FNB Arthroplasty Fellowship Programme

Department of Orthopaedic Surgery & Joint Reconstruction FNB Arthroplasty Fellowship Programme

1. About the Programme

The Department of Orthopaedic Surgery & Joint Reconstruction at ISIC Multispeciality Hospital, New Delhi, offers a highly structured and clinically intensive Fellowship in Arthroplasty under the aegis of the National Board of Examinations (NBE). This fellowship is designed for orthopaedic surgeons who wish to acquire subspecialty expertise in joint replacement surgery - one of the fastest growing and most impactful surgical disciplines in modern musculoskeletal medicine. ISIC Multispeciality Hospital is one of India's foremost centres for joint replacement surgery, performing approximately 1,200 joint replacement procedures annually. This exceptional surgical volume, combined with the breadth and complexity of cases managed - ranging from primary hip and knee replacements to complex revision arthroplasty and shoulder reconstruction - makes ISIC an ideal training environment for aspiring arthroplasty specialists. The FNB (Fellow of National Board) Arthroplasty programme integrates advanced clinical training, structured surgical skill development, and rigorous academic and research activities. Fellows emerge from this programme as confident, competent, and academically well-rounded arthroplasty surgeons, equipped to establish or lead joint replacement programmes at institutions across India and globally.

2. Programme Details

Key details of the FNB Arthroplasty fellowship programme: institution

3. Fellowship Objectives

The FNB Arthroplasty fellowship at ISIC Multispeciality Hospital is designed with clear, structured learning objectives spanning clinical skills, surgical technical competence, cognitive and academic knowledge, and professional responsibilities. At the completion of the fellowship, a fellow will be expected to have achieved the following outcomes: 3.1 Clinical Skills

• Demonstrate the ability to assess patients with degenerative joint disease through a thorough history, systematic physical examination, and appropriate investigation.
• Perform a complete musculoskeletal and neurological examination of the upper and lower limbs, with particular emphasis on hip, knee, and shoulder joint assessment.
• Arrive at a well-reasoned differential diagnosis for complex joint pathology, incorporating clinical findings, laboratory investigations, and imaging results.
• Order and critically interpret relevant laboratory tests, radiological investigations (plain X- rays, CT scans, MRI, nuclear medicine bone scans), and other diagnostic procedures relevant to arthroplasty decision-making.
• Develop and articulate a comprehensive and individualized management plan for patients presenting with osteoarthritis, rheumatoid arthritis, osteonecrosis, post-traumatic arthritis, and other joint disorders requiring reconstructive surgery.
• Display knowledge and competence in recognizing, evaluating, and managing surgical and medical complications related to joint replacement surgery, including periprosthetic joint infection (PJI), implant loosening, instability, periprosthetic fractures, and thromboembolic events.
• Develop and communicate a structured plan for long-term patient follow-up, including implant surveillance, functional rehabilitation, and complication monitoring. 3.2 Surgical Technical Skills
• Exhibit proficiency in the non-operative management of joint disease, including physiotherapy prescription, activity modification, analgesic strategies, intra-articular injections, and orthotic prescription.
• Demonstrate technical competence in the primary surgical management of degenerative joint disease, including total hip arthroplasty (THA), total knee arthroplasty (TKA), unicondylar knee arthroplasty (UKA), and total shoulder arthroplasty (TSA).
• Develop competence in complex revision arthroplasty procedures including revision THA and revision TKA for loosening, infection, instability, and periprosthetic fractures.
• Show capacity for the correct selection, handling, and use of surgical instrumentation, implant systems, and specialized tools for joint replacement procedures.
• Demonstrate understanding and application of surgical approaches to the hip (posterior, direct anterior, anterolateral, direct lateral), knee, and shoulder.
• Develop proficiency in implant templating, pre-operative planning, and the use of digital planning tools and 3D models for complex arthroplasty cases.
• Gain exposure to computer-assisted navigation and robotic-arm-assisted arthroplasty systems for enhanced precision in implant positioning.
• Learn and apply principles of wound management, haemostasis, and perioperative blood conservation strategies in joint replacement surgery. 3.3 Cognitive & Academic Knowledge
• Demonstrate a fundamental and comprehensive knowledge of the incidence, aetiology, pathophysiology, natural history, diagnosis, investigation, management, prognosis, and complications of disease processes affecting the hip, knee, shoulder, and other joints amenable to arthroplasty.
• Develop an in-depth understanding of arthroplasty biomechanics, implant design principles, bearing surfaces (polyethylene, ceramic, metal), fixation methods (cemented vs. cementless), and the evolving evidence base for implant selection.
• Understand and apply current evidence-based protocols for perioperative care in arthroplasty, including enhanced recovery after surgery (ERAS), multimodal analgesia, VTE prophylaxis, and infection prevention strategies.
• Acquire knowledge of the diagnosis and management of periprosthetic joint infection (PJI), including the Musculoskeletal Infection Society (MSIS) criteria, the role of aspiration and synovial fluid analysis, one-stage and two-stage revision protocols, and suppressive antibiotic therapy.
• Actively participate in clinical orthopaedic research relevant to arthroplasty, contributing to study design, data collection, analysis, and manuscript preparation.
• Exhibit proficiency in the critical appraisal of scientific literature, specifically in evaluating the design, methodology, statistical analysis, and clinical applicability of studies relevant to arthroplasty surgery.

