Complex primary total hip and knee replacement. Generally speaking hip and knee replacements are very common procedures that we perform, and for the most part the reason that we perform them is for degenerative conditions, such as osteoarthritis. For the most part, these are very straightforward reasons to perform these surgeries. However, depending on the situation, and depending on a patient’s past history, which could include things like pediatric issues, which they’ve had their entire life, also somebody who has undergone a trauma previously and had damage to that joint, performing a hip and knee replacement for that particular issue can become quite complex and that could mean the surgery itself could take longer, or it could also mean that the implants that are used are actually more robust and a little bit more complex than the usual primary implants we use. That is where fellowship training comes in with hip and knee arthroplasty. The additional year of training that a fellowship trained surgeon does specifically focuses on things like revision surgery and also performing primary hip and knee arthroplasty in straightforward and also complex situations. Fellowship training gives us the experience in a training environment to see a multitude of different pathologies, and hopefully allows us to have plans that are not typically seen in most straightforward total hip and knee arthroplasty.