The SAAS Edinburgh Arthroplasty Fellowship Experience of Dr Cobus Erasmus (2021)

After passing my final exams in the first semester of 2020, I was not completely sure in which direction I wanted to steer my career long term.  It was during this time that I saw the advertisement for the SAAS Arthroplasty Fellowship in Edinburgh, Scotland.  Arthroplasty was my favourite sub-discipline and Scotland had always held a romantic appeal, conjuring up images of remote castles, rustic pubs, colourful kilts, and majestic natural scenery.  I applied for the fellowship and two weeks later I received the news that I would be spending 2021 in Scotland.  I was elated and the rest of the year went by quickly, tending to all the preparations, applications, visas, and registrations that had to be done.

My wife and I arrived in a cold, dark Edinburgh in full Covid-19 lockdown-mode in the middle of January 2021.  After completing our mandatory ten-day self-isolation (which included sleeping under our coats on a bare matrass for the first four nights as most shops were closed and we couldn’t find anywhere to buy blankets), we were greeted by a winter wonderland as we stepped out of our apartment for the first time.  Edinburgh had heavy snowfall during our first week out, and people were skiing and snowboarding down Arthur’s Seat, the iconic hill just behind our flat.  It was a fantastic sight, and we were lucky to see it, as it doesn’t usually snow this heavily in Edinburgh.

I started work at the Royal Infirmary of Edinburgh shortly after this.  I was allocated to work with Mr Phil Simpson for the first six months.  I was happy to find that he is an excellent teacher, taking his time to show me everything from suture techniques to soft tissue handling and the full spectrum of primary and revision arthroplasty.  Mr Simpson is very experienced with robotic-assisted joint replacements and I had the opportunity to observe and assist with total knee, partial knee and hip replacements with the MAKO system on his theatre lists at the Spire Murrayfield private hospital.  He had a revision-heavy practice, and I got a lot of exposure to handling periprosthetic joint infections as well as revising hip and knee replacements for a variety of other reasons. Mr Simpson had much insight into how to run a successful private practice and I gained a wealth of knowledge that helped me set up my own practice.

The second six months of my time in Edinburgh, I continued working with Mr Phil Simpson but was also allocated to work with Mr Paul Gaston.  Mr Gaston is the Royal Infirmary’s resident hip guru, performing almost exclusively primary and revision hip arthroplasty, and hip arthroscopy. Mr Gaston was a great teacher and very meticulous in everything he did.  I enjoyed our discussions about all things arthroplasty related (and not) and he taught me a lot about the finer nuances of hip examination and hip surgery.  I saw very interesting hip pathology while working with Mr Gaston and picked up many tricks and techniques on diagnosing and handling the less common and more subtle hip pathologies.

During my year there, I had the opportunity to work with ten different arthroplasty surgeons.  This was extremely valuable to me, as I got to work with a range of very experienced surgeons, all with their own unique techniques and knowledge to impart.

There were plenty of opportunities for research during the year, and I gained a deeper understanding of statistics, gathering data and how to write interesting articles from the multitude of publishing powerhouses at the Royal Infirmary.  I got one article published in an international journal, had a poster displayed at the British Hip Society’s annual meeting and presented research done during my fellowship at two congresses in South Africa the following year.

Edinburgh is a fantastic city to live in for a year, with great places to eat, amazing history all around, beautiful architecture and a never-ending supply of alleyways, hills, parks, and pubs to explore.  It also served as a great base from which to travel to the rest of Scotland, Wales, and England.  Ireland is just a short ferry ride away and well worth visiting.

Scotland is well-known as paradise for whiskey lovers.  You can visit a new distillery every weekend and run out of time before you run out of distilleries to see.  The pubs in Edinburgh are very cosy and made for a great place to meet up after work with the other fellows for a pint.  There are an excellent variety of restaurants to choose from (including several Michelin star restaurants).  Your time in Scotland won’t be complete without trying haggis, Lorne sausage, black pudding, bacon rolls for breakfast and brown sauce with your fish and chips.  The Scottish are keen rugby supporters, and one of the highlights of our year was attending the Springboks vs Scotland game at the Murrayfield stadium.  It was quite amusing to see the large number of confused fans wearing both Springbok jerseys and kilts.

One of our best summer trips included visiting Glen Coe, climbing Ben Nevis, wild camping, visiting the Isle of Skye and then navigating the epic North Coast 500 route – this was Scotland at its most rugged and remote best.

We ended the year with a lovely Christmas dinner at Mr Simpson’s house, saw a great performance of The Nutcracker, enjoyed the Christmas lights and market and, to end it all on a high note, were chased by an irate coo (native Scottish cow) while doing a last bit of hill walking in the Pentlands.

The fellowship and the time spent in Edinburgh was wonderful and I made many great friends and memories.  I give it 10/10 stars – highly recommended.



With the world gripped by the worst pandemic since the Spanish flu of 1918, local and International lockdowns threatened many events and saw humanity having to adjust to a “new Normal”. Like rerouting a vessel in a storm healthcare delivery and academic programs had to change with the tide, fellowships were no exception to this challenge. From the cold mornings to the beautiful late autumn evenings, time spent at my flat on 32 Balcarres street were indeed memorable.

The Royal infirmary of Edinburgh became a home away from home and in no time I would settle into my role and really felt part of the team. The warm reception from the host Professor Colin Howie, The consultants, registrars and support staff really made my stay enjoyable. From learning a bit of Scottish slang to sharing a famous South African past time "Lunch Bar" advertisement with my consultant Mr. Paul Gaston, it is safe to say there was never a dull moment in the operating room. The Wednesday outpatient clinics were always insightful, from discussions around primary and revision knee arthroplasty with Mr. Richard Burnett to listening to his travels to our beautiful shores.

Meeting new people and forging new friendships is what makes fellowships truly an amazing experience, I would spend most of my time with a fellow from Singapore and one from the Netherlands and we would soon be known as the three musketeers. From sharing meals together to collaborating on research projects, this became a truly phenomenal brotherhood. The cold and wet Saturday mornings on the golf course with the registrars and consultants would provide for a relaxed setting to interact and share life experiences.