Orthopaedic Surgery Residency Program: COMPETENCY BASED STREAM
MODULE 6: ARTHROPLASTY Dr. John Murnaghan
Learning
CanMEDs
Learning Outcomes:
Source
Specific
Context
Role (s)
Goals/Objectives
Doc(s)
Competencies
Medical
The goal of
KNOW:
Campbell’s
DO:
this module will Expert (Knee)
Be able to advise
Arthroplasty Perform an
be for the
patients regarding the Chp 6
appropriate
trainee to
non-operative
work up
diagnose and
management of knee
Source
(including
treat patients
arthritis; including
documents
history,
with hip or
indications,
on Portal
physical
knee arthritis
complications and
examination,
and be able to
effectiveness of such
and diagnostic
perform a total
treatment
imaging) for
knee and total
patients with
hip
knee arthritis
arthroplasty
and organize
with guidance
an appropriate
and/or
non-operative
supervision.
plan, when
indicated
Residents will
spend
approximately
4 weeks on a
Medical
Be able to explain the Campbell’s
DO: Be able to
block
Expert (Knee)
indications, results
Arthroplasty explain the
dedicated to
and complications of
Chp 6
indications,
the knee at
surgery for knee
results and
the Holland
arthritis with respect
Source
complications
Centre with
to age, gender and
documents
of surgery for
Dr. J.
activity level.
on Portal
knee arthritis
Murnaghan
with respect to
and
age, gender
approximately
and activity
4 weeks on a
level.
block
dedicated to
the hip with
Dr. O. Safir at
Mount Sinai
20Jan15 Version
Learning/Teaching
Strategies
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
Evaluation Method or
Tools
Assessment of performance
on these competencies will
be a continuous process
over the course of the
rotation with both summative
and formative feedback
coming from supervising
surgeons and allied health
professionals
Observed clinical history and
physical to give real-time
assessment of clinical skills
(one per month) with global
ratings (last week of module)
Mid-module assessment will
occur where resident will be
given an oral examination,
short-answer questions, and
a STACER on either a
primary total hip or knee
arthroplasty. A summative
and formative evaluation will
then follow Hx PE exam
(oral) form
End-of-module assessment
will occur where resident will
be given an oral
examination, short-answer
questions, and a STACER
on either a primary total hip
or knee arthroplasty. A
summative and formative
evaluation will then follow
1
Learning
Context
CanMEDs
Role (s)
Medical
Expert (Knee)
Learning Outcomes:
Goals/Objectives
Be able to explain the
principles of knee
reconstructive surgery
for arthritis including
osteotomy,
arthrodesis and joint
replacement
Source
Doc(s)
Campbell’s
Arthroplasty
Chp 6
Source
documents
on Portal
Specific
Competencies
Learning/Teaching
Strategies
DO: Be able to
explain the
principles of
knee
reconstructive
surgery for
arthritis
including,
osteotomy,
arthrodesis
and joint
replacement
One day surgical skills
session on cadavers
reviewing
approaches, and
techniques for total
knee arthroplasty
DO:
Carry out the
pre-operative
planning for
primary knee
arthroplasty,
with guidance
DO: Perform
arthrotomy and
primary total
joint
replacement of
the knee (and
osteotomy and
arthrodesis if
opportunity
arises)
Medical
Expert (Knee)
Demonstrate an
understanding of the
recovery and
rehabilitation following
knee replacement
Campbell’s
Arthroplasty
Chp 6
Source
DO:
Manage
postoperative
care and
Evaluation Method or
Tools
Observed assessment
throughout module on
teaching rounds
An ITER will be filled out at
the end of the module at time
of exit interview
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
Review of source
documentation
Resident observation
of staff surgeon
2
Learning
Context
CanMEDs
Role (s)
Learning Outcomes:
Goals/Objectives
Source
Doc(s)
documents
on Portal
Specific
Competencies
common
complications
following knee
arthroplasty
Learning/Teaching
Strategies
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Evaluation Method or
Tools
Resident opportunity
to perform
assessments under
supervision of
supervisor
Medical Expert
(Hip)
Medical Expert
(Hip)
Be able to advise
patients regarding the
non-operative
management of hip
arthritis including
indications,
complications and
effectiveness of such
treatment
Demonstrate an
understanding of the
indications, results
and complications of
surgery for hip arthritis
with respect to age,
gender and activity
level.
Campbell’s
Arthroplasty
Chp 7
Source
documents
on Portal
Campbell’s
Arthroplasty
Chp 7
Source
documents
on Portal
DO:
Perform
appropriate
work up
(including
history,
physical
examination,
and diagnostic
imaging) for
patients with
hip arthritis
and organize
an appropriate
non-operative
plan, when
indicated
Review of source
documentation
DO:
Demonstrate
an
understanding
of the
indications,
results and
complications
of surgery for
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
3
Learning
Context
CanMEDs
Role (s)
Medical Expert
(Hip)
Learning Outcomes:
Goals/Objectives
Able to explain the
principles of
reconstructive hip
surgery for arthritis
including osteotomy,
arthrodesis and joint
replacement
Source
Doc(s)
Campbell’s
Arthroplasty
Ch’s 7
Source
documents
on Portal
Specific
Competencies
hip arthritis
with respect to
age, gender
and activity
level.
