Modern techniques in total knee arthroplasty
Authors: James Gillespie
Publication date: 01 Dec 2012
Total knee arthroplasty or replacement is a common elective orthopaedic operation. It is usually performed for osteoarthritis and uses metal to replace the articular surfaces of the tibia and femur.
When a senior orthopaedic trainee demonstrates a good understanding of the principles behind this procedure, he or she is gradually allowed to perform this surgery under supervision. This course reassures trainees, and their consultants, that they have understood why the surgery is performed as well as how it is performed.
The course is run by the medical education department of Depuy, a Johnson and Johnson company. The topics discussed are generic and are not specific to any particular type of implant.
Who is it for?
This two day course is for trainees in orthopaedic surgery and would suit any trainee who is getting exposure to elective knee arthroplasty clinics and theatre.
There were 40 people on the course I attended. Although it is aimed at specialty doctors and specialty trainees in their third year and above, there were some core trainees present.
When did you do it?
This two day course is held two to three times a year in Harlow, Essex. I attended in March 2012, in my specialty trainee year 4.
Why did you do it?
I attended this course to gain an in-depth understanding of the decision making process and technical skills involved in total knee arthroplasty. I hoped that demonstrating this awareness and problem solving would give my own consultants more confidence to allow me to perform more knee arthroplasty procedures.
What did it involve?
On day 1 a bioengineer discussed knee biomechanics and how they influence total knee arthroplasty design. The focus throughout the lecture was on general principles rather than on promoting a particular brand. It was of great value to have a forum where clinicians and biomechanics could look at a set of problems and goals from different points of view.
We were then split into groups of six to discuss the cases provided in the pre-course materials. We were able collectively to make reasoned decisions on these cases as to the sort of device we would use, which led nicely into a course-wide debate between the candidates, with advice from the faculty. The interactive nature of that discussion spilled over to the lectures, where we were encouraged to interrupt, ask questions, and steer the topics to where we thought most relevant.
Of course, no orthopaedic course would be complete without skills workshops. Here we had the opportunity to roll up our sleeves and have some fun performing surgery on artificial bones. We had a member of faculty at each table guiding the “surgery,” with their individual tips and tricks thrown in for good measure. This was an excellent and stress-free way for a trainee to become familiar with the equipment available for total knee arthroplasty.
By the end of the first day we had discussed different clinical issues, including the indications for surgery. Several different patterns of osteoarthritis were used to present cases with varying levels of difficulty. We were schooled in how to select patients for “standard” total knee arthroplasty and the limitations of these procedures. This led on to the topics of “complex primary” and “revision” arthroplasty. In both of these types of surgery we explored anatomical restoration, stability, and balancing of the knee.
Almost everyone attended the informal course dinner held at the end of the first day of the course.
On day 2, we drove by coach to the education centre of a local hospital, where a live video feed gave us a view of a primary and revision knee arthroplasty being done on a patient. The operating consultant talked us through the surgery, and a second consultant sat with us, facilitating two-way real-time discussion between the operating consultant and the course participants. The value of watching an expert via video link is that he or she can demonstrate and describe techniques and tips in a manner that would be difficult to replicate with text and photographs. We were encouraged to keep asking questions to get the most out of the opportunity.
How much effort did it entail?
Before the course I received a USB stick with nine case studies to review. This was an evening’s worth of work. These cases were then the focus of group discussion at the end of the first day. I have worked with several arthroplasty consultants in the past, and so the pathologies in the cases were familiar to me. Attendees with less previous exposure to the specialty may have required an extra few hours of background reading.
How much did it cost?
This course cost £100, which included an overnight stay in a hotel and meals.
Was there an exam?
There was no exam. It was an instructional course.
Was it worth it?
Yes, this course was worth attending. By the end of the two days most of the course participants felt comfortable with the topics covered, and completing the course has allowed me to gain more experience as the primary surgeon in total knee arthroplasty. It has also laid the foundations for attending a future advanced technical course.
Read up on knee biomechanics and how they relate to basic primary and revision knee arthroplasty before you attend the course.
Competing interests: None declared.
James Gillespie specialty registrar in trauma and orthopaedics
Forth Valley Royal Infirmary, UK