Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 4 | Apr, 2016

Objective Structured Assessments of Technical Skills (OSATS) Does Not Assess the Quality of the Surgical Result Effectively

Donald D. Anderson PhD, Steven Long BSE, Geb W. Thomas PhD, Matthew D. Putnam MD, Joan E. Bechtold PhD, Matthew D. Karam MD

Performance assessment in skills training is ideally based on objective, reliable, and clinically relevant indicators of success. The Objective Structured Assessment of Technical Skill (OSATS) is a reliable and valid tool that has been increasingly used in orthopaedic skills training. It uses a global rating approach to structure expert evaluation of technical skills with the experts working from a list of operative competencies that are each rated on a 5-point Likert scale anchored by behavioral descriptors. Given the observational nature of its scoring, the OSATS might not effectively assess the quality of surgical results.

Musculoskeletal Medicine Is Underrepresented in the American Medical School Clinical Curriculum

Benedict F. DiGiovanni MD, Leigh T. Sundem BS, Richard D. Southgate MD, David R. Lambert MD

Musculoskeletal (MSK) conditions are common, and their burden on the healthcare system is increasing as the general population ages. It is essential that medical students be well prepared to evaluate and treat MSK disorders in a confident manner as they enter the workforce. Recent studies and the American Association of Medical Colleges have raised concern that medical schools may not give sufficient instruction on this topic. Other authors have shown that preclinical instruction has increased over the past decade; however, it is unclear if required clinical instruction also has followed that trend.

Does Residency Selection Criteria Predict Performance in Orthopaedic Surgery Residency?

Tina Raman MD, Rami George Alrabaa BS, Amit Sood MD, Paul Maloof MD, Joseph Benevenia MD, Wayne Berberian MD

More than 1000 candidates applied for orthopaedic residency positions in 2014, and the competition is intense; approximately one-third of the candidates failed to secure a position in the match. However, the criteria used in the selection process often are subjective and studies have differed in terms of which criteria predict either objective measures or subjective ratings of resident performance by faculty.

Orthopaedic Surgery Residents and Program Directors Agree on How Time Is Currently Spent in Training and Targets for Improvement

Christopher L. Camp MD, John R. Martin MD, Matthew D. Karam MD, Daniel B. Ryssman MD, Norman S. Turner MD

Although much attention has been paid to the role of deliberate practice as a means of achieving expert levels of performance in other medical specialties, little has been published regarding its role in maximizing orthopaedic surgery resident potential. As an initial step in this process, this study seeks to determine how residents and program directors (PDs) feel current time spent in training is allocated compared with a theoretical ideal distribution of time.

Cognitive and Psychomotor Entrustable Professional Activities: Can Simulators Help Assess Competency in Trainees?

Tim Dwyer MBBS, Veronica Wadey MD, MEd, Douglas Archibald PhD, William Kraemer MD, Jesse Slade Shantz MD, John Townley MD, Darrell Ogilvie-Harris MD, MSc, Massimo Petrera MD, Peter Ferguson MD, MSc, Markku Nousiainen MD, MEd

An entrustable professional activity describes a professional task that postgraduate residents must master during their training. The use of simulation to assess performance of entrustable professional activities requires further investigation.

Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?

Markku T. Nousiainen MD, MSc, MEd, Sydney A. McQueen BSc, MSc, Peter Ferguson MD, MSc, Benjamin Alman MD, William Kraemer MD, Oleg Safir MD, MEd, Richard Reznick MD, MEd, Ranil Sonnadara PhD

Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time.

Is Teaching Simple Surgical Skills Using an Operant Learning Program More Effective Than Teaching by Demonstration?

I. Martin Levy MD, Karen W. Pryor BA, Theresa R. McKeon BA

A surgical procedure is a complex behavior that can be constructed from foundation or component behaviors. Both the component and the composite behaviors built from them are much more likely to recur if it they are reinforced (operant learning). Behaviors in humans have been successfully reinforced using the acoustic stimulus from a mechanical clicker, where the clicker serves as a conditioned reinforcer that communicates in a way that is language- and judgment-free; however, to our knowledge, the use of operant-learning principles has not been formally evaluated for acquisition of surgical skills.

