What I Learned From Fellowship Training

Four Questions with Dr. Krenzel on Subspecialty Orthopedic Care

When a patient is selecting an orthopedic surgeon, the surgeon’s training and experience are paramount. Most look for a doctor that they trust, who has a record of established, proven patient care.

Fellowship trained orthopedic surgeons have chosen to subspecialize in a specific area of orthopedic care, spending extra time learning often complicated techniques and surgeries. Brian Krenzel MD, a hip and knee surgeon with OrthoCarolina Hickory and OrthoCarolina Boone, shares why becoming fellowship trained was important to him.

What type of education and training does a fellowship-trained orthopedic surgeon have?

The best way to understand fellowship training is to explain it as a voluntary additional year or more of orthopedic training that allows us to focus on and specialize in a specific area of orthopedics. I chose hip and knee surgery. That additional year gave me great experience and exposure to complex cases as well as better understanding of straightforward cases. I’m in a better position to be more skilled at those surgeries than had I completed just a standard orthopedic residency. That additional year of training is what really differentiated my skill set and allowed me to develop expertise at the elements of hip and knee replacement surgery.

You are fellowship trained in hip and knee. What made you choose that specialty?

Fellowship trained surgeons can choose any orthopedic specialty but two things in particular drew me to hip and knee. One is the technical aspects of hip and knee surgery; specifically the biomechanical components. I like the reproducibility of it, meaning we can give each patient the same high standard of care. I enjoy the actual surgery itself and working with high quality, high-tech implants that are the latest in the medical field.

The other reason I chose hip and knee, and the more important reason, is really it is such an honor to treat patients. The quality of life improvement makes it a joy to come to work every day. I can meet a patient for the first time and tell them the surgery will change their life for the better and be extremely confident in what I am telling them. I didn’t find that sense of fulfillment from other areas of orthopedics. It is a really rewarding career for me and seeing my patients regain their function and enjoy life is so meaningful.

What is something about your years of training and experience that really stands out?

I have one particular patient who has spondyloepiphyseal dysplasia, a congenital bone growth disorder that results in short stature (dwarfism). When I first met her she was in a wheelchair with deformed hips on both sides. She couldn’t walk or find a doctor to help, and she was worn out by pain and immobility. From the start we connected well, and she trusted me to handle this complex problem.

I performed a complex reconstruction on one hip of her hips and we even made a custom implant on her other. Both surgeries went well and within a year she was back up and walking. She hadn’t walked in two years. Now she’s working, smiling, walking more and more, out of her wheelchair and dancing. That’s the rewarding part to me. Her case took a lot of time to discuss, design, and plan. But you work the problem and find something for every patient no matter how unique the case to help the patient have the best outcome and quality of life possible.

As orthopedic technologies and new surgical techniques evolve, how does that affect the practice of a fellowship trained orthopedic surgeon?

Orthopedics is constantly changing. By focusing on a small area of orthopedics, I am able to best respond to the new technologies and techniques in joint replacement surgery. I read journals, teach, and attend meetings regularly. This knowledge translates into confidence to tackle challenging cases and to provide new techniques to my patients. One great example of this involves same-day discharge to home joint replacement, or outpatient joint replacement (no hospital stay). We have studied this and for many patients it is a safe option. I have witnessed this type of care provide the highest quality outcome at a lower cost for my patients.

My fellowship training and surgical experience have allowed me the confidence to help create a significant change in how we deliver health care in our community. I’m excited to be part of such a rapidly evolving field of healthcare that is truly changing lives.