty and the use of robotic-assisted hip and knee replacements to help set up a similar practice at Portsmouth.

In December 2023 it was a privilege to shadow and learn from Dr Antonia Chen, Associate Professor at Harvard Medical School and Director of Research for Arthroplasty at Brigham and Women’s Hospital (BWH), Boston, Massachusetts, USA. We also shared cases and arthroplasty related issues in the UK, USA and Hong Kong, for example bone cement for arthroplasty is not widely used in the USA compared to the UK; uncemented femoral implants are used by most arthroplasty surgeons.

At BWH four total joint replacements were handled during the working day; very similar to the NHS practice (pre-COVID era). However, the proficiency between turnover of cases was evident as there was minimal disruption during patient flow. Day-case arthroplasty has been championed at BWH over the last few years and their practice has led the way with evidence and protocols that are followed in the USA and worldwide. The uncemented total hip replacements (THR) were performed through the direct anterior approach (DAA) with the patient in supine position. The surgeons who prefer DAA for THR attribute this muscle sparing technique to faster recovery and quicker discharge. Post-operative radiographs were taken before discharge and follow-up was organised accordingly.

Uncemented total knee replacements were performed with robotic assistance and high-volume, local infiltration anaesthetic was standard practice. Robotic-assisted arthroplasty was standard practice for both hip and knee arthroplasty cases for Dr Chen. As a high-volume arthroplasty, robotic-assisted surgery has been used for more than five years. Data is collected for the registry and patient outcome scores, very similar practice to the UK and our National Joint Registry. This experience was extremely valuable and provided an insight into a different healthcare system with a strong ethos on proficiency, innovation and pioneering new techniques. I am very honoured to represent BOA and the members who gave me this amazing opportunity to travel, meet and learn from other institutions to further my surgical portfolio and develop my practice at Portsmouth.