Global Rating Scales and Motion Analysis Are Valid Proficiency Metrics in Virtual and Benchtop Knee Arthroscopy Simulators

Justues Chang MD, Daniel C. Banaszek MD, Jason Gambrel MD, Davide Bardana MD

Work-hour restrictions and fatigue management strategies in surgical training programs continue to evolve in an effort to improve the learning environment and promote safer patient care. In response, training programs must reevaluate how various teaching modalities such as simulation can augment the development of surgical competence in trainees. For surgical simulators to be most useful, it is important to determine whether surgical proficiency can be reliably differentiated using them. To our knowledge, performance on both virtual and benchtop arthroscopy simulators has not been concurrently assessed in the same subjects.

A Porcine Knee Model Is Valid for Use in the Evaluation of Arthroscopic Skills: A Pilot Study

R. Kyle Martin MD, Danny Gillis MD, Jeff Leiter MSc, PhD, Jesse Slade Shantz MD, MBA, Peter MacDonald MD

Previously validated knee arthroscopy evaluation tools have used human cadaveric knees. This is unsustainable because of the cost and scarcity of these specimens. Porcine (pig) knees are anatomically similar, affordable, and easily obtainable; however, whether porcine knees represent a suitable alternative to human specimens has not been evaluated.

Does Surgical Approach Affect Patient-reported Function After Primary THA?

Sara C. Graves MD, MS, Benjamin M. Dropkin MD, Benjamin J. Keeney PhD, Jon D. Lurie MD, MS, Ivan M. Tomek MD

Total hip arthroplasty (THA) relieves pain and improves physical function in patients with hip osteoarthritis, but requires a year or more for full postoperative recovery. Proponents of intermuscular surgical approaches believe that the direct-anterior approach may restore physical function more quickly than transgluteal approaches, perhaps because of diminished muscle trauma. To evaluate this, we compared patient-reported physical function and other outcome metrics during the first year after surgery between groups of patients who underwent primary THA either through the direct-anterior approach or posterior approach.

Ceramic Heads Decrease Metal Release Caused by Head-taper Fretting and Corrosion

Sevi B. Kocagoz BS, Richard J. Underwood PhD, Daniel W. MacDonald MS, Jeremy L. Gilbert PhD, Steven M. Kurtz PhD

Metal release resulting from taper fretting and corrosion is a clinical concern, because wear and corrosion products may stimulate adverse local tissue reactions. Unimodular hip arthroplasties have a conical taper between the femoral head (head bore taper) and the femoral stem (stem cone taper). The use of ceramic heads has been suggested as a way of reducing the generation of wear and corrosion products from the head bore/stem cone taper junction. A previous semiquantitative study found that ceramic heads had less visual evidence of fretting-corrosion damage compared with CoCr heads; but, to our knowledge, no studies have quantified the volumetric material loss from the head bore and stem cone tapers of a matched cohort of ceramic and metal heads.

How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

Maria Grazia Benedetti MD, Yusuke Okita PT, PhD, Elena Recubini MD, Elisabetta Mariani MD, Alberto Leardini PhD, Marco Manfrini MD

Rotationplasty may be indicated for some children with osteosarcoma in the distal femur or proximal tibia; in properly selected patients, it may offer functional advantages over transfemoral amputation and more durable results than a prosthesis. The clinical and functional outcomes reported for this procedure generally have been limited to studies with a mean followup of approximately 8 years in terms of Musculoskeletal Tumor Society Score (MSTS), physical examination, and gait analysis. However, the effects of residual thigh-shank length on gait have not been explored to our knowledge.

