A Career in Arthroplasty: Training, Fellowship and Practice

An arthroplasty surgeon replaces and, when necessary, re-replaces joints, mostly hips and knees. Primary replacement is the core of the job. Revision, periprosthetic joint infection and periprosthetic fracture are the hardest parts of it. To work as an arthroplasty consultant or attending, you complete orthopaedic training and then, in almost every health system, a dedicated arthroplasty (adult reconstruction) fellowship. This guide covers the work itself, the training route in the US, UK and Australia, how fellowship selection works and what selectors rank highest, using figures from the matching bodies and joint registries.

What does an arthroplasty surgeon actually do?

In theatre, the work is precise and repetitive. You restore joint mechanics with implants positioned to within a few degrees and millimetres. Small errors cost the patient: a malrotated knee component can leave a stiff, painful knee, and a poor cement mantle can loosen early. Most lists are elective and planned weeks ahead. Planning matters as much as the operation, from templating a hip replacement to choosing between knee alignment philosophies.

In clinic you decide who needs an operation, and that is the harder skill. Some patients with severe radiographic arthritis are coping and should not be operated on. Others with modest radiographic change are disabled by pain. You have to match symptoms, examination and imaging, and set realistic expectations. A replacement does not restore a young joint. Patients need to understand the risks of infection, venous thromboembolism, leg-length difference and long-term wear before they consent.

Revision surgery is a different discipline. You work through scar tissue in bone damaged by osteolysis, loosening or infection, and reconstruct defects with augments, allograft or custom acetabular components. Classifying acetabular bone loss and planning reconstruction is core fellowship content. Managing infected joints means regular multidisciplinary work with microbiologists, staged surgery, and long, difficult conversations with patients who have had several operations.

How big is arthroplasty, and how visible is your work?

Joint replacement is one of the highest-volume operations in orthopaedics, and some of the most closely audited.

• The UK National Joint Registry (opens in a new tab) has collected data since April 2003 and had recorded more than 4.5 million procedures by its 22nd Annual Report (2025).
• The Australian Orthopaedic Association National Joint Replacement Registry (opens in a new tab) has recorded more than 2.28 million procedures since 1999.

For a career this has two consequences. First, registry research is open to trainees and is the obvious route into arthroplasty research. Second, your results are public. The NJR's Surgeon and Hospital Outcomes website (opens in a new tab) lets anyone look up a consultant by name or GMC number. It shows their primary and revision volumes over one and three years, 90-day mortality after hip and knee replacement, and their use of ODEP-rated implants, each against national averages. From your first year as a consultant, your implant choices and revision rate are on record.

What is the training pathway into arthroplasty?

The route has the same three stages everywhere: medical school, general orthopaedic training ending in a specialist qualification, then subspecialty fellowship. How each stage is structured and how fellowships are filled varies by country.

ACGME rules allow an adult reconstruction programme to cover arthritis in several regions or to be limited to the hip and knee, or to the shoulder, elbow and upper limb. Programmes that focus on hip and knee must include both primary and revision knee arthroplasty. The exam you sit at the end of core training is covered in our global orthopaedic board exam atlas. Deciding whether to take a consultant job straight after CCT or another fellowship year is covered in job or fellowship: when to stop training.

How does the US adult reconstruction fellowship match work?

US hip and knee fellowships are filled through the Adult Reconstruction Fellowship Match, which the American Association of Hip and Knee Surgeons (AAHKS) runs on the SF Match platform. You apply about two years ahead. The AAHKS timeline (opens in a new tab) for the 2027 match, for fellowships starting in 2028, is:

How competitive is it? The SF Match orthopaedic fellowship match report for April 2026 (opens in a new tab) lists 114 adult hip and knee programmes offering 236 positions. Of these, 211 filled and 25 were vacant. Across all eight orthopaedic subspecialties in the match, 979 applicants registered, 818 matched and 59 did not. The average applicant sent 34 applications.

Signals. For the current cycle the AAOS Board of Specialty Societies introduced preference signalling through SF Match. Each applicant has up to 10 signals across all orthopaedic subspecialties (opens in a new tab). Programmes see only whether you signalled them. If you are split between arthroplasty and another subspecialty, you have to divide the 10 between them.

Conduct rules. The AAHKS code of conduct asks applicants not to ask how they will be ranked, discourages thank-you notes and emails after interview, and directs logistical questions to the programme coordinator, not the director. If you accept a post outside the match, you must withdraw from the match and tell the programmes you applied to. An accepted offer is binding.

How do UK and Australian arthroplasty fellowships work?

