What are key concepts for orthopedic recertification exams, based on the structure and content of Orthopaedic Knowledge Update (OKU) 14, American Academy of Orthopaedic Surgeons (AAOS), and American Board of Orthopaedic Surgery (ABOS) resources?

From the Guidelines

The most appropriate approach for managing osteoarthritis of the knee is to follow the AAOS clinical practice guideline summary, which emphasizes a multidisciplinary approach including non-pharmacologic and pharmacologic interventions, as well as surgical options when necessary, as outlined in the 2022 guideline update 1. When considering the management of osteoarthritis of the knee, it's essential to prioritize a comprehensive approach that addresses the patient's overall health, functional status, and quality of life.

• Non-pharmacologic interventions such as weight loss, exercise, and physical therapy should be considered first-line treatments.
• Pharmacologic options, including acetaminophen and NSAIDs, can be used to manage pain and inflammation.
• Surgical options, such as total knee arthroplasty, may be necessary for patients who have failed conservative management and have severe osteoarthritis. The 2022 AAOS clinical practice guideline update provides evidence-based recommendations for the management of osteoarthritis of the knee, emphasizing the importance of a multidisciplinary approach and individualized patient care 1. Key considerations in managing osteoarthritis of the knee include:
• Assessing the patient's overall health and functional status
• Developing a personalized treatment plan that addresses the patient's unique needs and goals
• Monitoring the patient's response to treatment and adjusting the plan as needed
• Considering the potential risks and benefits of different treatment options, including surgical interventions. The AAOS guideline recommends a stepped-care approach, starting with non-pharmacologic interventions and progressing to pharmacologic and surgical options as necessary, to optimize patient outcomes and minimize morbidity and mortality 1.

From the Research

Orthopedic Recertification Exams

• The American Board of Orthopaedic Surgery (ABOS) is responsible for recertification of orthopedic surgeons, ensuring quality medical care by competent and knowledgeable physicians 2.
• The recertification process is designed to assess the current status of orthopedic surgeons and determine how it will change in the near future 2.

Multiple-Choice Questions

• The Orthopaedic In-Training Examination (OITE) is a standardized, national test administered annually to orthopaedic residents, consisting of 275 multiple-choice questions that cover 11 domains of orthopaedic knowledge 3.
• The OITE has been validated and is considered predictive of success in both orthopaedic surgery residency and on the ABOS part I examination 3.
• For examination preparation, residents are encouraged to start early, practice on old OITE or self-assessment examination questions, focus on comprehension over memorization, and recognize and avoid burnout 3.

Hip Replacement

• Total hip replacement is a frequently done and highly successful surgical intervention, undertaken to relieve pain and improve function in individuals with advanced arthritis of the hip joint 4.
• The procedure is often performed on patients with symptomatic osteoarthritis, and assessment of surgery outcomes should include patient-reported outcome measures and implant survival rates 4.
• Total hip replacement for hip fracture requires consideration of unique factors, such as poor bone stock, older age, and co-morbidities, and may involve different surgical techniques, such as cementing the implant in place and using a large head size 5.

Acetabular Fractures

• Total hip replacement after acetabular fracture presents unique challenges to the orthopaedic surgeon, including infection, residual pelvic deformity, and acetabular bone loss 6.
• Indications for an acute total hip replacement include young patients with both femoral head and acetabular involvement with severe comminution, and the elderly with severe bony comminution 6.
• The outcomes of total hip replacement for established post-traumatic arthritis include excellent pain relief and functional improvements 6.

Sample Questions

• What is the primary indication for total hip replacement?
  • Answer: Symptomatic osteoarthritis 4.
• What is the recommended approach for total hip replacement in hip fracture patients?
  • Answer: Anterolateral approach, cementing the implant in place, and using a large head size 5.
• What are the unique challenges of total hip replacement after acetabular fracture?
  • Answer: Infection, residual pelvic deformity, acetabular bone loss, and heterotopic ossification 6.