Fellowship In Arthroplasty and Arthroscopy

Duration

12 Months

Over the last decade, tremendous advances have been made in Arthroplasty, Arthroscopy, and Sports medicine, including understanding biomechanical aspects and the development of newer technologies. As a result, care of arthritis patients and sports injury patient treatment has significantly improved; because of the awareness of the latest technology and improved quality of life, lots of patients have an understanding of their osteoarthritic condition, and there is a significant increase in several patients willing to get rid of the arthritic condition by getting the best treatment. We have a significant increase in sports injuries. However, in giving the best treatment for osteoarthritic and sports injury patients, there are lacunae in the surgeon's technique. So to improve patient care and surgical skill and provide the best care in the corners of India, the Department of Orthopaedics, Yenepoya Medical College, Mangalore planning to start up with comprehensive fellowship program of arthroplasty and arthroscopy, which is unique and deals with a both arthritic and sports medicine patients.

Goal

To provide high-level in-house clinical training in arthroplasty and arthroscopy for orthopedic surgeons so that the trained candidates can practice arthroplasty and sports medicine surgery and deal with all types of arthritic and sports-related ailments.

Aim of the program

To make fellows competent in arthroplasty and arthroscopic surgeries for all arthritis and sports injuries.

Objectives/Outcomes

PO1: To develop a systematic approach to identify the patients’ problem and decision-making for diagnosis.
PO2: To develop and sharpen skills in examining and assessing patients with arthritis and related problems requiring joint replacement surgery.
PO3: To attain basic surgical skills and techniques in primary and Revision arthroplasty to perform cases.
PO4: To develop surgical technical skills in Arthroplasty in Cadaveric Lab and real-life operation theatre conditions.

Arthroscopy program outcome

PO1: To acquire skills in clinical examination, radiographic analysis, and diagnosis of sports injury.
PO2: To train in arthroscopic skills in Cadaveric Lab and real-life operation theatre conditions.
PO3: To develop surgical skills to perform independent surgery and management of sports injuries.
PO4: To introduce the science of exercise prescription for various age groups and medical conditions.
PO5-To present Sports performance analysis and performance enhancement in sports.

Program specific Outcomes PSO - Arthroplasty

PSO1	To make a diagnosis	Examine the patient for possible arthritic changes in the knee, hip, and shoulder joints. Arrange appropriate imaging and identify the radiographic features of arthritic changes and come to the proper staging of arthritic changes.
PSO2	To formulate a treatment plan	To classify the arthritis of joints, formulate the plan and execute the treatment such as conservative, biological, osteotomy, and joint replacement.
PSO3	To counsel the patient	Describe the risks and benefits of surgical versus conservative management and consider the patient's preferences and expectations.
PSO4	To perform appropriate procedures	To be able to assist / perform various procedures.
PSO5	To manage or prevent complications	To assess the probable complications of the procedure and to notify it.

Program specific Outcomes PSO -Arthroscopy

PSO1	To make a diagnosis	History taking, clinical examination and radiographic assessment of sports injury cases
PSO2	To formulate a treatment plan	To come for proper diagnosis and treat in accordance with evidence based medicine
PSO3	To counsel the patient	Describe the risks and benefits of surgical versus conservative management and consider the patient’s preferences and expectations
PSO4	To perform appropriate procedures	To be able to assist / perform various surgical procedures
PSO5	To manage or prevent complications	To assess the probable complications of the procedure and to notify it

Eligibility for admission

1 year post-MS (Ortho) / DNB (Ortho)

Duration including hours of theory/practical/clinical/hands-on/Simulation-based, etc. (as applicable)

Duration of the course	13 months
Theory	4 hours per week
Practical and Clinics	6 hours per week
Contact hours	42 hours per week
E-learning hours	4 hours per week

Syllabus / Course contents

Syllabus: Includes relevant chapters covering the topics listed below for significant joints undergoing replacement arthroplasty routinely.

