Department of Orthopaedics

All India Institute of Medical Sciences, Raipur CG 492099

M.Ch Joint Replacement and Reconstructions
 M. Ch JOIN REPLACEMENT AND RECONSTRUCTION
3 YEAR COURSE
Justification:

AIIMS Raipur is the largest tertiary care center in Chhattisgarh state and caters to patients of CG, MP, Jharkhand,
Orissa, Bihar and Telangana. It lies in the geographical belt of sickle cell prone diseases and so avascular necrosis
of the femoral head needing total hip arthroplasties is in vogue. With growing age of population geriatric problems
including osteoporosis and osteoarthritis of the knee is rampant. Rheumatoid arthritis as the prototype of
inflammatory illnesses and TKR are in abundant in this population. The Department of Orthopaedics AIIMS
Raipur is performing Joint replacement surgeries for the last 5 years with success and currently performing around
200 surgeries every year. The Central Govt. and state Govt also through various schemes are financially helping
poor patients in getting their joints replaced. Department of Orthopaedics AIIMS Raipur with a daily OPD of more
than 250 patients and fully equipped 2 operation theaters is at par to any world class facilities for arthroplasties and
so we want to start the course.
Faculty:
1. Dr. Alok C Agrawal, Professor and Head of department
2. Dr. Bikram Keshri , Associate Professor
3. Dr. Harshal Shakle, Associate Professor
4. Dr. Alok Rai Raman, Assistant Professor
5. Dr. Arkesh M, Assistant Professor

Ordinance:

A. AIM OF TRAINING
The aim of training in M Ch Joint Replacement and Reconstructions is that at the end of the course the
trainee should have acquired knowledge, skills, aptitude and attitudes to be able to function as an
independent clinician performing joint replacements of the hip and knee with proficiency / Exposure to
other joint replacements and Revisions. He should be able to perform as a consultant and a teacher
acquainted with research methodology.
OBJECTIVES
At the end of the training the trainee:
1. Should be well acquainted with the current literature on relevant aspects of the basic, investigative,
clinical and operative Science of Arthroplasty.
2. Should have learned indications and performance skills of common Arthroplasty operations.
3. Should have acquired performance skills and ability to interpret relevant clinical investigations.
4. Should be able to diagnose, plan investigations and treat common conditions in the specialty by
relevant current therapeutic methods.
5. Should be acquainted with allied and general clinical disciplines to ensure appropriate and timely
referral.
 6. Should be capable of imparting basic orthopaedic and Arthroplasty training.
7. Should be able to identify, frame and carry out research proposals in the relevant specialty.
B. TRAINING SYSTEM
Exclusively on whole time service basis and on residency pattern. Two residents per academic year will
be selected for the same.

C. ELIGIBILITY
Essential
For Post MS
M S (orthopaedics only) degree of an Indian University recognized by the Medical Council of India or
any other examination recognized for the purpose by the MCI with an experience of three years as a
senior resident.
Mode of Selection
On All India basis based (by a written test followed by departmental assessment). For written test (MCQ
type) 75% of questions should be of ORTHOPAEDICS. Only those acquiring more than 50% marks in
the theory would be eligible for departmental assessment. 3 times of the no. of post available should be
called for departmental assessment strictly on the basis of merit . In service candidates with
requisite qualification will also be eligible for the course. For other trainees remuneration
will be as per rules and at par with 3 rd year senior resident of the institute.
A. TRAINING METHODS
1. Clinical teaching in the OPD and Operation theatres. Clinical teaching rounds in orthopaedics Ward
and bed side presentations.
2. Special teaching sessions like with radiology, PMR and rheumatology.
3. Seminars, Journal clubs, Mortality, Morbidity conferences, specialty clinics and case presentations.
4. Treatment planning sessions.
5. Assisting and performing operations.
6. Paper presentations at conferences.
7. A surgical Audit on the allotted topic.
8. Preparation of manuscript for publication.
B. Research and Thesis: The trainee will have to do research on an allotted topic duly approved by the
institute review committee and institute ethical committee and this will form Part 1 of the M Ch exam.
D. COURSE CONTENTS
Orientation Programme(6 months): This will consist of training in various peripheral specialities in the
institute like interventional radiology/ basic ultrasound diagnosis/ Trauma and Emergency management/
ICU / Plastic surgery/ Anaesthesia and Pain Clinic and PMR.
After Orientation he will devote full time in arthroplasty services.
1. Clinical learning including history taking, physical examination, diagnosis, selection and planning of
relevant investigations, appropriate treatment and rehabilitation of patients with JOINT disorders.

2. Essentials of joint pathology especially with reference to disorders common in India and those likely
 to present for joint replacement.
3. Basic medical sciences relevant to the practice of Arthroplasty
4. Development of proper attitudes towards patients, subordinates, colleagues and seniors.
5. Should have basic knowledge about application of computers.

