APAS Travelling Fellowship Report (2018-2019)

In October 2018, I had appeared for APAS Travelling Fellowship Interviews, which were held at APAS Annual Conference at Bangkok, Thailand. I was pleasantly surprised when the results of Fellowship Interviews revealed that I along with my colleague Dr. Abhijit Sahu, were selected for this prestigious fellowship. After a few email communications with Prof. Parag Sancheti and Prof. Dr. Rami Sorial (my mentors for the fellowship) and confirmation regarding the mutually suitable dates, I could prepare well for my intended travel in the months of June-August 2019.

Our fellowship involved 3 weeks in Sydney (23 June-13 July 2019) and 1 week each in Indonesia (14-21 July 2019), Malaysia (21-28 July 2019), Mumbai (4-11 August 2019), Chennai (11-17 August 2019) and Pune (18-24 August 2019). Following the flight tickets and Visa requirements being fulfilled, we flew to Sydney in Australia to be warmly greeted by Dr. Rohit (Dr. Rami's Fellow) at the airport on a Sunday afternoon. He provided us with Dr. Rami’s car (which was with us for the duration of our stay in Sydney), drove us to our accommodation and familiarised us with the city. I was put up at Dr. Yaseer Khatib's huge home while Abhijit and his wife stayed at a beautiful Airbnb accommodation arranged by Dr. Sorial.

We were provided with a detailed schedule for the upcoming three weeks organised by Dr. Rami. We visited and worked with Dr. Rami Sorial (Nepean Private and Public Hospitals-NPH), Dr. Yaseer Khatib (NPH), Dr. Simon Coffey (NPH), Dr. Michael Neil (St. Vincent's Hospital, Sydney), Dr. Craig Waller (Macquarie University Hospital-MUH), Dr. James Sullivan (MUH), Dr. Michael Stening (Lakeview Hospital) and Dr. Sol

Qurashi (St. Luke's Hospital). We were exposed to a wide variety of cases in Hip and Knee Arthroplasty with something different/unique to learn from every surgeon. With Dr. Rami, we assisted in uncemented THR being operated with the Posterior Approach and Paragon Hip Prosthesis. Patient-Specific Instrumentation (PSI)- MRI based were being used routinely for the TKRs with Zimmer Persona Prosthesis, mostly CR, totally uncemented and without a tourniquet. Dr. Sullivan showed us the Medial Pivot Knee, CT based PSI, Direct Anterior Approach for THR and Optimal Positioning System (OPS) by Corin company for taking spinopelvic balance into consideration during THR prosthesis positioning. Dr. Stening showed us the CT based PSI for TKR, Hybrid cementation technique in TKR, ACL reconstruction with transfix, open rotator cuff repair and Roux Goldthwait procedure for patellar dislocation. Dr. Qurashi demonstrated the SuperPath Approach (Minimally Invasive approach) for THR with excellent immediate post-op functional outcomes. Dr. Khatib demonstrated

Arthroscopic Rotator Cuff repairs, MRI based TKR (CR knees), Arthroscopic MPFL, ACL Reconstruction and Fulkerson's Osteotomy. Dr. Waller operated THR's with dual mobility cups and using navigation (Intelli joint system). Dr. Neil operated a few revision knees with Depuy PFC Sigma TC3 and Zimmer Biomet Arcos modular revision system. He used the Stryker Navigation for TKR. Dr. Coffey introduced us to the concept of kinematic alignment and demonstrated it in TKRs. We also got the opportunity to participate in Nepean weekly morning meetings on Tuesdays (Trauma) and Wednesdays, by presenting our research work. My accommodation at Dr. Yaseer's home was very spacious and comfortable, I am thankful to him for hosting me.

He also hosted us for lunch on a Sunday afternoon with Dr. Rami. Dr. Rami's car made the daily commute between hospitals a relatively easy task. I am grateful to him for the exceptional hospitality and the socialisation over dinners hosted by him. We went on to Jakarta (Indonesia) to visit Dr. Nicolaas Budhiparama's Hospital (Medistra) and his magnificent home. Prof. Nico had planned our week in Indonesia

quite extensively with visitations to three different cities (Jakarta, Bandung and Surabaya) assisting different prolific surgeons. We got introduced to Dr. Kiki, Dr. Franky and the Indonesian Hip and Knee Society (IHKS) fellows, while we participated in a couple of Oxford UKRs and Knee Arthroscopic procedures. CME with Complex Arthroplasty case discussions and lectures was organised by Prof. Nico where we presented our work and were also felicitated. We then travelled to Bandung via intercity train and assisted Dr. Dicky and Prof. Fachry in numerous surgeries at Hasan Sadikin Hospital and Santosa Hospital. We actively participated in pre-operative case discussions and surgeries like THRs following Excision Arthroplasty, Reverse Hybrid Cementation for TKR, GOLD Knee Prosthesis, TKR (CR knees) and Bipolar Prosthesis for NOF fracture. We were the witness to excellent hospitality, by not just being taken around the city by the orthopaedic residents but also tasting the local cuisine. Dr. Dicky ensured we had a comfortable stay and a good learning experience.

