2006 President-Elect Address / Address de president élu 2006 Dr. Brendan D. Lewis

Good Morning folks. Welcome to this the 61^st COA Meeting here in Toronto. Welcome to our distinguished guests, ladies and gentleman.

I want to thank Bob and Donna for their strong representation of the Canadian Orthopaedic Association in Canada and around the world in the past year.

J’aimerais vous remercier, Donna et Bob, pour avoir si bien représenté l’Association Canadienne d’Orthopédie au Canada et à l’étranger.

We need to acknowledge the extensive work that three people do at the COA Office. Our CEO Doug Thomson, who has been with us since 2001, has helped bring the COA forward. He has been an excellent spokesperson in many matters and has provided unparalleled leadership for the COA. Cynthia Vezina and Yuri Kojima help bring it all together.

Something to Consider
COA travelling fellowships are not a thing of the past

Emil H. Schemitsch, M.D., FRCSC
Editor in Chief

There has been significant discussion as of late regarding the lack of interest in the travelling fellowships sponsored by the Canadian Orthopaedic Association.

These travelling fellowships include the ABC (American/British/Canadian), NATF (North American), ASG (Austrian/Swiss/German) and other prestigious fellowships. This has occurred despite the tremendous job done by the Chair of the Exchange Fellowship Committee to promote these opportunities.

Federal Wait Times Advisor Releases Final Report

Doug Thomson
CEO, Canadian Orthopaedic Association

You may have missed seeing any detailed reporting on the Final Report of the Federal Advisor on Wait Times, authored by Dr. Brian Postl. That was likely by design. In what has become a time honoured tradition in Ottawa, when the government wishes to avoid highlighting a report, that report is released on a Friday before a long weekend. Such was the case for this useful report as it was released just before the Canada Day weekend. There are some strong indications that the Harper government is quietly backing away from its only stated health care priority, the so-called ‘wait time guarantees’.

Working Conditions for Medical Specialists in Quebec Imposed by Special Law

Pierre Lavallée, M.D., FRCSC
President, Quebec Orthopaedic Association
Quebec City, Quebec

The Quebec Government hastily adopted Bill 37 at the end of the parliamentary session on June 13, 2006. This special bill not only establishes the working conditions of medical specialists in Quebec until 2010 but also imposes hefty penalties for organized efforts that impede the continuity of care.

A Call to Action
preventing secondary fragility fractures

Dennis Jeanes
Special to the Canadian Orthopaedic Association

Amid the symposia, CME sessions and socializing at the COA’s recent Annual Meeting in Toronto, a small group of care-givers and advocates met to discuss forming a national alliance that would then campaign for an integrated strategy to prevent secondary fragility fractures.

Wrap-up of the 2006 Annual General Meeting in Toronto

Emil H. Schemitsch, M.D., FRCSC
Programme Committee Chair 2006 AGM
Toronto, ON

Dear Members,

I would like to take this opportunity to wrap up this year’s Annual Meeting, which was recently held in Toronto from June 2-4. The meeting, by many accounts, was highly successful.

COA Awards of Merit and Excellence
2006 Recipients

Robert B. Bourne, M.D., FRCSC
Past President, Canadian Orthopaedic Association
London, ON

One of the highlights of each Canadian Orthopaedic Association Annual Meeting is the opportunity to recognize individuals who have made major contributions to orthopaedic surgery in Canada. The COA Award of Merit is awarded, at the discretion of the President in consultation with the Executive Committee, to an individual that has made an outstanding contribution to the art and science of orthopaedics. The recipient of the Award does not necessarily need to be an orthopaedic surgeon.

Acknowledgement to Our Sponsors

It is with the support of our sponsors that we are able to offer a quality, cost-effective meting. We believe that the partnership of the Health Care Industry and Health Care Providers is fundamental in achieving our objectives.

We therefore welcome industry participation in supporting educational and various other programme activities in addition to highlighting their products at our Annual Meeting. Thank you.

The Mary Johnston Professorship Fund

On May 16, 2006, the Alberta Cancer Foundation announced the establishment of the Mary Johnston Professorship Fund. This fund will be used to create Canada’s first Melanoma translational research position, linking basic science research and clinical outcome studies. The goal of this fund is to create Canada’s first chair in Melanoma research.

Mary Johnston was very active in the COA for many years. With her husband Dr. Bill Johnston, who was President from 1999-2000, they travelled extensively representing the Association. Mary was also President of the CORE/ACORE, a very successful fundraising arm of the Canadian Orthopaedic Foundation.

Thanks to the University of Alberta and the Alberta provincial government, all donations will be matched.