4. Patient Care Duties & Clinical Responsibilities

Fellows at ISIC Multispeciality Hospital are expected to function as integral members of the arthroplasty surgical team, contributing meaningfully to all phases of patient care throughout their fellowship tenure. 4.1 Operative Participation

• Fellows are expected to be present and actively participate in all arthroplasty surgical procedures, progressing from assisting to performing procedures under supervision as competence is demonstrated.
• With approximately 1,200 joint replacement surgeries performed annually at ISIC, fellows are assured of extensive operative exposure across a diverse case mix, including primary and complex revision procedures.
• Fellows are involved in pre-operative surgical planning, including templating, implant selection, and intraoperative decision-making under senior guidance.
• Post-operatively, fellows participate in the immediate management of patients in the recovery room and ward, ensuring safe and effective perioperative care. 4.2 Outpatient Clinics
• Fellows attend and actively contribute to the Surgeon's Outpatient Clinics and dedicated Arthroplasty Clinics, where new referrals, pre-operative assessments, and post-operative follow-up consultations are conducted.
• For fellows with Orthopaedic training, participation in Fracture Clinics may also be incorporated, providing additional exposure to the management of periarticular and periprosthetic fractures.
• Fellows are expected to develop independent clinical assessment skills and to present and discuss cases with the supervising consultant, receiving structured feedback on clinical reasoning and management planning. 4.3 Inpatient & Perioperative Care
• Fellows serve as a resource and senior support for surgical residents-in-training in the management of inpatient arthroplasty cases, reinforcing their own knowledge through teaching others.
• Fellows provide backup support for the perioperative management of arthroplasty patients, including the assessment and management of post-operative complications such as wound issues, haematoma, DVT, and early implant-related concerns.
• Fellows are involved in the coordination of multidisciplinary perioperative care, including liaison with physiotherapy, anaesthesia, haematology, and infectious diseases teams as required.

5. Arthroplasty Rounds & Academic Meetings

The FNB Arthroplasty fellowship at ISIC incorporates a rigorous and structured programme of daily rounds and regular academic meetings that form the backbone of the educational experience:

• Daily Arthroplasty Rounds: Conducted in conjunction with the Department of Orthopaedics, these rounds cover all current inpatient arthroplasty cases. Fellows are expected to present cases, discuss management decisions, and participate actively in ward-based teaching sessions.
• Weekly Case & Topic Presentation Meetings: Fellows present clinical cases or assigned academic topics in a structured format, with discussion and critique by consultant faculty. This builds presentation skills, systematic clinical thinking, and depth of knowledge.
• Monthly Departmental Academic Meetings: Fellows assist in the preparation and conduct of monthly academic meetings, including literature reviews, morbidity and mortality conferences, and implant outcome review sessions.
• Joint Reconstruction Multidisciplinary Team (MDT) Meetings: Complex cases - including those involving periprosthetic joint infection, oncology-related arthroplasty, and revision surgery planning - are discussed in a multidisciplinary forum involving orthopaedic surgeons, microbiologists, radiologists, and rehabilitation specialists.
• National & International Conference Participation: Fellows are encouraged and supported to attend and present at major arthroplasty and orthopaedic conferences including those organized by the Indian Arthroplasty Association (IAA), Indian Orthopaedic Association (IOA), and international bodies such as the American Academy of Orthopaedic Surgeons (AAOS), EFORT, and ISTH.

