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Papers by David Backstein

Spine, 2013

A cross-sectional survey of spine surgery fellowship educators and trainees. To determine educato... more A cross-sectional survey of spine surgery fellowship educators and trainees. To determine educator and trainee perspectives on the relative importance of core cognitive and procedural competencies in fellowship training. To determine perceptions of confidence in competencies by trainees near the end of their fellowship. Finally, to determine potential differences comparing surgeons by background specialty training (neurosurgical or orthopedic) of their views on competencies. Spine surgery is a growing subspecialty with increasing collaboration among specialists of varied specialty backgrounds involved in education. With the recent implementation of competency-based curricula during specialty training, opportunities may exist in enhancing fellowship education. A questionnaire on cognitive and procedural competencies was administered (online and paper) to fellowship educators and trainees across Canada. A follow-up questionnaire was administered to nonresponders 3 months later. Survey results were summarized using qualitative and descriptive statistics with comparative analyses performed. Of the identified respondents, the response rate was 91%, (15/17 fellow trainees; 47/51 educators). Twelve of the 13 core cognitive skill categories were rated as being important to acquire by the end of fellowship. Trainees were not comfortable performing, and requested additional training in 8 of the 29 less common and technically demanding procedural skills. There were different perceptions on the relative importance of competencies comparing trainees by specialty background as well as different perceptions on the types of competencies where additional training was desired to achieve competency (P < 0.05). Fellowship educators and trainees possessed similar perceptions on the relative importance of core cognitive and procedural competencies required for successful training. Background specialty influenced the perceptions of both fellowship educators and trainees. This study identified potential gaps or perceived deficiencies in the competency of current fellows. Improvements in spine fellowship education should target these areas through developing evidence-based curriculum changes.

The Journal of Arthroplasty, 2015

Thorough radiographic evaluation is necessary for perioperative assessments in revision total kne... more Thorough radiographic evaluation is necessary for perioperative assessments in revision total knee arthroplasty. There has been a large degree of variability in reporting these findings within the peer-reviewed literature. Our purpose was to evaluate studies that radiographically assessed alignment in the coronal and sagittal plane, patella alignment and thickness, presence and characterization of implant interface, and radiolucency. Secondly, we reviewed studies using a standardized reporting system to evaluate radiographic findings (the Knee Society Roentgenographic Evaluation and Scoring System) and the number of times it was referenced. Only 62% of studies evaluated all radiographic parameters, 57% to 91% assessed each metric, and 55% used standardized reporting systems. This emphasizes the need for a uniform evaluation method to ensure consistent radiographic assessment and optimal standard of care.

The Journal of Arthroplasty, 2015

To accompany the new clinical Knee Society Score, a committee was formed to develop an updated ra... more To accompany the new clinical Knee Society Score, a committee was formed to develop an updated radiographic assessment and evaluation system. The purpose is to accumulate radiographic data in a standardized manner to facilitate more accurate interpretation, documentation and clinical correlation. We systematically reviewed the TKA radiographic evaluation literature as well as the original Knee Society Radiographic Evaluation and Scoring System. A modern system was developed, approved by the Knee Society membership, which ensured proper radiographic documentation of coronal and sagittal implant alignment, fixation interface integrity with respect to radiolucent lines and osteolysis, and a zonal classification system to document precise deficiency locations. It is hoped that data may be accumulated in a standardized manner with eventual formulation of implant risk "criteria" or "scores'.

Procedia - Social and Behavioral Sciences, 2010

The purpose of this study was to look for equivalency between Self-directed (SD) and guided learn... more The purpose of this study was to look for equivalency between Self-directed (SD) and guided learning of a relatively complex surgical technique. Residents learned three Z-plasty repairs, were given a pre-test and after an hour of practice, a post-test. Fifteen surgical residents were randomly assigned into a SD group (choose practice order) or a Control group (prescribed a practice order yoked to a subject in the SD group). No learning advantage of guided practice over SD practice was found (p < .05). Our findings suggest that SD practice schedules may be in fact suitable for learning complex technical skills.