Alberta Cancer Foundation
Cross Cancer Institute
11560 University Avenue
Edmonton, AB T6G 1Z2
CANADA

James P. Waddell, M.D., FRCSC
Coordinator, Canadian National Action Network
For the Bone and Joint Decade

The first meeting of regional representatives to discuss access to bone and joint surgery under the auspices of the National Action Network for the Bone and Joint Decade was held in conjunction with the Canadian Orthopaedic Association Annual Meeting in Toronto this past June. I am delighted to say that we had excellent participation and representation from virtually every province and several regions within the larger provinces at the meeting.

We bid the very best wishes to Yuri and thank her for the dedication and hard work that she has given to the COA over the past six years. Her friendly personality, helpful nature and always stocked candy dishes will be missed!

Please join us in wishing her all the best in her next endeavours.

You Had to Be There
Residents host another successful meeting in Toronto

Daniel Penello, M.D.
Anna Kulidjian, M.D.
Co-Presidents, 2006 CORA Annual Meeting

University of Toronto
Toronto, ON

The past year has been very successful and exciting for the Canadian Orthopaedic Residents’ Association (CORA). In the next few paragraphs, we will highlight the events that made this year a memorable one. In the early Fall of 2005, the results from CORA’s country-wide orthopaedic residency programme survey were compiled, revealing important differences among the various programmes. Questions regarding research opportunities, funding for books and conferences, scheduled teaching rounds and resident educational activities as well as protected study time for the final-year residents were included in the survey. The results were provided to the CORA resident representatives from each programme. Hopefully, these results will stimulate change and result in a standardized educational experience for all residents across the country.

Obesity and Joint Replacement Surgery: CJRR Update

Nicole de Guia, Program Lead, CJRR
Cassandra Linton, Project Lead, CJRR
Canadian Institute for Health Information
Toronto, ON

The Canadian Joint Replacement Registry (CJRR) has recently published topical studies and reports using data voluntarily submitted by almost 500 surgeons across Canada in every province and one territory. To date, over 103,000 procedures have been captured in the CJRR database, and the database continues to grow with increased interest in submissions by electronic files as well as by paper.

The Canadian Society of Orthopaedic Technologists
and Twenty-Eight Years Examining Candidates

Pamela Smith
Registrar, Canadian Society of Orthopaedic Technologists

The Canadian Society of Orthopaedic Technologists (CSOT) became incorporated under Federal Letters Patent on February 25, 1974 as a non-profit society.

Its purposes and objectives are:

Winner of the 2006 J.A. Nutter Award

Best Paper Overall Presented at the 2006 CORA Annual Meeting

Patients with Traumatic Anterior Shoulder Instability Have Restricted External Rotation Range of Motion

Matthew D. Di Silvestro, M.D., MSc
Calgary, AB

Ian K.Y. Lo, M.D., FRCSC,
Nicholas Mohtadi, M.D., MSc, FRCSC
Kristie Pletsch BKin
Richard S. Boorman, M.D., MSc, FRCSC

Winner of the 2006 Alexandra Kirkley Award

Best Clinical Paper Presented at the 2006 CORA Annual Meeting

Timing of Operative Management In the Treatment of Open Fractures: Does Delay to OR Increase the Risk of Complications?

Sonja Mathes, M.D.
Vancouver, BC

Pierre Guy, M.D., FRCSC

Winner of the 2006 COSA Award

Best Science Paper Presented at the 2006 CORA Annual Meeting

Detection and Quantitative Microscopic Evaluation of Osteoarthritis and Osteoporosis by Magnetic Resonance Imaging (MRI)

Michael Weber, M.D, PhD
Vancouver, BC

Vijay Daniels, M.D.
F. William Orr, M.D.

Introduction
The growing interest in minimally invasive techniques has lead to a resurgence in popularity of unicompartmental knee arthroplasty. There is continued controversy over the mobile-bearing versus fixed-bearing designs used in this technique. This has prompted the current point/counterpoint debate between Dr. Douglas Naudie and Dr. Richard Kendall.

The Case for a Fixed-Bearing Unicompartmental Knee Arthroplasty

Douglas Naudie, M.D., FRCSC
Assistant Professor, University of Western Ontario
London, ON

First introduced in the 1970’s, the unicompartmental knee arthroplasty did not gain initial widespread acceptance. Early reports by Insall and Aglietti, and Laskin suggested a high failure rate. However these studies included patients who underwent concomitant patellectomy, had inflammatory arthropathy, or who had a very thin (6 mm) tibial polyethylene component^1,2. Over the subsequent decade, however, good results were reported for both medial and lateral unicompartmental designs, as the indications for unicompartmental arthroplasty gradually became better defined^3,4. Longer follow-up studies have since reported ten-year survival rates without revision for unicompartmental implants ranging from 82% to 98%^5-14.