United Kingdom. There is no national match for arthroplasty. Individual units advertise post-CCT fellowships and appoint by interview. The British Hip Society's standards for a post-CCT fellowship (opens in a new tab) make a useful checklist for judging any post:

• advertised nationally and filled by formal application and competitive interview;
• named educational supervisors;
• at least one clinic and at least three sessions of hip surgery a week, with a named consultant for every list;
• exposure to both elective and trauma hip surgery, and a regular multidisciplinary meeting;
• one paid research session a week with research-active supervisors;
• study leave, development aims agreed at the start and a formal appraisal at the end.

A post that misses several of these is likely to be a service job with a fellowship title. Once you are a consultant, the BHS also funds travelling fellowships. The Rothman-Ranawat Travelling Fellowship (opens in a new tab), for example, requires BHS membership, FRCS (Tr&Orth), specialist registration and fewer than 10 years in consultant hip practice.

Australia. The Australian Orthopaedic Association accredits fellowships (opens in a new tab) as short-term supervised subspecialty training taken after accredited orthopaedic training. Accreditation is voluntary. AOA states that these fellowships are not formal surgical training, so the experience may not count towards its training programme, and that some are funded by medical device companies under its accredited fellowships policy. Ask who funds a post and what that means for your implant exposure.

What do arthroplasty fellowship selectors look for?

The best evidence is a survey of US adult reconstruction programme directors (Cotter et al., 2020 (opens in a new tab)). It was sent to 92 directors and 32 replied (34.8%), so treat it as indicative. Three-quarters of responding programmes interviewed between 21 and 40 applicants a year. Directors ranked these factors first:

Larger programmes gave more weight to geographical ties to the city. In practice, an application is a filter that gets you an interview, and the interview and your referees decide the result.

Build these during residency or registrar training:

1. A logbook that shows progression. Fellowships teach exposure, balancing and component positioning. They assume you can already operate. Aim to have performed supervised primary hip and knee replacements as the operating surgeon. If your unit does little revision work, arrange a clinical attachment at a tertiary revision centre.
2. Two or three referees who have seen you operate. Directors rank letters second, so who writes them matters. Choose arthroplasty surgeons who have worked with you over time. Give each one your CV, a draft personal statement and reminders of specific cases and projects, so they can write a detailed letter.
3. Focused research. One or two projects you led on an arthroplasty question will impress more than a list of minor co-authorships. Registry analyses, audits of your unit's infection or dislocation rate, and PROMs studies are all realistic for a trainee.
4. A specific personal statement. Explain why arthroplasty and why this programme. If a unit is known for revision or infection work, say what you want to learn there. A generic statement sent to every programme reads as generic.

What happens at an arthroplasty fellowship interview?

Expect a mix of conversation and clinical scenarios. A common format is to show radiographs of a failed knee or hip replacement and ask how you would investigate and plan the revision. Panels are judging your reasoning and safety more than whether you reach a particular answer. Be ready to discuss current debates, such as robotic-assisted arthroplasty, bearing choice in young patients and anterior versus posterior approaches to the hip, using the evidence rather than your unit's habits.

Panels also judge whether you would be a good colleague for a year, so be calm and teachable, and honest about the limits of your experience. For general interview structure and question types, see our orthopaedic fellowship application guide.

What is the lifestyle like?

Predictable weeks. Most work is elective, so job plans are scheduled well ahead. That is the main lifestyle difference from trauma. Emergencies still happen: periprosthetic fractures, dislocations and acute infections all need urgent care.

Physical work. Impacting components, handling heavy lower limbs and standing at the table for long revision cases strain your back, shoulders and wrists over decades. Paying attention to table height, positioning and assistance is a career-length habit, not a minor point.

Practice patterns. Elective joint replacement suits both public and private practice. Our guide to starting a private orthopaedic practice covers the private side. Within arthroplasty, surgeons often specialise further in complex revision and infection, young-adult hip preservation, robotic and computer-assisted surgery, or registry and outcomes research. Academic routes are covered in a career in academic orthopaedic surgery.

Is arthroplasty the right subspecialty for you?

Arthroplasty suits surgeons who enjoy planning, technical repetition aimed at precision, long-term follow-up and a predictable schedule. It is harder for those who want variety in every list or who find it difficult to turn down surgery for patients whose imaging looks bad. If you are still deciding between subspecialties, when to choose your orthopaedic subspecialty sets out the timing. If you have already decided, the most useful step is to identify two or three arthroplasty surgeons who will see enough of your work to write strong references.