Techniques in Knee Surgery, 2005

Journal of Motor Behavior, 2007

Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice... more Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice of the individual skills composing the task in either a blocked or a random order. The authors used those 3 schedules to study 18 participants' learning of an orthopedic surgical task. They assessed learning by obtaining expert evaluation of performance and objective kinematic measures

Current Orthopaedic Practice, 2008

A 69-year-old woman with a history of bilateral developmental hip dysplasia presented for routine... more A 69-year-old woman with a history of bilateral developmental hip dysplasia presented for routine follow-up of her left acetabular revision arthroplasty. This was performed 13 years previously through a transtrochanteric approach and consisted of a cemented, all-polyethylene cup ...

Seminars in Arthroplasty, 2009

Extensor mechanism failure after total knee arthroplasty is an infrequent but devastating complic... more Extensor mechanism failure after total knee arthroplasty is an infrequent but devastating complication. Several techniques for reconstruction have been proposed. Satisfactory results have been reported using whole extensor allograft implantation. However, this surgery can be technically demanding, may require specialized tissue, and often demands attention to critical technical parts of the procedure. Preoperative considerations should include an assessment of patient potential for rehabilitation compliance, eradication of infection, and ensuring that a sufficient soft-tissue envelope will be available for a safe and successful closure. Critical surgical techniques relate to the incision and approach, preparation of the graft, distal and proximal graft fixation, all in the context of proper prosthetic component implantation. Finally, appropriate postoperative rehabilitation protocols must be adhered to protect the graft and encourage healing, while providing optimal conditions for restoration of extensor mechanism strength and knee range of motion. A review of the reported results to date suggests that the application of the principles of whole allograft reconstruction for extensor mechanism failure after total knee arthroplasty can lead to satisfactory outcomes with improved function and mild extensor lags in most patients. Semin

The Journal of Arthroplasty, 2014

In some cases, above knee amputation (AKA) for a chronically infected total knee arthroplasty is ... more In some cases, above knee amputation (AKA) for a chronically infected total knee arthroplasty is the only option. The purpose of this study was to assess patient satisfaction following AKA and to identify factors which may be indicative of successful outcome following AKA. A review was performed of 7 patients who underwent an AKA for a recurrent peri-prosthetic knee infection. Patient satisfaction was gauged through a modified questionnaire. All patients were satisfied with their AKA and 6 of 7 stated that they would have chosen an amputation earlier. Greater than 6 attempts at limb-salvage and failed gastrocnemius flap were identified by expert opinion as possible poor prognostic factors. Despite poor function, patients with chronically infected TKAs are satisfied following an AKA.

The American Journal of Surgery, 2005

Background: Practicing surgical tasks on bench models can be arranged in 3 ways: as the entire ta... more Background: Practicing surgical tasks on bench models can be arranged in 3 ways: as the entire task, or as individual skills practiced separately in blocked or random order. The issue of the optimal practice schedule for the acquisition of surgical tasks is critical for enhancing training programs. Method: An orthopedic bone-plating task was practiced as a whole, or in parts in either a random or a blocked order. Learning was assessed on global ratings, checklists, and final product analysis before, immediately after, and an hour after practice. Results: Checklists, and final product analysis, but not the global ratings showed that practicing the entire task resulted in the most learning, followed by the random practice. Practice of the skills in a blocked order yielded the least amount of learning. Conclusions: It is recommended that surgical tasks composed of several discrete skills should be practiced as a whole. However, if part practice is necessary, these skills should be arranged in random order to optimize learning.

Procedia - Social and Behavioral Sciences, 2010

... Stapleton, A. Serious games: Serious opportunities. In Proceedings of the 2004 Australian Gam... more ... Stapleton, A. Serious games: Serious opportunities. In Proceedings of the 2004 Australian Game Developers Conference, pages 1-6, Melbourne, Australia, 2004. ... Proceedings of the IEEE International Conference on Systems, Man and Cybernetics, 2003, pages 2932-2937 ...