The Syllabus will include the following topics:

A. Knee
1. Biomechanics of knee
2. Evolution and design of modern prosthesis
3. Pre op evaluation , indication and contraindication of total knee replacement
4. Assessment and results of total knee Arthroplasty
5. Various methods of TKR and techniques
6. Management of bone deficiency during TKR
7. TKR and specific problems
8. TKR in problem knee
9. Revision TKR
10. COMPLICATION OF total knee Arthroplasty and their management
11. Unicondylar knee replacement
12. Patellofemoral Arthroplasty
13. Alternative to TKA
• Arthrodesis
• Osteotomy
• HTO

B. Hip
1. Biomechanics of the hip joint
2. Selection of total hip replacement implants
3. Pre operative evaluation of a patient for THR including indications and contraindications
4. Surgical approaches and techniques for THR
5. Arthroplasty in septic hip disorders
6. Complications of THR
7. Revision THR
8. Postoperative management
9. Indication for hip preservation and technique
10. Indication for hip fusion and conversion of Arthrodesis to hip Arthroplasty
11. Alternative to hip arthroplasty

C. Ankle
1. Ankle Arthroplsty and Salvage
2. Alternative to ankle arthroplasty
3. Biomechanics of the ankle joint
4. Selection ankle replacement implants
5. Pre operative evaluation of a patient for Ankle arthroplasty including indications and
contraindications
6. Surgical approaches and techniques for Total Ankle Arthroplasty
 7. Arthroplasty in septic hip disorders
8. Complications of TAR
9. Reconstruction procedure of Ankle
10. Postoperative management
11. Indication for Ankle arthrodesis and conversion of Arthrodesis to Arthroplasty

D. Shoulder
1. Study of biomechanics and anatomy of shoulder joint
2. Indication and technique of Total Shoulder Arthroplasty
3. Reverse Shoulder Arthroplasty
4. Alternative to TSA
5. Revision TSA
6. Management of TSA
7. Selection of total shoulder replacement implants
8. Pre operative evaluation of a patient for TSR including indications and contraindications
9. Surgical approaches and techniques for TSR
10. Arthroplasty in septic hip disorders
11. Complications of TSR
12. Postoperative management
13. Indication and techniques for shoulder fusion

E. Elbow
1. Biomechanics and structure of the Elbow joint
2. Selection of elbow replacement implants
3. Pre operative evaluation of a patient for TER including indications and contraindications
4. Surgical approaches and techniques for TER
5. Arthroplasty in septic disorders
6. Complications of TER
7. Revision TER
8. Postoperative management
9. Indication for elbow preservation and techniques
10. Indication for elbow fusion and conversion of Arthrodesis to Arthroplasty
11. Alternative to elbow arthroplasty
12. Types of TEA
13. Salvage of TEA

F. Wrist and small joints

1. Biomechanics and surgical anatomy of the wrist Joint
2. Selection of replacement implants
3. Pre operative evaluation of a patient for wrist arthroplasty including indications and
contraindications
4. Surgical approaches and techniques for wrist arthroplasty
5. Arthroplasty in septic wrist disorders
6. Complications of wrist arthroplasty
7. Postoperative management
8. Indication for wrist preservation and techniques
9. Indication for wrist arthrodesis
10. Alternative to wrist arthroplasty
11. Arthroplasty of wrist , biomechanics, indications and types
 12. Anatomy and biomechanics of Small joints
13. Arthroplasty and alternatives to joint salvage in small joints.

G. General Orthopaedics and Reconstructions related to Congenital/ Post –traumatic/Inflammatory,

degenerative, metabolic, regenerative and Neoplastic illnesses.

E. VISIT TO OTHER INSTITUTIONS

Candidate in 3rd year should visit other Arthroplasty centers recognized by MCI for about 4 weeks to be
able to observe difference in approaches to various problems.
F. ESSENTIAL PRE-REQUISITE FOR APPEARING FOR M Ch (ARTHROPLASTY)
EXAMINATION
1. Logbook of work done (surgical procedures performed/assisted case presentation and other academic
activities): rotations, internal assessment report.
2. Completion of Surgical Audit.
3. Publications (a) paper on review of available clinical material from the department.

4.
Attendance 75% and internal assessment 50% as minimal requirement for appearing in exams.
I. EVALUATION OF M Ch (ARTHROPLASTY)
1. Internal assessment – 50% weightage
To be done by all teachers concerned in the training of the candidate both inside and outside
the parent department independently and entered into log book on a standard marking system .
The course director will average out and put the final evaluation.
2. Theory Papers 4 papers (100 Marks each)
1. Basic Sciences
2. Lower Limb Arthroplasties
3. Upper Linb Arthroplasties
4. Recent Advances
Minimum pass marks 50% in each paper.

i. Practical Examinations
Distributed as follows:
1. Clinical

2. Operative demonstration for M Ch

3. Viva

1. ACADEMIC ACTIVITIES
– By rotation each resident is expected to present 3-4 Clubs and 3-4 topics a year and enter it in the
log books.
– Additionally each resident (2nd year onwards) has to participate in one clinical Case Round and
one Clinical Grand Round which are presented to the entire faculty.
 – 3rd year residents are required to present cases one/week (5th semester) and thrice/week in the
final semester.
– By rotation residents are allowed to participate in and attend National and international
conference.

2. RESEARCH AND PROJECT WORK

– All M.Ch. candidates are required to submit their proposed project protocols, within 6 months
of joining the department.
– The final submission is mandatory 3 months prior to the final examination.
– The candidate is allowed to appear in the examinations only after the research projects have
been approved by the examiners.
3. INTRA DEPARTMENTAL EVALUATION OF RESIDENTS
– Every 6 months the department conducts an internal examination of the residents designed to test
their theoretical knowledge as well as clinical skills. For this purpose the residents take a
written theory paper of 3 hrs.duration and also present cases.

– In addition to this, he is also graded and marked for his academic presentations within the department.
– The log books endorsed every 6 months by the HOD also give an idea of each resident’s programe.
– In addition, the candidates are assessed on day to day basis on clinical ward rounds as well as
routine and emergency clinical/operative management of the patients.
4. DEGREE QUALIFYING EXAMINATION
The Degree qualifying examination is held at the end of 3 years after successful submission of research
projects/papers. This is conducted in the Department in the presence of 2 external and 2 Internal
examiners.The 2 external and one internal examiner apart from HOD can rotate amongst qualified
superspeciality teachers.
The examiners should not be below the rank of additional professor in the concerned subject.