- The initial written exam has 200 four-option, single-best-answer questions in 4 hours; the oral is a separate 4-case, 2-hour exam.
- Joint Reconstruction/Replacement (13%), Sports Medicine (11%) and Fractures/Bone Healing/Grafting (10%) carry the most written weight.
- The ordinary initial fee total is $3,300 when you apply and test on time; late fees raise it.
- Oral eligibility requires a written pass, 18 consecutive months of privileges and a 12-month log of 100+ primary-surgeon procedures.
Which Credential This Cheat Sheet Covers
This one-page review is about Board Certification in Orthopedic Surgery, awarded through the Board of Certification in Orthopedic Surgery (BCOS) of the ABPS. "Orthopedic Surgery" is the label this site uses for the credential rather than an official abbreviation, so check the certifying body's name on any fee schedule, date list or content outline before you rely on it. Several unrelated credentials use similar shorthand, and mixing their details into your plan is an easy way to budget the wrong amount or study the wrong blueprint.
If you are still deciding whether this is the right credential for you, start with What Is Orthopedic Surgery Certification? and Is the Orthopedic Surgery Certification Worth It?. This page assumes you have decided and want the facts in one place.
Exam Format at a Glance
Certification has two separate stages: a computer-based written exam and a live oral exam. Keep them distinct in your head, because they test different skills and have different eligibility rules and fees.
| Feature | Initial Written Exam | Oral Exam |
|---|---|---|
| Format | Computer-based, ABPS-arranged testing | Live case discussion; 2026 sessions by Zoom |
| Content | 200 four-option, single-best-answer questions | 4 cases |
| Time | 4 hours | 2 hours |
| Scoring approach | Standard set using a modified Angoff method | Aggregate must meet case thresholds |
| 2026 schedule | Window of May 1-21 | November 6-7 |
| Retake | $800 | Full oral fee |
The modified Angoff approach means a panel judges how a minimally competent candidate would perform on each question, and that judgment sets the passing standard. In practice, your score is measured against a fixed standard rather than against other candidates that year. For more on what this means for your preparation, see Orthopedic Surgery Passing Score 2026.
Fees, Windows and Dates
Fee mechanics are where candidates most often lose money, because timely and late rates differ for the application and the written exam. All figures below are in USD.
| Item | Timely | Late |
|---|---|---|
| Application | $500 | $995 |
| Written exam | $1,200 | $1,450 |
| Oral exam | $1,600 | |
| Ordinary initial total (calculated) | $3,300 | |
| Written retake | $800 | |
| Annual Certification Management Fee (after initial certification) | $895 | |
The $3,300 total is simply $500 + $1,200 + $1,600 when everything is filed on time. Missing a deadline on both the application and the written exam would add $245 and $250 respectively. Because an oral retake costs the full oral fee, it is far more expensive to fail the oral than the written, which is another reason to prepare for the oral deliberately. A fuller breakdown is in Orthopedic Surgery Certification Cost 2026, and scheduling detail is in Orthopedic Surgery Exam Dates 2026.
Eligibility Checklist
Eligibility is staged. You qualify for the written exam first, then separately for the oral.
To Apply and Sit for the Written Exam
- A qualifying MD or DO degree.
- An unrestricted license.
- Accepted orthopedic training, or the documented four-year faculty route.
- References and verification documents.
To Advance to the Oral Exam
- A passing written result.
- 18 consecutive months of privileges at one qualifying institution.
- A 12-month log showing at least 100 primary-surgeon procedures.
The 15 Domains and Their Weights
The initial written outline has 15 approximate weights that total 100%. The outline is undated, and the review noted for this guide is September 29, 2026, so treat the weights as approximate and check for updates. Sorted by weight:
| Domain | Weight |
|---|---|
| Joint Reconstruction/Replacement | 13% |
| Sports Medicine | 11% |
| Fractures/Bone Healing/Grafting | 10% |
| Orthopedic Radiology and Imaging | 8% |
| Bone and Soft Tissue Infections | 7% |
| Joint Injuries | 7% |
| Neurology and Spinal Disorders | 7% |
| Arthritis and Connective Tissue Disorders | 7% |
| Pediatric Orthopedics | 6% |
| Soft Tissue Physiology and Repair | 6% |
| Ortho Medical and Traumatic Problems | 5% |
| Rehabilitation | 4% |
| Biomaterials/Biomechanics | 4% |
| Principles of Orthopedic Practice, Ethics, Epidemiology | 3% |
| Orthopedic Pathology | 2% |
The top three domains account for 34% of the written exam. The bottom four account for just 13%. A detailed walk-through of each area is in Orthopedic Surgery Exam Domains 2026: Complete Guide to All 15 Content Areas.
High-Yield Topics by Domain
The outline gives domain names and weights, not itemized topic lists, so the points below are the kinds of material each domain naturally covers in orthopedic practice. Use them as a prompt for your own review against the official outline.
Joint Reconstruction/Replacement (13%)
The heaviest domain, and a core part of daily orthopedic practice.
- Indications and decision-making for arthroplasty versus joint-preserving options
- Implant fixation, bearing surfaces and failure modes
- Periprosthetic infection and revision considerations
- Perioperative complications and their management
Sports Medicine (11%)
Expect clinical-vignette questions that move from presentation to diagnosis to treatment.
- Ligament, meniscal and cartilage injury patterns
- Shoulder instability and rotator cuff pathology
- Return-to-play reasoning and surgical timing
Fractures/Bone Healing/Grafting (10%)
Combines biology with operative judgment.
- Primary versus secondary bone healing and what disrupts each
- Graft types and their properties
- Fixation choice by fracture pattern and location
- Nonunion and malunion recognition
Orthopedic Radiology and Imaging (8%)
Image interpretation is a recurring skill, so practice reading rather than only reciting.