How Do Hindfoot Fusions Affect Ankle Biomechanics: A Cadaver Model

Ian D. Hutchinson MD, Josh R. Baxter PhD, Susannah Gilbert MS, MaCalus V. Hogan MD, Jeff Ling FRCAS, Stuart M. Saunders MD, Hongsheng Wang PhD, John G. Kennedy MD

While successful subtalar joint arthrodesis provides pain relief, resultant alterations in ankle biomechanics need to be considered, as this procedure may predispose the remaining hindfoot and tibiotalar joint to accelerated degenerative changes. However, the biomechanical consequences of isolated subtalar joint arthrodesis and additive fusions of the Chopart’s joints on tibiotalar joint biomechanics remain poorly understood.

Smoking is Associated with Increased Blood Loss and Transfusion Use After Lumbar Spinal Surgery

Peter T. McCunniff MD, Ernest S. Young MD, Kasra Ahmadinia MD, Uri M. Ahn MD, Nicholas U. Ahn MD

Little is known about the association between smoking and intraoperative blood loss and perioperative transfusion use in patients undergoing spinal surgery. However, we found that although many of the common complications and deleterious effects of smoking on surgical patients had been well documented, the aspect of blood loss seemingly had been overlooked despite data reported in nonorthopaedic sources to suggest a possible connection.

Periosteal Fiber Transection During Periosteal Procedures Is Crucial to Accelerate Growth in the Rabbit Model

Matthew A. Halanski MD, Tugrul Yildirim MD, Rajeev Chaudhary MS, Matthew S. Chin MD, Ellen Leiferman DVM

Disruption of the periosteum has been used to explain overgrowth after long bone fractures. Clinically, various periosteal procedures have been reported to accelerate growth with varied results. Differences between procedures and study populations, in these prior studies, make drawing conclusions regarding their effectiveness difficult.

What Are the Biomechanical Effects of Half-pin and Fine-wire Configurations on Fracture Site Movement in Circular Frames?

Daniel J. Henderson FRCS (Orth), Jeremy L. Rushbrook FRCS (Orth), Todd D. Stewart PhD, Paul J. Harwood FRCS (Orth)

Fine-wire circular frame (Ilizarov) fixators are hypothesized to generate favorable biomechanical conditions for fracture healing, allowing axial micromotion while limiting interfragmentary shear. Use of half-pins increases fixation options and may improve patient comfort by reducing muscle irritation, but they are thought to induce interfragmentary shear, converting beam-to-cantilever loading. Little evidence exists regarding the magnitude and type of strain in such constructs during weightbearing.

How do Orthopaedic Devices Change After Their Initial FDA Premarket Approval?

Andre M. Samuel BBA, Vinay K. Rathi BA, Jonathan N. Grauer MD, Joseph S. Ross MD, MHS

The FDA approves novel, high-risk medical devices through the premarket approval (PMA) process based on clinical evidence supporting device safety and effectiveness. Devices subsequently may undergo postmarket modifications that are approved via one of several PMA supplement review tracks, usually without additional supporting clinical data. While orthopaedic devices cleared via the less rigorous 510(k) pathway have been studied previously, devices cleared through the PMA pathway and those receiving postmarket PMA supplements warrant further investigation.

Dissociation and Intrapelvic Entrapment of a Dual-mobility Polyethylene Component

Keith A. Fehring MD, Daniel J. Berry MD

Dual-mobility bearings have gained popularity in recent years as a proposed method of reducing the risk of dislocation after primary and revision hip arthroplasties. Intraprosthetic dislocation, defined as dissociation of the smaller femoral head from the larger outer polyethylene head, is a known complication of these designs. Intraprosthetic dislocation typically requires reoperation and revision as closed reduction of intraprosthetic dislocations of these components is not effective. The small femoral head typically remains inside the large diameter acetabular component during intraprosthetic dislocation, thus the diagnosis may be missed if femoral head eccentricity is not identified on radiographs. Intraprosthetic dislocation leads to a free polyethylene bearing which typically stays in the joint space, however in theory, migration of the bearing is possible.

Erratum to: How Much Clinical and Functional Impairment do Children Treated With Knee Rotationplasty Experience in Adulthood?

Maria Grazia Benedetti MD, Yusuke Okita PT, PhD, Elena Recubini MD, Elisabetta Mariani MD, Alberto Leardini PhD, Marco Manfrini MD
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