Following two days stay at Bandung, we flew to Surabaya to visit Dr. Soemoto Hospital. Dr. Dwikora and Dr. Chilmi showed us the facility, university, orthopaedic department, cadaveric skills lab, bone/ tissue banking lab and organised two CME for us with presentations on tissue banking, difficult Arthroplasty cases and our research work. We assisted Dr. Chilmi in a difficult THR for a post TB excision arthroplasty case and learned many intraoperative tips from him. Excellent socialisation and hospitality were extended in Indonesia overall by all the mentors involved.

We then flew to Kuala Lumpur (Malaysia) to be greeted by Prof. David Choon himself and his wife, at the Sentral Station (KLIA) on a Sunday afternoon. He put us up at his apartment and provided us with travel passes to seamlessly commute via the local metro. We used to visit his outpatient clinic, rounds at the hospital and learned a lot by the discussions, especially about evidence-based medicine and its application in clinical scenarios. We assisted him in total knees and hips (modified Hardinge approach) and learned many practical tips from him. Socially, he had organised a visit for us to the Batu caves/temple followed by a get-together at his residence, where we got to eat a new fruit "Durian". After the completion of the foreign leg of the fellowship, we were looking forward to learn from the masters in our homeland.

During the week spent at Mumbai with Dr. Arun Mullaji, we worked at Hinduja and Breach Candy Hospitals on alternate days. We got to assist in a large number of cases during the time we spent there. Navigated (Brainlab) TKRs (PS), Revision cases and Oxford UKRs (fixed and mobile-bearing) were being operated routinely and we learned a lot about the research aspects apart from the operative skills. In Chennai, we visited Asian Joint Reconstruction Institute (AJRI) at SRM Institute of Medical Sciences (SIMS). We assisted Dr. Vijay Bose, Dr. Suryanarayan and Dr. Ashok in Navigated TKRs, Robotic TKRs, UKR, Revision Arthroplasty cases and lot of THRs for Dysplastic hips. They took special lectures for our in-depth understanding and we also got an opportunity to attend the monthly South Indian Arthroplasty Association (SIAA) clinical meeting. Our last stop was at Pune, where I visited my alma mater, Sancheti Institute for Orthopaedics and Rehabilitation. Didactic lectures were taken for us by Dr. K.H. Sancheti and Dr. Joshi, with active participation in clinical morning meetings every day. We got to actively participate by scrubbing in for difficult arthroplasty (Hip and Knee) cases with severe deformities/ bone loss apart from multi-ligament reconstructions (ACL +PCL), Isolated ACL reconstructions, Meniscal repairs, Synovectomies and Rotator Cuff repairs. We assisted Dr. Parag, Dr. Joshi, Dr. K. Patil and Dr. Gugale in the daily list of arthroplasty cases. Dr. Parag Sancheti went an extra mile to ensure we had a comfortable stay at the Hospital Guest House and made us feel at home by sharing home-cooked lunches with us.

The fellowship concluded with myself and my colleague presenting the fellowship report, sharing our experiences with the coveted International faculty at the 20th Annual Meeting of Asia Pacific Arthroplasty Society Incorporated held in Xiamen, China from 29-31st August 2019.

Apart from academics, I have gained a lot, both on the personal and professional front from this fellowship. Making new friends, meeting colleagues, connecting with seniors and forging new mentorships made an integral part of APAS Travelling Fellowship. Every consultant went out of their way to explain and resolve my never-ending queries, making it a wonderful learning experience. I am sure that the experiences I had during these two months of travelling have broadened my horizon and would ultimately reflect in my clinical practice/ research work, benefitting the patients I treat in future.

I would like to express sincere gratitude to Dr. Parag Sancheti and Dr. Rami Sorial for giving me this opportunity and for the excellent organisation of the Indian and Foreign legs of the fellowship respectively. I am thankful to APAS for providing young professionals with this unique opportunity to learn from stalwarts in the field. I am certain that this experience would be a stepping stone for me to progress further in my professional career and for that, I am forever grateful.

With Warm Regards,

Dr. Kunal Aneja
M.S., D.N.B., Diploma SICOT (Cape Town), M.N.A.M.S., M.I.M.S.A.,
Fellowships in Arthroplasty and Arthroscopy:
D.O.A. Fellow (Ganga Hospital), SICOT meets SICOT Fellow (Hungary), A.P.A.S. Fellow (Australia, Indonesia,
Malaysia, India), ISKSAA Midlands U.K. Fellow (Birmingham, Solihull),
Global Scholar (Edinburgh, U.K.), Assoc. Fellow A.C.S.
New Delhi, India