6. Teaching Responsibilities

Teaching is considered a professional obligation and a measure of surgical maturity. Fellows at ISIC are expected to actively contribute to the educational development of junior trainees and allied health professionals:

• Fellows participate in structured teaching sessions for DNB and MS Orthopaedic residents, covering arthroplasty-specific topics including surgical approaches, implant biomechanics, complications management, and evidence-based arthroplasty practice.
• Fellows contribute to teaching activities for allied health professionals including physiotherapists, nurses, and operating theatre technicians, enhancing the overall quality and consistency of perioperative arthroplasty care.
• Fellows are encouraged to develop and deliver seminars, journal club sessions, and operative technique demonstrations, building communication and educational skills that are essential for an academic surgical career.
• Fellows may be involved in cadaveric surgical courses and simulation-based training workshops organized by the department, serving as demonstrators for junior trainees.

7. Research & Academic Activities

Research is an essential and non-negotiable component of the FNB Arthroplasty fellowship at ISIC Multispeciality Hospital. The department is committed to advancing the science of joint replacement surgery through meaningful clinical and translational research. 7.1 Research Domains

• Biomechanics: Studies on implant design, bearing surface wear, fixation strength, component positioning, and kinematic analysis of replaced joints.
• Basic Science: Investigations into bone biology, osseointegration, material science relevant to arthroplasty implants, and the host response to prosthetic materials.
• Epidemiology: Registry-based studies examining arthroplasty outcomes, implant survival rates, revision rates, and patient-reported outcome measures (PROMs) in the Indian population.
• Clinical Studies: Prospective and retrospective studies on operative techniques, perioperative protocols (ERAS, blood conservation, infection prevention), novel implant systems, and outcomes of complex revision arthroplasty.
• Health Technology Assessment: Comparative effectiveness research examining the cost- effectiveness and long-term value of different arthroplasty approaches in the Indian healthcare context. 7.2 Fellow Research Commitments
• Each fellow is expected to actively participate in at least one primary research project during their fellowship tenure, from study conception and ethical approval through data collection, analysis, and dissemination.
• Fellows are required to submit a Dissertation to the National Board of Examinations as a mandatory prerequisite for the award of the FNB degree. The dissertation must be based on original research conducted during the fellowship period.
• Fellows are strongly encouraged to submit their research findings for presentation at national and international conferences and for publication in peer-reviewed orthopaedic and arthroplasty journals.
• The department provides dedicated research mentorship, statistical support, access to the hospital's clinical data registry, and editorial guidance for manuscript preparation.
• Regular research methodology workshops covering study design, biostatistics, systematic review methodology, and ethical research conduct are organized for fellows.

8. Scope of Surgical Exposure

Fellows at ISIC gain exposure to the full breadth of modern arthroplasty surgery. The department's high surgical volume and subspecialty expertise ensure comprehensive training across all major joint replacement procedures: 8.1 Hip Arthroplasty