The Journal of bone and joint surgery. American volume, 2003

The management of large posttraumatic full-thickness osteochondral defects in the proximal part o... more The management of large posttraumatic full-thickness osteochondral defects in the proximal part of the tibia remains a challenge. The goal of treatment is a pain-free range of motion of the knee that provides enduring function and enables a young patient to participate in a wide range of activities. The use of fresh osteochondral allograft transplantation for tibial plateau lesions has been well documented. The purpose of the present study was to assess the survivorship and the long-term functional outcome following fresh osteochondral transplantation for unipolar posttraumatic tibial plateau defects in young, high-demand patients. A cohort study was carried out to assess outcome in patients who had undergone fresh tibial osteochondral grafting for the treatment of a posttraumatic defect that measured at least 3 cm in diameter and 1 cm in depth. Sixty-five (97%) of sixty-seven patients were identified and were evaluated clinically and radiographically. A modified Hospital for Specia...

The journal of knee surgery, 2003

This study assessed the Modified Coventry-Maquet technique for high tibial osteotomy with respect... more This study assessed the Modified Coventry-Maquet technique for high tibial osteotomy with respect to the incidence of patella baja using the Insall-Salvati index. Twenty-seven high tibial osteotomies performed or supervised by a single surgeon (A.E.G.) between 1996 and 2000 were analyzed. Eight knees were excluded; the remaining 19 were evaluated. Mean patient age at surgery was 49 years, and the mean postoperative Insall-Salvati index was 0.83. This represented an average decrease in patellar height of 15% (P<.000001). The incidence of new-onset postoperative patella baja was 26% (5/19). Tibial posterior slope increased by an average of 4.3 degrees (P<.0001). Mean tibial tuberosity height decreased by an average of 8.9 mm (P<.0001). The mechanical axis was corrected by an average of 11.9 degrees and loss of range of motion postoperatively was negligible. The correlation between tibial slope, tuberosity height, and patellar height was not significant. The modified Coventry-...

Clinical orthopaedics and related research, 2006

Massive bone defects are challenging problems in revision knee surgery. When defects are large an... more Massive bone defects are challenging problems in revision knee surgery. When defects are large and uncontained (without a cortical rim), structural allografts may be used to provide support for femoral and tibial components. This study reviewed 68 structural allografts at a mean of 5.4 years for clinical and radiographic outcomes. Indications for grafts included periprosthetic fracture in 19 knees, aseptic loosening in 29, infection in 11 and instability in 2. Seven knees had both femoral and tibial allografts. Multiple implant designs were used including 7 hinged prostheses. Thirteen knees (13/61) failed due to graft related complications including one graft nonunion, three aseptic loosenings, three periprosthetic fractures, four infections, and two for instability. The case of graft nonunion was successfully treated with revision fixation and autologous bone graft. There were three cases of graft resorption, two graded as severe and one as moderate. These results are satisfactory ...

Orthopedics, 2009

Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental h... more Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental hip dysplasia is often complex due to anterolateral acetabular bone deficiency. The use of femoral head (shelf) autograft during the index arthroplasty provides nonimmunogenic, osteoconductive support with the potential for enhanced bone stock should revision surgery be required. Few long-term studies document the outcome of the use of shelf grafts in primary THA or quantify the need for further bone graft at revision surgery. A retrospective analysis was conducted of a single surgeon's series of 31 THAs performed in 25 patients with developmental hip dysplasia. Postoperative biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range, 8-18 years). Grafts were assessed for union, resorption, and displacement. The need for acetabular bone graft at revision surgery was recorded. Bony union was observed in 93% of cases; fibrous uni...

Canadian journal of surgery. Journal canadien de chirurgie, 2014

Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation bet... more Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation between the components revised during hip arthroplasty (femur only, acetabulum only and both components) to the rates of dislocation in the first and multiple revision THA. We obtained data from consecutive revision THAs performed between January 1982 and December 2005. Patients were grouped into femur-only revision, acetabulum-only revision and revision THA for both components. A total of 749 revision THAs performed during the study period met our inclusion criteria: 369 first-time revisions and 380 repeated revisions. Dislocation rates in patients undergoing first-time revisions (5.69%) were significantly lower than in those undergoing repeated revisions (10.47%; p = 0.022). Within the group of first-time revisions, dislocation rates for acetabulum-only revisions (10.28%) were significantly higher than those for both components (4.61%) and femur-only (0%) reconstructions (p = 0.025). Alth...