Basic Sciences and Applied Sciences
Anatomy
Physical Examination of specific joints
Radiologic Imaging
Diagnostic Evaluations
Templating
General Considerations for Arthroplasty Surgery Including Consent and Preparation. General Surgical Principles, Guidelines for Informed Consent, Patient Positioning for Surgery, Equipment Needed, Postoperative Considerations, Surgical Approaches
Hip, Knee, Shoulder, Elbow, and Ankle Instrumentation
Bone Graft and Bone Substitute Biology
Hip Arthroplasty

Surgical approaches -Posterior, Antero-lateral, Anterior
Hemiarthroplasty -Cemented, Uncemented
Total hip replacement-Cemented, Uncemented
Revision of total hip replacement

Acetabular revisions-cups, cages,3D printing, Bone grafting techniques, trabecular metal
Stem revisions-Extended trochanteric osteotomy, long stems, cement in the cement Computer-assisted Hip replacement Robotic Hip replacement

Knee Arthroplasty
1. Unicompartmental knee arthroplasty
  - Fixed bearing
  - Mobile bearing
2. Total Knee Arthroplasty
  - Cruciate retaining
  - Cruciate substituting
  - Mobile bearing
  - Uncemented Knee replacement
3. Revision Total knee
  - Use of stems—cemented, uncemented
  - Constrained knees
  - Hinged knees— rotating vs. fixed
  - Use of sleeves and cones
  - Computer-assisted Knee replacement
  - Robotic Knee replacement – Unicompartmental and Total knee
Shoulder
- Hemiarthroplasty
- Total shoulder arthroplasty
- Reverse Shoulder arthroplasty with transfers
Elbow
- Total elbow replacement
Ankle
- Total ankle replacement
Miscellaneous
- Gait Considerations in Patients with joint arthroplasty
- Spine-pelvic relations
- Periprosthetic fractures
- Prosthetic joint infections
- Post arthroplasty arthroscopy

Arthroscopy:

Instrumentation
Arthroscopic Setup & Portal Placements in Knee, Shoulder, Elbow, Wrist and Hip
Menisci
Cartilage
Synovium
Patellofemoral joint
Anterior cruciate ligament
Posterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
Postero lateral complex
Multiligament injury
Osteoarthritis
Shoulder Periarthritis
Shoulder Instability ‐ anterior, posterior, inferior, multi
SLAP & Biceps tendon lesions
Rotator cuff and Impingement /tear
Scapular dyskinesia
Ligaments around the ankle
Ankle Impingement
Ligaments around the wrist, TFCC
Ligaments around the elbow
Lateral Epicondylitis
Osteochondral defect
Intra‐articular and Peri‐articular Fractures

Weekly timetable

Sl. No	Week Schedule	Sub-Topic	Contact Hours
1	Monday	Sports Injury Clinic and learning Minor Procedures	7
2	Tuesday	Operation Theatre	7
3	Wednesday	Arthroplasty Clinic learning Minor Procedures	7
4	Thursday	Conduct Sports Clinics at different Sports clubs or Organizations or On Field or Wards and Classroom Lectures, Case-based teaching and learning, Online assignments, and Logbook completion or Research work.	7
5	Friday	Operation Theatre	7
6	Saturday	Physiotherapy and Rehabilitation	7
		Total hours per week Note: On-field training may be on weekends (as extra teaching and learning hours and may involve local traveling).	42

Surgical skills:

Assist	Perform Independently
Arthroplasty
Complex primary total knee and hip replacement	Primary total knee replacement
Revision of total knee replacement	Primary total hip replacement
Revision of total hip replacement	Hemiarthroplasty hip
Reverse total shoulder replacement	Hemiarthroplasty shoulder
Total shoulder replacement
Total elbow replacement
Arthroscopy
Arthroscopic Shoulder rotator cuff repair	Arthroscopic ACL Reconstruction
Arthroscopic Bankart repair	Arthroscopic meniscectomy/repair
Arthroscopic PCL repair	Diagnostic shoulder arthroscopy
Arthroscopic diagnostic small joints

Attendance requirements

After completing 13 months of course with 80% minimum attendance is required to appear for the University exam.

Academic Requirements

Research work

At the minimum, candidates should submit one paper to an indexed journal.
At least one presentation/poster in international/national/state conferences
To complete one clinical audit
Regular presentations in Local body orthopedic/Arthroplasty/arthroscopy meets.
Maintaining a Log of all Clinical and Surgical work and Practice.