Learning/Teaching
Strategies
questions and
discussion afterwards
DO: Able to
explain the
principles of
hip
reconstructive
surgery for
arthritis,
including
osteotomy,
arthrodesis
and joint
replacement
One day surgical skills
session on cadavers
reviewing
approaches, and
techniques for total
hip arthroplasty
DO:
Carry out preoperative
planning for
primary hip
arthroplasty,
with guidance
DO: Perform
arthrotomy and
primary total
joint
replacement of
the hip (and
osteotomy and
arthrodesis if
opportunity
Evaluation Method or
Tools
Resident opportunity
to perform
assessments under
supervision of
supervisor
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
4
Learning
Context
CanMEDs
Role (s)
Learning Outcomes:
Goals/Objectives
Medical Expert
(Hip)
Demonstrate an
understanding of the
recovery and
rehabilitation following
hip replacement
Source
Doc(s)
Campbell’s
Arthroplasty
Ch’s 7
Source
documents
on Portal
Specific
Competencies
arises)
DO:
Manage
postoperative
care and
common
complications
following hip
arthroplasty
Learning/Teaching
Strategies
Evaluation Method or
Tools
Review of source
documentation
Resident observation
of staff surgeon
performing all of the
specific
competencies, with
the opportunity for
questions and
discussion afterwards
Resident opportunity
to perform
assessments under
supervision of
supervisor
Medical
Expert
Communicator
Demonstrate an
understanding of the
unique medical
problems of the
geriatric population
KNOW:
Provide appropriate
information to others
involved in the care of
the patient
Listen effectively and
obtain an appropriate
history from patients
and their families and
Campbell’s
Arthroplasty
Chp 6 + 7
Source
documents
on Portal
Manage perioperative
issues in the
geriatric
population,
with regards to
total joint
arthroplasty
Perform live
surgical timeout effectively
to display
appropriate
communication
Regular observation
time with supervising,
with opportunity to
discuss diagnosis and
evidence-based
treatments
Review of source
documentation
Resident will do live
time out with feedback
from the surgical team
in the OR
Real-time assessments of
ability to perform surgical
time out to occur when
resident in operating room
Summative assessment at
end of module – as
reflected in ITER
5
Learning
Context
CanMEDs
Role (s)
Learning Outcomes:
Goals/Objectives
gather information not
only about the specific
problem but also
about the patient’s
beliefs, expectations
and concerns about
their illness.
Source
Doc(s)
Specific
Competencies
Learning/Teaching
Strategies
Evaluation Method or
Tools
Provide information to
the patient in a
humane manner with
language that they
can understand so
that they may be
involved in the
decision making
process regarding
their care.
Manager
Obtain an appropriate
informed consent for
patients undergoing
interventions.
KNOW:
Demonstrate an
understanding of the
importance of the
allocation of health
care resources and
how that effects wait
list management
Apply evidence and
management
processes for costappropriate care
Triage of
patients on
elective
surgical list
requiring hip
and knee
arthroplasty
(as per priority
level)
Direct feedback from
supervisor on
assessment of case
booking
Assessment of triaging
cases (form)
Resident to spend half
days (2) in advanced
practice
physiotherapist clinic
at Holland Centre to
understand triage
process of newlyreferred patients (for
hip and knee arthritis).
Manager encounter form
OSCE or MCQ
Direct feedback and
opportunity for
6
Learning
Context
CanMEDs
Role (s)
Learning Outcomes:
Goals/Objectives
Source
Doc(s)
Specific
Competencies
Learning/Teaching
Strategies
questions and
answers from
supervising physio
and clinic manager
Evaluation Method or
Tools
Reference textbooks:
 Campbells Operative Orthopaedics, 10th edition, chapter 6
 Surgery of the Knee, 4th Edition, Norman Scott Editor.
 AAOS Orthopaedic Basic Science Text book
Optional Readings and/or Required – Resident to be notified:
 Wear and Osteolysis Around Total Knee Arthroplasty. J. Am. Acad. Ortho. Surg., January 2007; 15: 53 - 64.
 Hannah Morgan, Vincent Battista, and Seth S. Leopold. Constraint in Primary Total Knee Arthroplasty. J. Am. Acad. Ortho. Surg., December
2005; 13: 515 – 524
 Paul J. Favorito, William M. Mihalko, and Kenneth A. Krackow. Total Knee Arthroplasty in the Valgus Knee. J. Am. Acad. Ortho. Surg.,
January/February 2002; 10: 16 - 24.
 Matthew R. Bong and Paul E. Di Cesare. Stiffness After Total Knee Arthroplasty
J. Am. Acad. Ortho. Surg., May/June 2004; 12: 164 - 171.
 Christopher J. Vertullo, Mark E. Easley, W. Norman Scott, and John N. Insall
Mobile Bearings in Primary Knee Arthroplasty. J. Am. Acad. Ortho. Surg., November/December 2001; 9: 355 – 364
 Robert L. Barrack and Michael W. Wolfe. Patellar Resurfacing in Total Knee Arthroplasty. J. Am. Acad. Ortho. Surg., March/April 2000; 8: 75 - 82.