The Journal of bone and joint surgery. American volume, Jan 2, 2014

Osteochondral defects of the knee in young, active patients represent a challenge to the orthopae... more Osteochondral defects of the knee in young, active patients represent a challenge to the orthopaedic surgeon. Our study examined long-term outcomes of the use of fresh allograft for posttraumatic osteochondral and osteochondritis dissecans defects in the distal aspect of the femur.METHODS: We reviewed the cases of sixty-three patients who underwent osteochondral allograft transplantation to the distal aspect of the femur between 1972 and 1995. Five patients who resided out of the country were lost to follow-up. Indications for the allograft procedure were an age of less than fifty years and a unipolar posttraumatic osteochondral or osteochondritis dissecans defect in the distal aspect of the femur that was larger than 3 cm in diameter and 1 cm in depth.RESULTS: Fifty-eight patients ages eleven to forty-eight years at the time of surgery (mean age, twenty-eight years) were followed for a mean of 21.8 years (range, fifteen to thirty-two years). Thirteen of the fifty-eight cases requir...

Seminars in Arthroplasty, 2010

ABSTRACT Treatment of massive contained acetabular defects is challenging. The current generation... more ABSTRACT Treatment of massive contained acetabular defects is challenging. The current generation of reconstruction cages in combination with either morcellized or structural allograft bone has given promising results. However, a significant proportion will fail due to lack of biological fixation of the cage, resulting in fatigue fracture. This study examines the early results of a new technique of combining a cage with a shell of Trabecular Metal (Zimmer, Warsaw, IN), because this material has the potential to enhance biological fixation. Fourteen patients with major acetabular defects underwent revision total hip arthroplasty with a Cup-Cage construct. Clinical and radiographic outcomes were determined at minimum 2-year follow-up. Complications, reoperations, and functional status (overall satisfaction, pain, limp, and use of gait-aids) were assessed. Radiographs were analyzed for evidence of implant migration, new radiolucent lines, and bone graft resorption. Mean follow-up was 27 months (range: 1-39), excluding 1 death in less than 1 year after surgery. Outcomes were 82% excellent or good, 12% fair, and 6% poor. Average pre- and postoperative Western Ontario MacMaster scores were 64 and 33 points, respectively. Oxford hip scores were an average of 45 preoperative and 28 postoperative. Short-form-36 averaged 351 preoperative and 601 postoperative. Radiographically, all the implants were stable and none had migrated.

The American Journal of Surgery, 2004

Background: The addition of video feedback to bench model training offers residents the opportuni... more Background: The addition of video feedback to bench model training offers residents the opportunity to see themselves perform a surgical task. Videotaped feedback therefore promotes self-evaluation, a critical learning skill, and also has the potential to influence how a resident executes a skill once they have had the opportunity to see themselves perform the task. Methods: Twenty-nine surgical residents were video recorded while performing three technical skills. They then were randomly assigned to receive either no feedback, video feedback alone, or video feedback with the help of an expert, an orthopedic surgeon. The surgical task was then repeated. Orthopedic surgeons evaluated the videotapes using the global rating scale and technical checklist form. Results: One-way between-subject analysis of variance comparing the pretest and post-test difference scores on three different measures for each of the three tasks revealed no statistically significant differences. After controlling for rater variance, the global rating scores across the three surgical tasks did not reveal any statistically significant differences. Conclusions: This study failed to demonstrate an improvement in technical skills based on utilization of video feedback.

Surgery, 2008

Background. Practice using computer-based video instruction (CBVI) leads to improvements in surgi... more Background. Practice using computer-based video instruction (CBVI) leads to improvements in surgical skills proficiency. This study investigated the benefits of the introduction of (a) learner-directed, interactive video training and (b) the addition of expert instruction on the learning and retention of the basic surgical skills of suturing and knot-tying in medical students. Methods. Using bench models, students were pre-tested on a suturing and knot-tying skill after viewing an instructional video. The students were then randomly assigned to three practice conditions: self-study with video; self-study with interactive video; or the combination of self-study with interactive video with the addition of subsequent expert instruction. All participants underwent 18 trials of practice in their assigned training condition. The effectiveness of training was assessed by an immediate post-test and a retention test one month later. Performance was evaluated using expert-and computer-based assessments. Data were analyzed using repeated-measures ANOVA.

