Cleveland Clinic Among Top 10 Most Academically Productive Adult Reconstruction Fellowships in U.S.

Pictured above: Cleveland Clinic adult reconstruction fellows in the operating room.

Out of 112 adult reconstruction and arthroplasty fellowships in the U.S., Cleveland Clinic ranks No. 7, according to a 2024 list in Arthroplasty Today. Rankings were based on total number of scientific publications: Cleveland Clinic’s program tallied 1,083, compared with a mean of 289.

“There are different types of joint replacement fellowships,” explains Viktor Krebs, MD, Enterprise Director of Cleveland Clinic Adult Reconstruction. “Some programs teach trainees how to operate, or how to operate and present. In our program, trainees learn how to operate, analyze data, write a publication and use scientific methods to advance orthopaedics. Trainees who are academically productive tend to become leaders in our field — among the first to adopt new technologies and practices.”

Dr. Krebs led Cleveland Clinic’s one-year James A. Dickson Fellowship in Adult Reconstructive Surgery from 2005 through 2024. During this time, Cleveland Clinic’s adult reconstruction practice grew from four surgeons to 16 — and the training program transitioned from a highly competitive clinical fellowship into an academic powerhouse. Today, the fellowship trains six physicians per year from across the U.S.

Notable research by fellows

“Foremost, our fellowship provides surgeons with an immersive training experience that includes robotics, minimally invasive approaches and complex arthroplasty cases,” says orthopaedic surgeon Matthew Deren, MD, a former Cleveland Clinic fellow who is now Director of the adult reconstruction fellowship. “This leads to our fellows’ involvement in the publication and presentation of some of these innovations. By contributing to the literature as orthopaedic surgeons, our trainees are better suited to evaluate the literature during their careers and make educated assessments to help guide their future practice.”

Below are a few examples of the notable research published in high-impact journals by Cleveland Clinic adult reconstruction fellows.

Are We Appropriately Compensated by Relative Value Units for Primary vs Revision Total Hip Arthroplasty? (J Arthroplasty. 2018 Feb;33(2):340-344)

Thomas J. Kryzak Jr., MD, (Fellow 2017) and other Cleveland Clinic researchers compared mean relative value units (RVUs) and mean operative times between primary and revision total hip arthroplasty (THA). They revealed that revision THAs, while more complex and requiring longer surgeries and greater technical skill, were compensated less than primary THAs per minute of operative time (0.249 RVU vs. 0.260 RVU).

Effect of liner offset and inclination on cement retention strength of metal-in-metal acetabular constructs: A biomechanical study (J Orthop Res. 2021 Apr;39(4):813-820)

Jennifer Peterson, MD, (Fellow 2018) and other Cleveland Clinic researchers studied the biomechanics of positioning cemented liners in acetabular shells during revision THA. They reported that the more offset the liner, the weaker the cement retention.

How Accurate Is ICD-10 Coding for Revision Total Knee Arthroplasty? (J Arthroplasty. 2021 Dec;36(12):3950-3958)

In this multicenter study, Ahmed Siddiqi, DO, (Fellow 2020) and a team assessed the accuracy of ICD-10 procedural codes for revision total knee arthroplasty (TKA). They found that more than 40% of revision TKA procedures were incorrectly coded for removed and replaced components, suggesting that the coding process should be reevaluated.

The Use of Metaphyseal Cones and Sleeves in Revision Total Knee Arthroplasty (J Am Acad Orthop Surg. 2021 Sep 15;29(18):e904-e920)

Dr. Siddiqi was lead author of this comprehensive review of metaphyseal cones and sleeves used during revision TKA. The article explored the design, manufacturing and clinical outcomes of various cones and sleeves, as well as their interchangeability with different revision TKA systems.

Demographic, Comorbidity, and Episode-of-Care Differences in Primary Total Knee Arthroplasty (J Bone Joint Surg Am. 2021 Feb 3;103(3):227-234)

Dr. Siddiqi was lead author of this study evaluating trends in patients who had TKA between 2008 and 2018. The research team reported that patients’ health status (i.e., smoking status, malnutrition, hypertension, anemia, functional status, overall morbidity and mortality risk) improved during that decade, while age, BMI and chronic disease status stayed the same. These findings indicated a potential increase in procedural value of TKA.

How Does Robotic-Arm Assisted Technology Influence Total Knee Arthroplasty Implant Placement for Surgeons in Fellowship Training? (J Knee Surg. 2022 Jan;35(2):198-203)
Zachary Yenna, MD, (Fellow 2018) and a multicenter team explored the accuracy of robotic-assisted TKA versus manual TKA when performed by orthopaedic fellows. They found that, similar to experienced surgeons, fellows with less experience had improved accuracy when positioning knee implants with robotic assistance.

Research productivity signifies academic achievement

“While only one aspect of a fellowship program, research productivity adds to the quality of training and is a marker of academic achievement,” says Nicolas S. Piuzzi, MD, fellowship faculty member and Enterprise Vice Chair of Research for Orthopaedics and Rehabilitation at Cleveland Clinic.

According to the Arthroplasty Today study, Cleveland Clinic and other fellowship programs in the top 10 contribute 49% of academic productivity in adult reconstruction and arthroplasty.

“Publishing research is essential for training new surgeons,” Dr. Piuzzi says. “It sharpens analytical skills, nurtures innovative thinking and grounds clinical practice in evidence-based medicine. In our Cleveland Clinic Adult Reconstruction Research group, our fellows are not just participants; they are a driving force behind our leading-edge research.”