The Adult Reconstructive Service is comprised of faculty members with special interest and fellowship training in the areas of upper and lower extremity total joint arthroplasty as well as musculoskeletal oncology. With a broad geographic tertiary and quaternary referral base, nearly 50 percent of the joint replacement procedures performed are revisions for failed prior operation, with the balance comprising both common and complex primary reconstructive problems. In addition to reconstructive procedures for benign conditions, the service also includes patients with malignant disease involving the bony axial skeleton and extremities on both a primary and metastatic basis. More than 300 total joint arthroplasties and 100 new tumor cases are seen each year.
The Musculoskeletal Oncology group employs a strong multidisciplinary team approach to the diagnosis, treatment and reconstruction of benign, malignant and metastatic disease affecting the musculoskeletal system. The team is composed of fellowship-trained subspecialists from orthopaedics, radiology, pathology, adult and pediatric oncology and radiation therapy. A monthly multidisciplinary conference is held to review cases of interest from the preceding month. More than 100 surgical procedures are performed on an annual basis for this patient population. Two clinics per week provide an opportunity for the resident to preoperatively evaluate patients with musculoskeletal neoplasms and follow them postoperatively.
ImageThe Rehabilitation Center, a contiguous 36-bed inpatient rehabilitation unit, is the site for the majority of the postoperative rehabilitation for adults and children following reconstructive orthopaedic procedures. An integral multidisciplinary approach brings together physical and occupational therapy, patient education, prosthetics and orthotics and functional training for activities of daily living to maximize patient recovery. The resident is provided with a well-balanced exposure to complete rehabilitation of the patient.
Clinical investigation is an integrated part of the adult reconstructive service. Thromboembolic disease and heterotopic ossification are areas of ongoing prospective study. Many other clinical outcome studies involving performance of both implants and specific operative procedures as well as different treatment protocols for musculoskeletal sarcomas are underway. In the Division of Musculoskeletal Sciences, servohydraulic testing equipment provides the ability for an array of biomechanical testing protocols which cover a broad variety of topics including enhanced fatigue life of bone cement, the effect of anterior femoral cortical notching on the success of total knee arthroplasty, fixation strength of various implant configurations, and study of the physiologic bone remodeling process around cementless femoral stems of various designs.
The Adult Reconstructive Service is organized to provide a strong, balanced exposure to the challenges of clinical practice and the problems of basic and clinical scientific investigation. This service provides a broad exposure to both upper and lower extremity reconstructive problems and arthroplasty techniques in the shoulder, elbow, hand and wrist as well as the hip and knee. The junior/senior resident pairing on this service provides an introductory exposure to these clinical problems early in the residency, followed by a senior experience while the resident assumes increasing responsibility for overall patient care and operative case load. At the conclusion of the chief year, the graduating resident is capable of handling a wide range of complex adult reconstructive problems and has mastered a logical and thoughtful approach to primary and revision arthroplasty.
For more information regarding Penn State Orthopaedics' residency training program, please email the residency program coordinator at OrthoResidency@hmc.psu.edu.