Spine, 2013

A cross-sectional survey of spine surgery fellowship educators and trainees. To determine educato... more A cross-sectional survey of spine surgery fellowship educators and trainees. To determine educator and trainee perspectives on the relative importance of core cognitive and procedural competencies in fellowship training. To determine perceptions of confidence in competencies by trainees near the end of their fellowship. Finally, to determine potential differences comparing surgeons by background specialty training (neurosurgical or orthopedic) of their views on competencies. Spine surgery is a growing subspecialty with increasing collaboration among specialists of varied specialty backgrounds involved in education. With the recent implementation of competency-based curricula during specialty training, opportunities may exist in enhancing fellowship education. A questionnaire on cognitive and procedural competencies was administered (online and paper) to fellowship educators and trainees across Canada. A follow-up questionnaire was administered to nonresponders 3 months later. Survey results were summarized using qualitative and descriptive statistics with comparative analyses performed. Of the identified respondents, the response rate was 91%, (15/17 fellow trainees; 47/51 educators). Twelve of the 13 core cognitive skill categories were rated as being important to acquire by the end of fellowship. Trainees were not comfortable performing, and requested additional training in 8 of the 29 less common and technically demanding procedural skills. There were different perceptions on the relative importance of competencies comparing trainees by specialty background as well as different perceptions on the types of competencies where additional training was desired to achieve competency (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Fellowship educators and trainees possessed similar perceptions on the relative importance of core cognitive and procedural competencies required for successful training. Background specialty influenced the perceptions of both fellowship educators and trainees. This study identified potential gaps or perceived deficiencies in the competency of current fellows. Improvements in spine fellowship education should target these areas through developing evidence-based curriculum changes.

The Journal of Arthroplasty, 2015

Thorough radiographic evaluation is necessary for perioperative assessments in revision total kne... more Thorough radiographic evaluation is necessary for perioperative assessments in revision total knee arthroplasty. There has been a large degree of variability in reporting these findings within the peer-reviewed literature. Our purpose was to evaluate studies that radiographically assessed alignment in the coronal and sagittal plane, patella alignment and thickness, presence and characterization of implant interface, and radiolucency. Secondly, we reviewed studies using a standardized reporting system to evaluate radiographic findings (the Knee Society Roentgenographic Evaluation and Scoring System) and the number of times it was referenced. Only 62% of studies evaluated all radiographic parameters, 57% to 91% assessed each metric, and 55% used standardized reporting systems. This emphasizes the need for a uniform evaluation method to ensure consistent radiographic assessment and optimal standard of care.

The Journal of Arthroplasty, 2015

To accompany the new clinical Knee Society Score, a committee was formed to develop an updated ra... more To accompany the new clinical Knee Society Score, a committee was formed to develop an updated radiographic assessment and evaluation system. The purpose is to accumulate radiographic data in a standardized manner to facilitate more accurate interpretation, documentation and clinical correlation. We systematically reviewed the TKA radiographic evaluation literature as well as the original Knee Society Radiographic Evaluation and Scoring System. A modern system was developed, approved by the Knee Society membership, which ensured proper radiographic documentation of coronal and sagittal implant alignment, fixation interface integrity with respect to radiolucent lines and osteolysis, and a zonal classification system to document precise deficiency locations. It is hoped that data may be accumulated in a standardized manner with eventual formulation of implant risk &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;criteria&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;scores&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;.

Procedia - Social and Behavioral Sciences, 2010

The purpose of this study was to look for equivalency between Self-directed (SD) and guided learn... more The purpose of this study was to look for equivalency between Self-directed (SD) and guided learning of a relatively complex surgical technique. Residents learned three Z-plasty repairs, were given a pre-test and after an hour of practice, a post-test. Fifteen surgical residents were randomly assigned into a SD group (choose practice order) or a Control group (prescribed a practice order yoked to a subject in the SD group). No learning advantage of guided practice over SD practice was found (p < .05). Our findings suggest that SD practice schedules may be in fact suitable for learning complex technical skills.

