COVID-19 and the transition to virtual teaching sessions in an orthopaedic surgery training program: a survey of resident perspectives.

BACKGROUND: COVID-19 has had a tremendous impact on medical education. Due to concerns of the virus spreading through gatherings of health professionals, in-person conferences and rounds were largely cancelled. The purpose of this study is the evaluate the implementation of an online educational curriculum by a major Canadian orthopaedic surgery residency program in response to COVID-19. METHODS: A survey was distributed to residents of a major Canadian orthopaedic surgery residency program from July 10th to October 24th, 2020. The survey aimed to assess residents' response to this change and to examine the effect that the transition has had on their participation, engagement, and overall educational experience. RESULTS: Altogether, 25 of 28 (89%) residents responded. Respondents generally felt the quality of education was superior (72%), their level of engagement improved (64%), and they were able to acquire more knowledge (68%) with the virtual format. Furthermore, 88% felt there was a greater diversity of topics, and 96% felt there was an increased variety of presenters. Overall, 76% of respondents felt that virtual seminars better met their personal learning objectives. Advantages reported were increased accessibility, greater convenience, and a wider breadth of teaching faculty. Disadvantages included that the virtual sessions felt less personal and lacked dynamic feedback to the presenter. CONCLUSIONS: Results of this survey reveal generally positive attitudes of orthopaedic surgery residents about the transition to virtual learning in the setting of an ongoing pandemic. This early evaluation and feedback provides valuable guidance on how to grow this novel curriculum and bring the frontier of virtual teaching to orthopaedic education long-term.

Three-dimensional printing in orthopaedic surgery: a scoping review.

Three-dimensional printing (3DP) has become more frequently used in surgical specialties in recent years. These uses include pre-operative planning, patient-specific instrumentation (PSI), and patient-specific implant production.The purpose of this review was to understand the current uses of 3DP in orthopaedic surgery, the geographical and temporal trends of its use, and its impact on peri-operative outcomesOne-hundred and eight studies (N = 2328) were included, published between 2012 and 2018, with over half based in China.The most commonly used material was titanium.Three-dimensional printing was most commonly reported in trauma (N = 41) and oncology (N = 22). Pre-operative planning was the most common use of 3DP (N = 63), followed by final implants (N = 32) and PSI (N = 22).Take-home message: Overall, 3DP is becoming more common in orthopaedic surgery, with wide range of uses, particularly in complex cases. 3DP may also confer some important peri-operative benefits. Cite this article: EFORT Open Rev 2020;5:430-441. DOI: 10.1302/2058-5241.5.190024.

Heterotopic Ossification following Total Elbow Arthroplasty in a Patient with Parkinson's Disease: Case Report and Literature Review.

Introduction. Heterotopic ossification (HO) usually develops following surgery or trauma. Risk factors for HO following elbow fractures include delay to surgery (>7 days), floating fractures, and elbow subluxation. Systemic risk factors for HO include male sex; concurrent cranial, neurological, or abdominal injury; high-energy trauma; previous development of HO; and contralateral fracture. To date, no studies have reported on Parkinson's disease (PD) as a risk factor for the development of HO. Case Presentation. A 68-year-old female with PD (treated with levodopa-carbidopa) sustained a right closed (OTA type A3) distal humerus fracture and was treated with a total elbow arthroplasty. Postoperatively, development of significant near-ankylosing HO was observed and contributed to significant restriction of elbow motion with activities of daily living. After HO maturation, the osseous growth was excised, and the area irradiated. The patient regained excellent elbow motion with no recurrence of HO. Discussion. A literature review revealed six cases of HO development in PD patients following arthroplasty. Patients with PD have higher serum concentrations of interleukins (IL) and tumor necrosis factor- (TNF-) α. These factors stimulate BMP-2 production which may promote osteogenesis. Levodopa-carbidopa may also influence HO through stimulation of growth hormone and IGF-1. Conclusion. Parkinsonism may promote heterotopic bone growth through the release of osteoinductive factors. HO development may also be mediated by levodopa-carbidopa therapy. Future research should highlight the link between HO and PD and identify if prophylaxis is warranted in PD patients undergoing arthroplasty.

Cement Waste During Primary Total Knee Arthroplasty and its Effect on Cost Savings: An Institutional Analysis.

Purpose Healthcare costs are increasingly garnering more media attention and there is increasing focus on improving efficiencies in daily practice. Orthopedic surgery is also subject to these fiscal pressures, particularly in arthroplasty surgeries, secondary to high volumes with costly equipment. Total knee arthroplasties (TKA) are one of the most common surgical procedures, with over 64,000 annual cases in Canada. Even marginal cost reductions per procedure can be compounded over the large volume to result in considerable savings. This study's purpose is to investigate and quantify the cost of wasted intraoperative cement used in primary TKA. Methods Residual amounts of wasted bone cement were collected and measured following uncomplicated primary TKAs performed by the senior authors in a high-volume arthroplasty centre between January and June 2017. Stryker Simplex® with Tobramycin Bone Cement was the specific institutional cement used. Results One hundred and two primary total knee arthroplasties were investigated. The results revealed that an average 91.2 g of surgical cement was wasted per case, with less than 30 g retained in the bone-implant interface (26.8 g). Institutional costs per package of cement is $120.62, amounting to $2.04 per gram of cement. This represents a value of $186.25 CAD per case. Conclusion On average, each primary TKA procedure wastes 91.2 g of bone cement per case. The value of this wasted cement is $186.25 CAD per TKA. When extrapolated to the most recent recorded numbers of TKAs done in Canada, that figure nears $12 million. The results of this study are important, as they reveal a potential source to target for both waste reduction and cost control.