 Michel Malo and Kelly G. Vince. The Unstable Patella After Total Knee Arthroplasty: Etiology, Prevention, and Management. J. Am. Acad. Ortho.
Surg., September/October 2003; 11: 364 - 371.
 David A. Parker, Michael J. Dunbar, and Cecil H. Rorabeck. Extensor Mechanism Failure Associated With Total Knee Arthroplasty: Prevention
and Management. J. Am. Acad. Ortho. Surg., July/August 2003; 11: 238 – 247
 Donna E. Smith, Robert W. McGraw, David C. Taylor, and Bassam A. Masri. Arterial Complications and Total Knee Arthroplasty. J. Am. Acad.
Ortho. Surg., July/August 2001; 9: 253 – 257
 John R. Watterson and John M. Esdaile. Viscosupplementation: Therapeutic Mechanisms and Clinical Potential in Osteoarthritis of the Knee. J.
Am. Acad. Ortho. Surg., September/October 2000; 8: 277 - 284.
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 JH Lonner and PA Lotke. Aseptic complications after total knee arthroplasty
J. Am. Acad. Ortho. Surg., Sep 1999; 7: 311 - 324.
 Vince KG, Abdeen A. Wound problems in total knee arthroplasty. Clin Orthop Relat Res. 2006 Nov;452:88-90.
 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.
 Sheth NP, Pedowitz DI, Lonner JH. Periprosthetic patellar fractures. J Bone Joint Surg Am. 2007 Oct;89(10):2285-96.
Hip
Reference textbooks
 Campbells Operative Orthopaedics, 10th edition, chapter 7
 AAOS Orthopaedic Basic Science Text book
Journal articles
 Michael A. Mont, Phillip S. Ragland, Gracia Etienne, Thorsten M. Seyler, and Thomas P. Schmalzried, Hip Resurfacing Arthroplasty. J. Am. Acad.
Ortho. Surg., August 2006; 14: 454 - 463.
 Maximillian Soong, Harry E. Rubash, and William Macaulay. Dislocation After Total Hip Arthroplasty. J. Am. Acad. Ortho. Surg.,
September/October 2004; 12: 314 – 321
 Richard Iorio and William L. Healy Heterotopic Ossification After Hip and Knee Arthroplasty: Risk Factors, Prevention, and Treatment. J. Am.
Acad. Ortho. Surg., November/December 2002; 10: 409 – 416
 MM DeHart and LH Riley, Jr. Nerve injuries in total hip arthroplasty. J. Am. Acad. Ortho. Surg., Mar 1999; 7: 101 – 111
 Charles R. Clark, Herbert D. Huddleston, Eugene P. Schoch, III, and Bert J. Thomas
Leg-Length Discrepancy After Total Hip Arthroplasty. J. Am. Acad. Ortho. Surg., January 2006; 14: 38 - 45.
 Alejandro González Della Valle, Douglas E. Padgett, and Eduardo A. Salvati
Preoperative Planning for Primary Total Hip Arthroplasty. J. Am. Acad. Ortho. Surg., November 2005; 13: 455 – 462
 Richard J. Friedman. Optimal Duration of Prophylaxis for Venous Thromboembolism Following Total Hip Arthroplasty and Total Knee Arthroplasty.
J. Am. Acad. Ortho. Surg., March 2007; 15: 148 – 155
 Della Valle CJ, Zuckerman JD, Di Cesare PE. Periprosthetic sepsis. Clin Orthop Relat Res. 2004 Mar;(420):26-31
 Hanssen AD, Spangehl MJ. Treatment of the infected hip replacement. Clin Orthop Relat Res. 2004 Mar;(420):63-71.
 Babis GC, Soucacos PN. Effectiveness of total hip arthroplasty in the management of hip osteonecrosis. Orthop Clin North Am. 2004
Jul;35(3):359-64
 Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B.Reducing the risk of dislocation after total hip arthroplasty: the effect of
orientation of the acetabular component. J Bone Joint Surg Br. 2005 Jun;87(6):762-9.
 Lieberman JR, Hsu WK. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 2005
Sep;87(9):2097-112.
 Beksaç B, González Della Valle A, Salvati EA. Thromboembolic disease after total hip arthroplasty: who is at risk? Clin Orthop Relat Res. 2006
Dec;453:211-24.
 Parvizi J, Campfield A, Clohisy JC, Rothman RH, Mont MA. Management of arthritis of the hip in the young adult. J Bone Joint Surg Br. 2006
Oct;88(10):1279-85.
 Board TN, Karva A, Board RE, Gambhir AK, Porter ML. The prophylaxis and treatment of heterotopic ossification following lower limb arthroplasty.
J Bone Joint Surg Br. 2007 Apr;89(4):434-40.
Dezateux C, Rosendahl K. Developmental dysplasia of the hip. Lancet. 2007 May 5;369(9572):1541-52.
8