Techniques in Knee Surgery, 2005

Journal of Motor Behavior, 2007

Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice... more Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice of the individual skills composing the task in either a blocked or a random order. The authors used those 3 schedules to study 18 participants' learning of an orthopedic surgical task. They assessed learning by obtaining expert evaluation of performance and objective kinematic measures

Current Orthopaedic Practice, 2008

A 69-year-old woman with a history of bilateral developmental hip dysplasia presented for routine... more A 69-year-old woman with a history of bilateral developmental hip dysplasia presented for routine follow-up of her left acetabular revision arthroplasty. This was performed 13 years previously through a transtrochanteric approach and consisted of a cemented, all-polyethylene cup ...

Seminars in Arthroplasty, 2009

Extensor mechanism failure after total knee arthroplasty is an infrequent but devastating complic... more Extensor mechanism failure after total knee arthroplasty is an infrequent but devastating complication. Several techniques for reconstruction have been proposed. Satisfactory results have been reported using whole extensor allograft implantation. However, this surgery can be technically demanding, may require specialized tissue, and often demands attention to critical technical parts of the procedure. Preoperative considerations should include an assessment of patient potential for rehabilitation compliance, eradication of infection, and ensuring that a sufficient soft-tissue envelope will be available for a safe and successful closure. Critical surgical techniques relate to the incision and approach, preparation of the graft, distal and proximal graft fixation, all in the context of proper prosthetic component implantation. Finally, appropriate postoperative rehabilitation protocols must be adhered to protect the graft and encourage healing, while providing optimal conditions for restoration of extensor mechanism strength and knee range of motion. A review of the reported results to date suggests that the application of the principles of whole allograft reconstruction for extensor mechanism failure after total knee arthroplasty can lead to satisfactory outcomes with improved function and mild extensor lags in most patients. Semin

The Journal of Arthroplasty, 2014

In some cases, above knee amputation (AKA) for a chronically infected total knee arthroplasty is ... more In some cases, above knee amputation (AKA) for a chronically infected total knee arthroplasty is the only option. The purpose of this study was to assess patient satisfaction following AKA and to identify factors which may be indicative of successful outcome following AKA. A review was performed of 7 patients who underwent an AKA for a recurrent peri-prosthetic knee infection. Patient satisfaction was gauged through a modified questionnaire. All patients were satisfied with their AKA and 6 of 7 stated that they would have chosen an amputation earlier. Greater than 6 attempts at limb-salvage and failed gastrocnemius flap were identified by expert opinion as possible poor prognostic factors. Despite poor function, patients with chronically infected TKAs are satisfied following an AKA.

The American Journal of Surgery, 2005

Background: Practicing surgical tasks on bench models can be arranged in 3 ways: as the entire ta... more Background: Practicing surgical tasks on bench models can be arranged in 3 ways: as the entire task, or as individual skills practiced separately in blocked or random order. The issue of the optimal practice schedule for the acquisition of surgical tasks is critical for enhancing training programs. Method: An orthopedic bone-plating task was practiced as a whole, or in parts in either a random or a blocked order. Learning was assessed on global ratings, checklists, and final product analysis before, immediately after, and an hour after practice. Results: Checklists, and final product analysis, but not the global ratings showed that practicing the entire task resulted in the most learning, followed by the random practice. Practice of the skills in a blocked order yielded the least amount of learning. Conclusions: It is recommended that surgical tasks composed of several discrete skills should be practiced as a whole. However, if part practice is necessary, these skills should be arranged in random order to optimize learning.

Procedia - Social and Behavioral Sciences, 2010

... Stapleton, A. Serious games: Serious opportunities. In Proceedings of the 2004 Australian Gam... more ... Stapleton, A. Serious games: Serious opportunities. In Proceedings of the 2004 Australian Game Developers Conference, pages 1-6, Melbourne, Australia, 2004. ... Proceedings of the IEEE International Conference on Systems, Man and Cybernetics, 2003, pages 2932-2937 ...

The Journal of bone and joint surgery. American volume, 2003

The management of large posttraumatic full-thickness osteochondral defects in the proximal part o... more The management of large posttraumatic full-thickness osteochondral defects in the proximal part of the tibia remains a challenge. The goal of treatment is a pain-free range of motion of the knee that provides enduring function and enables a young patient to participate in a wide range of activities. The use of fresh osteochondral allograft transplantation for tibial plateau lesions has been well documented. The purpose of the present study was to assess the survivorship and the long-term functional outcome following fresh osteochondral transplantation for unipolar posttraumatic tibial plateau defects in young, high-demand patients. A cohort study was carried out to assess outcome in patients who had undergone fresh tibial osteochondral grafting for the treatment of a posttraumatic defect that measured at least 3 cm in diameter and 1 cm in depth. Sixty-five (97%) of sixty-seven patients were identified and were evaluated clinically and radiographically. A modified Hospital for Specia...

