Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3 (late): Module 18: Complex Arthroplasty/Joint Reconstruction
Learning
Context
This module
builds on the
basic
concepts of
primary joint
arthroplasty.
In this module,
the trainee will
become
competent in
advanced
Arthoplasty
surgery and
will be
exposed to
the various
arthroplasty
Wait Times
initiatives.
This module
will reinforce
the trainee’s
role as
Manager and
Health
Advocate so
as to prepare
the trainee to
the societal
needs of
appropriately
managing
surgical wait
CanMEDS
Role (s)
Medical
Expert
Learning
Outcomes:
Goals/Objectives
Understand the
principles in
managing a patient
requiring a complex
primary hip or knee
replacement
Understand the
assessment,
treatment and
sequelae of
complications
associated with
complex primary hip
and knee
reconstructive
surgery.
Understand the
principles in
managing a patient
requiring a revision
hip or knee
replacement,
especially as they
pertain to sepsis,
aseptic loosening
and periprosthetic
fracture
Source Doc(s)
Specific
Competencies
See appended source
documents
Demonstrate
proficiency in the
following areas:
• pre-operatively
plan and perform
complex primary hip
(i.e. DDH) and knee
replacements (i.e.
genu valgum and/or
varum)
• pre-operatively
plan and perform
simple revision hip
and knee
replacements,
including the use of
a trochanteric slide
osteotomy, an
extended
trochanteric
osteotomy, and a
tibial tubercle
osteotomy.
• perform
osteotomies around
the knee.
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Learning/Teachin
g Strategies
Review of source
documentation
Application to
clinical settings
Observation by
clinical supervisor
with ongoing
feedback around
assessment and
formulation skills
Ongoing self-study
Consultation notes
with feedback from
supervisor
Evaluation
Method or Tools
GRS/Checklists for
pre-operative
assessment
Assessment of the
pre/postoperative
plan
Oral Examination –
to test knowledge
and management
of complications
GRS/Checklists for
key index
procedures :
● Primary hip/knee
replacement
● Simple revision
hip/knee
● Osteotomies
around the knee
ITER PBA for index
procedures
Oral examination
for practice
management
Understand the
assessment,
treatment and
sequelae of
1
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3 (late): Module 18: Complex Arthroplasty/Joint Reconstruction
times.
07Jan15 Version
complications
associated with
revision hip and
knee reconstructive
surgery.
Medical
Expert
�
Medical
Expert
Manager
See appended source
documentation
See appended source
documentation
KNOW
� Understand
population-based
Understand the
indications for and
perform a hip or
knee
osteotomy,
arthrodesis, and/or
joint replacement
For complex primary
joint arthroplasty
and revision hip and
knee replacement
surgery, the resident
should be able to
comprehensively
discuss the:
• selection of
appropriate implants
• the factors
affecting implant
survivorship and
function, including
design, biomaterials,
fixation and wear
properties
Be competent in:
-triaging surgical
cases
Oral examination
for choice of
implant to use
Review of
documentation re:
how to organize
Structured Oral
method using
simulated
2
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3 (late): Module 18: Complex Arthroplasty/Joint Reconstruction
approaches to
health care services
and understand the
management of an
arthroplasty
practice including
triage/priorities of
patients.
Be conscious and
knowledgeable of
human resources
and finances as
they relate to
implants.
-setting priorities in
surgical bookings
-be able to work with
vendors in re: preoperative planning
Be able to use
appropriate, costeffective implants in
surgeries dealing
with:
● bone loss
● deformity
● periprosthetic
fractures
Resident will be
responsible for preoperative planning
and working with
staff surgeon in the
ordering of implants
Health
Advocate
KNOW:
� Understand the
possibility of conflict
of interest in
performing the role
as health advocate
for a patient or
community with that
of being a manager
or gate keeper
Identify the health
needs in the
populations served
through the various
orthopedic
outpatient settings,
and promote its
growth through
ongoing
communication with
community
organizations, etc.
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sample list
Resident
observation of a
staff performing all
of the specific
competencies, with
the opportunity for
questions and
discussion
Resident
observation of
taped simulated
scenarios with
opportunity for
questions
Direct observation
of modeling
competencies
Regular
supervision time
with supervising
surgeons, with
opportunity to
discuss social
determinants of
orthopaedic health
and community
scenarios/patient
s and expert,
faculty examiners
around practice
management
Oral examination
of implant
selection
including factors
which affect
implant
survivorship
Pre-operative
plan – assessed
by GRS
Structured Oral
Simulated
scenarios with
simulated
patients.
Residents will be
assessed on their
knowledge and
communication of
providing
information
around access to
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3 (late): Module 18: Complex Arthroplasty/Joint Reconstruction
Learn about the
orthopaedic,
rehabilitation
resources available
to patients/families
through
community/intra/inte
r professional
setting
Be able to identify
and communicate
risk medication and
management
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resources available
to families
Attending
multidisciplinary
team rounds in
order to gain
broader
understanding of
resources
rehab services
and post
operative follow
up procedures for
the patient.
Knee
James H. MacDonald, et al Knee Arthrodesis. J. Am. Acad. Ortho. Surg., March 2006; 14: 154 - 163.
Mark H. Gonzalez and Anis O. Mekhail. The Failed Total Knee Arthroplasty: Evaluation and Etiology. J. Am. Acad. Ortho. Surg.,
November/December 2004; 12: 436 – 446
Edward T. Su, Hargovind DeWal, and Paul E. Di Cesare. Periprosthetic Femoral Fractures Above Total Knee Replacements J. Am. Acad. Ortho.
Surg., January/February 2004; 12: 12 – 20
Scuderi GR, Tenholder M, Capeci C. Surgical approaches in mini-incision total knee arthroplasty. Clin
Orthop Relat Res. 2004 Nov;(428):61-7.
Management of bone loss in revision total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:186-92
Backstein D, Safir O, Gross A. Management of bone loss: structural grafts in revision total knee arthroplasty. Clin Orthop Relat Res. 2006
May;446:104-12.
Hip
Paul E. Beaulé, Joel M. Matta, and Jeffrey W. Mast. Hip Arthrodesis: Current Indications and Techniques. J. Am. Acad. Ortho. Surg., July/August
2002; 10: 249 - 258.
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Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
Phase 3 (late): Module 18: Complex Arthroplasty/Joint Reconstruction
07Jan15 Version
RA Brand. Hip Osteotomies: A Biomechanical Consideration. J. Am. Acad. Ortho. Surg., Oct 1997; 5: 282 - 291.
Thomas P. Vail and John J. Callaghan. Minimal Incision Total Hip Arthroplasty. J. Am. Acad. Ortho. Surg., December 2007; 15: 707 – 715
EL Masterson, BA Masri, and CP Duncan. Surgical approaches in revision hip replacement. J. Am. Acad. Ortho. Surg., Mar 1998; 6: 84 - 92.
Howell JR, Garbuz DS, Duncan CP. Minimally invasive hip replacement: rationale, applied anatomy, and instrumentation. Orthop Clin North Am.
2004 Apr;35(2):107-18
Gross AE, Goodman S. The current role of structural grafts and cages in revision arthroplasty of the hip. Clin Orthop Relat Res. 2004
Dec;(429):193-200
Harris WH. An integrated solution to acetabular revision surgery. Clin Orthop Relat Res. 2006 Dec;453:178-82.
Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or
knee arthroplasty. J Bone Joint Surg Am. 2007 Apr;89(4):871-82
Huo MH, Gilbert NF, Parvizi J. What's new in total hip arthroplasty. J Bone Joint Surg Am. 2007 Aug; 89(8):1874-85
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