• Primary total hip arthroplasty (THA) using cemented, cementless, and hybrid fixation techniques across multiple surgical approaches (posterior, direct anterior, anterolateral, direct lateral).
• Revision THA for aseptic loosening, osteolysis, implant failure, instability, and periprosthetic fracture - including management of significant bone loss with augments, cages, and custom implants.
• Two-stage revision THA for periprosthetic joint infection (PJI) using antibiotic-loaded cement spacers.
• Hip resurfacing arthroplasty and large-head metal-on-metal implant management.
• Arthroplasty for complex femoral neck fractures, avascular necrosis (AVN), and post- traumatic arthritis. 8.2 Knee Arthroplasty
• Primary total knee arthroplasty (TKA) including posterior-stabilized, cruciate-retaining, and medially stabilized implant systems.
• Unicondylar knee arthroplasty (UKA) - medial, lateral, and patellofemoral components.
• Complex primary TKA in the setting of significant deformity, stiffness, and prior surgical scarring.
• Revision TKA for loosening, instability, infection, and periprosthetic fracture - including use of stems, augments, wedges, and constrained implant systems.
• Computer-assisted navigation and robotic-arm-assisted TKA for optimal component alignment and soft tissue balancing.
• Kinematic alignment and anatomic alignment techniques in TKA. 8.3 Shoulder & Upper Limb Arthroplasty
• Total shoulder arthroplasty (TSA) - anatomic total shoulder replacement for glenohumeral osteoarthritis.
• Reverse total shoulder arthroplasty (rTSA) for cuff tear arthropathy, complex proximal humerus fractures, and failed previous shoulder surgery.
• Hemiarthroplasty for acute proximal humerus fractures and humeral head avascular necrosis.
• Elbow arthroplasty for rheumatoid arthritis and complex distal humerus fractures.

9. Infrastructure & Facilities

ISIC Multispeciality Hospital provides a state-of-the-art environment for arthroplasty surgery and fellowship training:

• Dedicated Joint Replacement Operating Theatres with laminar airflow systems, intraoperative fluoroscopy, and a comprehensive inventory of implant systems from leading global manufacturers including Stryker, Zimmer Biomet, DePuy Synthes, Smith & Nephew, and Exactech.
• Robotic-Arm Assisted Surgery System (Mako or equivalent) for computer-guided, patient- specific arthroplasty procedures with real-time intraoperative feedback.
• Computer-Assisted Navigation System for conventional navigated THA and TKA.
• Full digital imaging suite including weight-bearing digital radiographs, EOS full-body low- dose imaging, 128-slice CT scanner, and 3 Tesla MRI for pre-operative planning and post- operative implant assessment.
• Joint Replacement Registry for prospective tracking of implant outcomes, complication rates, and patient-reported outcome measures (PROMs).
• Dedicated Arthroplasty Physiotherapy and Rehabilitation Unit with a structured joint replacement rehabilitation programme and gym facilities.
• Digital Library with access to the Journal of Arthroplasty, Bone & Joint Journal, Journal of Bone & Joint Surgery, Clinical Orthopaedics and Related Research, and major orthopaedic databases.
• Skills and Simulation Lab for implant handling workshops, sawbone model practice, and cadaveric surgical courses.
• Research Cell providing statistical analysis support, access to the hospital's arthroplasty outcomes database, and manuscript preparation assistance.

10. Faculty & Mentorship

The FNB Arthroplasty fellowship is supervised by a team of highly experienced, nationally and internationally recognized arthroplasty surgeons. Faculty members have completed fellowships at premier global arthroplasty centres and are active contributors to arthroplasty research, surgical technique innovation, and medical education. Each fellow is assigned a dedicated faculty mentor who provides individualized surgical training guidance, research supervision, academic support, and career mentorship throughout the fellowship. Regular structured assessments and feedback sessions ensure that each fellow's progress is monitored and any areas requiring additional focus are promptly identified and addressed.

11. Further Information

For complete and up-to-date information regarding the FNB Arthroplasty fellowship programme - including eligibility criteria, examination schedules, application procedures, seat matrix, and centralized counselling - candidates are advised to visit the official website of the National Board of Examinations: www.natboard.edu.in For institution-specific enquiries regarding the FNB Arthroplasty fellowship at ISIC Multispeciality Hospital, New Delhi, please contact the Department of Orthopaedic Surgery & Joint Reconstruction or the Academic Department - academics@isichealthcarcare.org NBE norms Dr. Vivek Mahajan MBBS MBBS (2004); MS Orthopaedics (2007); MRCS Sr. Consultant (2013); Dr. Apoorv Dua Sr. Consultant MS Orthopaedics (2016); Dr. Abhishek MBBS General (2012); MS Ortho (2018); Fellowship in Jr. Consultant Arthro ;