The journal of knee surgery, 2003

This study assessed the Modified Coventry-Maquet technique for high tibial osteotomy with respect... more This study assessed the Modified Coventry-Maquet technique for high tibial osteotomy with respect to the incidence of patella baja using the Insall-Salvati index. Twenty-seven high tibial osteotomies performed or supervised by a single surgeon (A.E.G.) between 1996 and 2000 were analyzed. Eight knees were excluded; the remaining 19 were evaluated. Mean patient age at surgery was 49 years, and the mean postoperative Insall-Salvati index was 0.83. This represented an average decrease in patellar height of 15% (P<.000001). The incidence of new-onset postoperative patella baja was 26% (5/19). Tibial posterior slope increased by an average of 4.3 degrees (P<.0001). Mean tibial tuberosity height decreased by an average of 8.9 mm (P<.0001). The mechanical axis was corrected by an average of 11.9 degrees and loss of range of motion postoperatively was negligible. The correlation between tibial slope, tuberosity height, and patellar height was not significant. The modified Coventry-...

Clinical orthopaedics and related research, 2006

Massive bone defects are challenging problems in revision knee surgery. When defects are large an... more Massive bone defects are challenging problems in revision knee surgery. When defects are large and uncontained (without a cortical rim), structural allografts may be used to provide support for femoral and tibial components. This study reviewed 68 structural allografts at a mean of 5.4 years for clinical and radiographic outcomes. Indications for grafts included periprosthetic fracture in 19 knees, aseptic loosening in 29, infection in 11 and instability in 2. Seven knees had both femoral and tibial allografts. Multiple implant designs were used including 7 hinged prostheses. Thirteen knees (13/61) failed due to graft related complications including one graft nonunion, three aseptic loosenings, three periprosthetic fractures, four infections, and two for instability. The case of graft nonunion was successfully treated with revision fixation and autologous bone graft. There were three cases of graft resorption, two graded as severe and one as moderate. These results are satisfactory ...

Orthopedics, 2009

Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental h... more Primary total hip arthroplasty (THA) in patients with osteoarthrosis secondary to developmental hip dysplasia is often complex due to anterolateral acetabular bone deficiency. The use of femoral head (shelf) autograft during the index arthroplasty provides nonimmunogenic, osteoconductive support with the potential for enhanced bone stock should revision surgery be required. Few long-term studies document the outcome of the use of shelf grafts in primary THA or quantify the need for further bone graft at revision surgery. A retrospective analysis was conducted of a single surgeon's series of 31 THAs performed in 25 patients with developmental hip dysplasia. Postoperative biplanar radiographic analysis was performed at 3 and 6 months and annually thereafter for a mean of 14 years (range, 8-18 years). Grafts were assessed for union, resorption, and displacement. The need for acetabular bone graft at revision surgery was recorded. Bony union was observed in 93% of cases; fibrous uni...

Canadian journal of surgery. Journal canadien de chirurgie, 2014

Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation bet... more Dislocation may complicate revision total hip arthroplasty (THA). We examined the correlation between the components revised during hip arthroplasty (femur only, acetabulum only and both components) to the rates of dislocation in the first and multiple revision THA. We obtained data from consecutive revision THAs performed between January 1982 and December 2005. Patients were grouped into femur-only revision, acetabulum-only revision and revision THA for both components. A total of 749 revision THAs performed during the study period met our inclusion criteria: 369 first-time revisions and 380 repeated revisions. Dislocation rates in patients undergoing first-time revisions (5.69%) were significantly lower than in those undergoing repeated revisions (10.47%; p = 0.022). Within the group of first-time revisions, dislocation rates for acetabulum-only revisions (10.28%) were significantly higher than those for both components (4.61%) and femur-only (0%) reconstructions (p = 0.025). Alth...