- Choosing the right modality for the clinical question
- Recognizing common radiographic findings in trauma, arthritis and tumor presentations
Mid-Weight Clinical Domains (5-7% each)
Bone and Soft Tissue Infections, Joint Injuries, Neurology and Spinal Disorders, Arthritis and Connective Tissue Disorders, Pediatric Orthopedics, Soft Tissue Physiology and Repair, and Ortho Medical and Traumatic Problems together make up a large share of the exam.
- Infection: diagnosis, organism patterns and the role of surgery versus antibiotics
- Spine and neurology: deficits, localization and indications for intervention
- Arthritis: differentiating inflammatory from degenerative disease
- Pediatrics: growth-related conditions and developmental considerations
Low-Weight Domains (2-4% each)
Rehabilitation, Biomaterials/Biomechanics, Principles of Orthopedic Practice/Ethics/Epidemiology and Orthopedic Pathology are small individually, but they are efficient to review and can be the difference on a close score.
- Biomechanics fundamentals tend to be learnable in a compact review block
- Ethics and epidemiology also reappear in renewal, where four approved ethics CME are required
For a broader plan that ties these topics to a calendar, see the Orthopedic Surgery Study Guide 2026.
Oral Exam Quick Facts
The oral exam is a different task from the written. It consists of four cases in two hours, and your aggregate must meet the case thresholds. That means weak performance on one case can matter, so breadth of readiness is more valuable than polishing a single strength.
- Structure: 4 cases, 2 hours total, roughly half an hour per case on average.
- Delivery: 2026 oral testing is by Zoom, so test your connection, camera and workspace ahead of time.
- Eligibility gate: You cannot sit for it until you have passed the written exam, completed 18 consecutive months of privileges at one qualifying institution, and documented a 12-month log of at least 100 primary-surgeon procedures.
- Cost of failure: A retake is the full $1,600 oral fee.
Key Takeaway
Your procedure log does double duty. It satisfies the oral eligibility requirement and gives you a ready bank of real cases to rehearse out loud. Practice presenting your own cases concisely, with your reasoning for diagnosis, treatment choice and complication management.
Eight-Year Cycle and Renewal
Certification is valid for eight years. Renewal is not a single event; it is a package of requirements you build over the cycle.
- CME: 400 Category 1 hours, including 200 orthopedic hours.
- Ethics: Four approved ethics CME.
- License: A current license.
- Exam: A 100-question, 2-hour recertification exam.
- Ongoing fee: The $895 annual Certification Management Fee begins after initial certification.
The recertification exam shifts its emphasis compared with the initial outline: Orthopedic Pathology drops to 3% and Orthopedic Radiology and Imaging rises to 7%, per the published weights. If you plan ahead for recertification, keep your imaging skills current throughout the cycle. For the long-term financial picture, see the Orthopedic Surgery Salary Guide, and for career context see Orthopedic Surgery Jobs.
Sequencing Your Review by Domain Weight
You do not need a generic study system here. The most useful scheduling principle is to front-load the heaviest domains while leaving time for the oral. A sample progression for a roughly eight-week written review:
Highest-Weight Domains
- Joint Reconstruction/Replacement (13%)
- Sports Medicine (11%)
- Fractures/Bone Healing/Grafting (10%)
Imaging and the 7% Cluster
- Orthopedic Radiology and Imaging (8%)
- Infections, Joint Injuries, Neurology/Spine, Arthritis (7% each)
Mid and Low-Weight Domains
- Pediatrics and Soft Tissue Physiology (6% each)
- Ortho Medical and Traumatic Problems (5%)
- Rehabilitation, Biomechanics, Ethics/Epidemiology, Pathology
Integration
- Mixed-domain practice at the 200-question, 4-hour scale
- Return to your weakest high-weight domain
- Begin rehearsing oral cases from your own log
Because the written exam uses single-best-answer questions with four options, practice choosing the best answer among several plausible ones rather than hunting for the only correct statement. Timed practice with realistic items is the most direct way to build that habit, and you can use the main practice test site for question-style repetition across all 15 domains.
If you are weighing how much effort this requires, How Hard Is the Orthopedic Surgery Exam? and Orthopedic Surgery Pass Rate 2026 discuss what is and is not known about difficulty and outcomes.
Frequently Asked Questions
The initial written exam has 200 four-option, single-best-answer questions to be completed in 4 hours. The oral exam is separate and consists of 4 cases in 2 hours.
With on-time filing, the calculated total is $3,300: a $500 application, a $1,200 written exam and a $1,600 oral exam. Late filing raises the application to $995 and the written exam to $1,450. Retakes and the $895 annual Certification Management Fee are additional.
Joint Reconstruction/Replacement is largest at 13%, followed by Sports Medicine at 11% and Fractures/Bone Healing/Grafting at 10%. Weights are approximate and the outline is undated, so confirm against the current official version.
You need a passing written result, 18 consecutive months of privileges at one qualifying institution, and a 12-month log of at least 100 primary-surgeon procedures. An older overview mentions 200 procedures, but the dedicated eligibility page lists 100, so verify with the board.
Certification lasts eight years. Renewal requires 400 Category 1 CME including 200 orthopedic hours, four approved ethics CME, a current license and a 100-question, 2-hour recertification exam.
Use this sheet as a checklist, not a substitute for the official candidate materials. Several details, including the written exam's testing vendor and its open-book, calculator, adaptive and at-home permissions, are not verified here, and should be confirmed with the certifying body before you commit to a plan. For deeper reading, explore the full Orthopedic Surgery Certification overview and build your practice routine on the practice test platform.