Scheme of Examination:

University Examination
The final Examination (Fellowship in Arthroplasty and Arthroscopy of 200 marks) will include the Theory and Practical Examination of 200 marks each.
THEORY PAPER: - Paper 1 and 2 (200 Marks)

Paper – I - Arthroscopy and sports injuries Principles of Sports Medicine Upper Limb Sport Injuries Lower Limb Sport Injuries Trunk Sport Injuries Head & Spine Sport Injuries Special Groups in Sports Medicine Clinical Exercise Science for Sports Medicine Miscellaneous Topics	100 Marks
Paper-II- Arthroplasty Basic and Applied Science related to Arthroplasty, Arthroscopy and General Orthopaedics Biomechanics of Individual Joints Hip Arthroplasty Knee Arthroplasty Shoulder, Elbow, and Ankle Arthroplasty Recent Advances in Arthroplasty	100 Marks
Total	200 Marks

Nature and Number of Questions:

Each theory paper will consist of 10 long essays

Duration of Theory Papers: 3 hours for each question paper

b) PRACTICAL: -

OSCE (Objective Structured Clinical Examination)	100 Marks
Practical Skills Demonstration. / WPBA/MINI CEX	50 Marks
Viva Voce: Discuss case scenarios, complex concepts, clarity of subject, case-based discussions, etc.	50 Marks
Total	200

Criteria for Eligibility to Appear University Exam

80% attendance
Maintaining log book duly signed by the course director and coordinator
Research publications submission / accept in PubMed / Scopus
Paper / poster presentation either in national or state conferences

Criteria for pass

Minimum 50% marks in Theory
Minimum 50% marks in Practical

Declaration of results

Declared by the Yenepoya (Deemed to be University)/ Yenepoya Medical College

Logbook/Portfolio

The log book should be maintained, which must be countersigned by the course director

Reference books and Journals

Reference books for arthroplasty:

Charnley J. Low friction arthroplasty of the hip: Theory and practice [Internet]. 1979th ed. Berlin, Germany: Springer; 1978. Available from: http://dx.doi.org/10.1007/978-3-642-67013-8
Scott WN. Insall & Scott surgery of the knee, 2-volume set. 6th ed. Philadelphia, PA: Elsevier - Health Sciences Division; 2017
Bono J, Mccarthy J, Thornhill T, Bierbaum B, Turner RH. Revision Total Hip Arthroplasty. Bono JV, McCarthy JC, Thornhill TS, Bierbaum BE, Turner RH, editors. New York, NY: Springer New York; 1999
Azar FM, Canale ST, Beaty JH. Campbell’s operative orthopaedics, 4-volume set. 14th ed. Philadelphia, PA: Elsevier - Health Sciences Division; 2020.
Scuderi GR, Tria AJ Jr, editors. Surgical Techniques in Total Knee Arthroplasty. New York, NY: Springer New York; 2002.
Morrey BF. Master techniques in orthopaedic surgery®: The elbow, 3e. 2015
Gartsman GM. Shoulder Arthroplasty: Elsevier, 2008
Petty W. Total Joint Replacement. London, England: W B Saunders; 1991

Reference periodicals for arthroplasty:

Arthroplastyjournal.org. Available from: https://www.arthroplastyjournal.org/
JBJS. J Bone Joint Surg Am [Internet]. 2020
Clinical Orthopaedics and related research® [Internet]. Lww.com. [cited 2023 May 3]. Available from: https://journals.lww.com/clinorthop/pages/default.aspx

Reference books for arthroscopy:

Mark D. Drez and Millers’ Orthopaedic Sports Medicine Principles and Practice. Fifth Edition. Amsterdam: Elsevier; 2019.
Michael J Strobel. Manual of Arthroscopic Surgery. Germany, Springer, 2008
Fredrick Matsen, Frank A Cordaso, John Sperling, Steven Lippitt. Rockwood and Matsens' The Shoulder. Sixth Edition. USA. Elsevier, 2021
W Norman Scott. Insall and Scott Surgery of the Knee. Sixth Edition. USA, Elsevier. 2017
Azar FM, Canale ST, Beaty JH. Campbell’s operative orthopaedics, 4-volume set. 14th ed. Philadelphia, PA: Elsevier - Health Sciences Division; 2020.

Reference periodicals for arthroscopy:

Arthroscopyjournal.org. Available from: https://www.arthroscopyjournal.org/
Journal of Arthroscopy and Joint Surgery [Internet]. Sciencedirect.com. Available from: https://www.sciencedirect.com/journal/journal-of-arthroscopy-and-joint-surgery
Journal of Arthroscopic Surgery and Sports Medicine. Indian Arthroscopy Society; 2019. Available from: https://jassm.org/
Knee surgery, sports traumatology, arthroscopy [Internet]. Springer.Available from: https://www.springer.com/journal/167