The Journal of bone and joint surgery. American volume, Jan 2, 2014

Osteochondral defects of the knee in young, active patients represent a challenge to the orthopae... more Osteochondral defects of the knee in young, active patients represent a challenge to the orthopaedic surgeon. Our study examined long-term outcomes of the use of fresh allograft for posttraumatic osteochondral and osteochondritis dissecans defects in the distal aspect of the femur.METHODS: We reviewed the cases of sixty-three patients who underwent osteochondral allograft transplantation to the distal aspect of the femur between 1972 and 1995. Five patients who resided out of the country were lost to follow-up. Indications for the allograft procedure were an age of less than fifty years and a unipolar posttraumatic osteochondral or osteochondritis dissecans defect in the distal aspect of the femur that was larger than 3 cm in diameter and 1 cm in depth.RESULTS: Fifty-eight patients ages eleven to forty-eight years at the time of surgery (mean age, twenty-eight years) were followed for a mean of 21.8 years (range, fifteen to thirty-two years). Thirteen of the fifty-eight cases requir...

Seminars in Arthroplasty, 2010

ABSTRACT Treatment of massive contained acetabular defects is challenging. The current generation... more ABSTRACT Treatment of massive contained acetabular defects is challenging. The current generation of reconstruction cages in combination with either morcellized or structural allograft bone has given promising results. However, a significant proportion will fail due to lack of biological fixation of the cage, resulting in fatigue fracture. This study examines the early results of a new technique of combining a cage with a shell of Trabecular Metal (Zimmer, Warsaw, IN), because this material has the potential to enhance biological fixation. Fourteen patients with major acetabular defects underwent revision total hip arthroplasty with a Cup-Cage construct. Clinical and radiographic outcomes were determined at minimum 2-year follow-up. Complications, reoperations, and functional status (overall satisfaction, pain, limp, and use of gait-aids) were assessed. Radiographs were analyzed for evidence of implant migration, new radiolucent lines, and bone graft resorption. Mean follow-up was 27 months (range: 1-39), excluding 1 death in less than 1 year after surgery. Outcomes were 82% excellent or good, 12% fair, and 6% poor. Average pre- and postoperative Western Ontario MacMaster scores were 64 and 33 points, respectively. Oxford hip scores were an average of 45 preoperative and 28 postoperative. Short-form-36 averaged 351 preoperative and 601 postoperative. Radiographically, all the implants were stable and none had migrated.

The American Journal of Surgery, 2004

Background: The addition of video feedback to bench model training offers residents the opportuni... more Background: The addition of video feedback to bench model training offers residents the opportunity to see themselves perform a surgical task. Videotaped feedback therefore promotes self-evaluation, a critical learning skill, and also has the potential to influence how a resident executes a skill once they have had the opportunity to see themselves perform the task. Methods: Twenty-nine surgical residents were video recorded while performing three technical skills. They then were randomly assigned to receive either no feedback, video feedback alone, or video feedback with the help of an expert, an orthopedic surgeon. The surgical task was then repeated. Orthopedic surgeons evaluated the videotapes using the global rating scale and technical checklist form. Results: One-way between-subject analysis of variance comparing the pretest and post-test difference scores on three different measures for each of the three tasks revealed no statistically significant differences. After controlling for rater variance, the global rating scores across the three surgical tasks did not reveal any statistically significant differences. Conclusions: This study failed to demonstrate an improvement in technical skills based on utilization of video feedback.

Surgery, 2008

Background. Practice using computer-based video instruction (CBVI) leads to improvements in surgi... more Background. Practice using computer-based video instruction (CBVI) leads to improvements in surgical skills proficiency. This study investigated the benefits of the introduction of (a) learner-directed, interactive video training and (b) the addition of expert instruction on the learning and retention of the basic surgical skills of suturing and knot-tying in medical students. Methods. Using bench models, students were pre-tested on a suturing and knot-tying skill after viewing an instructional video. The students were then randomly assigned to three practice conditions: self-study with video; self-study with interactive video; or the combination of self-study with interactive video with the addition of subsequent expert instruction. All participants underwent 18 trials of practice in their assigned training condition. The effectiveness of training was assessed by an immediate post-test and a retention test one month later. Performance was evaluated using expert-and computer-based assessments. Data were analyzed using repeated-measures ANOVA.