The course
Dr Kenneth Cutbush and Dr Kalman Piper ran a two-day shoulder arthroscopy and arthroplasty course in Bangkok for DePuy Synthes, attended mainly by Australian orthopaedic surgeons, together with a Korean surgeon and colleague learning the arthroscopic Latarjet procedure.
The format
Each day opened with lectures and continued with cadaver laboratory demonstrations at the Chulalongkorn Faculty of Medicine, followed by small-group practice. Day one covered arthroscopy and day two covered shoulder replacement.
The lecture topics included glenoid bone loss and instability, posterior instability, subscapularis and infraspinatus repair, glenoid exposure, reverse and anatomic replacement, and prevention of prosthetic joint infection.
How a cadaveric course works
The teaching sequence is the same on most such courses. A procedure is first explained in a lecture, with the indications, the anatomy involved and the reasoning behind each step. Faculty then perform it on a specimen with the view projected to the room, so that the instruments, the order of the steps and the appearance of the tissue can be followed. Participants then carry out the same steps themselves at the benches, with faculty moving between groups. The point of the specimen is that a surgeon can attempt an unfamiliar procedure, make the mistakes that are part of learning it, and have them corrected, without a patient being involved. This is the established way a new technique is taught before it is performed clinically. Individual results vary.
What the topics have in common
The subjects listed are the parts of shoulder surgery where the operation is hardest to execute or where a judgement has to be made. Glenoid bone loss determines whether a soft tissue repair will hold or whether bone must be transferred. Posterior instability is less common and more easily missed. Repairing the subscapularis at the front and the infraspinatus at the back presents different technical problems from repairing the tendons on top. Exposure of the glenoid governs how accurately a replacement component can be seated. Infection prevention appears on every arthroplasty programme because infection around an implant is among the more serious complications in joint replacement. Individual results vary.
Why courses are held regionally
Courses of this kind draw surgeons from several countries, and access to a suitable anatomy laboratory is one of the practical limits on running them, which is why they are usually hosted at a university faculty of medicine. Holding the course in the region also means that surgeons who would not travel to Europe or North America for a two-day programme can attend, and that faculty and participants from different countries meet.