Unicompartmental Knee Arthroplasty:
Mobile versus Fixed-Bearing

Richard Kendall, M.D., FRCSC
Clinical Instructor, University of British Columbia
Richmond, BC

Unicompartmental knee arthroplasty (UKA) for arthritis is becoming a more popular procedure in the treatment of isolated single compartment disease (Figure 1). However, when first introduced in the 1970’s unicompartmental arthroplasty was associated with high failure rates^{1, 2} and, for a time, fell out of favour. With better understanding of patient selection (single compartment, non-inflammatory disease, and an intact ACL), implant design (thicker polyethylene, cementing and avoidance of over correction) and minimally invasive techniques, there has been renewed interest in this technique.

Introduction
Anterior Cruciate Ligament (ACL) reconstruction is a very common intervention with many viable treatment options. The spectrum of ACL grafts available for a successful reconstruction includes patellar tendon autografts, hamstring autografts, artificial ligaments and tissue engineered ligaments. The themes section will discuss these graft options. It will present the latest indications and the risks and benefits of using the above mentioned ligament grafts.

Are Quadruple Hamstrings the New Gold Standard?

John Theodoropoulos, M.D., FRCSC
William Osler Health Centre
Brampton, ON

The current ideal graft for Anterior Cruciate Ligament (ACL) reconstruction is subject to debate. The use of central third Bone-Patellar Tendon-Bone (BPTB) grafts have historically been considered the “gold standard”. Notwithstanding the advantages of high initial strength and bone-to-bone healing seen with BPTB grafts for ACL reconstruction, there are some shortcomings. These are harvest site morbidity and include anterior knee pain, pain on kneeling, loss of extension and patellar fracture leading surgeons to seek an alternative graft.

Tissue-Engineered ACL
From the Laboratory to the Knee Joint

Francine Goulet
Lucie Germain
Réjean Cloutier
Jean Lamontagne
Hubert Robitaille
Ludovic Bouchard
François A. Auger
Laboratoire d'Organogénèse Expérimentale (LOEX)
Québec, QC

Tissue-engineering of Anterior Cruciate Ligament (ACL) substitutes involves some technical challenges. Considering native ACL biomechanical properties, including strength, the production of a tissue-engineered ACL in vitro seems impossible to achieve. In addition, strong links are required at the matrix-bone interface of ACL substitutes to allow proper ligament functional stability in the joint. Other issues may be raised post-implantation. Collagen, the main component of any soft tissue matrix, must be synthesized and remodeled in situ, to ensure a continuous regeneration of the broken matrix fibers following physical activities. The alignment and ultrastructural organization of the collagen fiber network that supports the tissue must be reproduced in vitro, similar to native ACL in vivo. These issues greatly influence the strategy used to develop tissue-engineered ACL substitutes. Various approaches can be proposed to reach this goal, creating different acellular and cellularized ACL substitutes.

Artificial Ligaments

Nicolas Duval, M.D., FRCSC
Duval Orthopaedic Clinic
Laval, Quebec

Anterior Cruciate Ligament (ACL) surgery with an artificial ligament is not commonly performed by Canadian orthopaedic surgeons. The lack of interest in this option is due to various factors, primarily the large number of ligament failures caused by rupture and secondly, synovitis as documented in publications in the 1990’s^1,2.

2006 Research Grants & Awards Recipients

Debbie Gates
Communications and Education Manager
Canadian Orthopaedic Foundation

The Canadian Orthopaedic Foundation is pleased to announce the recipients of its 2006 research grant awards. The number of applications funded is dictated by the success of the Foundation’s fundraising programmes during the year, the most important of which is Hip Hip Hooray!

A Vote of Confidence in Canada
… and an invitation to do more R&D

Dennis Jeanes
Special to the Canadian Orthopaedic Foundation

As part of satisfying a long-ago promise to encourage Canadian research, Angiotech has agreed to donate $20,000 annually for the next three years to the Canadian Orthopaedic Foundation for its Canadian Orthopaedic Research Legacy (CORL) programme.

Community Grants at Work

Debbie Gates
Communications and Education Manager
Canadian Orthopaedic Foundation

With more than 90% of Canadians requiring orthopaedic treatment at some point in their lifetime, the community grants funded by the Canadian Orthopaedic Foundation through its signature fund-raising event, Hip Hip Hooray! play an important part in the delivery of health care locally.

A Practice Web Site
What’s it for? What does it cost? Why should we bother?

Myles Clough, M.D., FRCSC
Kamloops, BC

Dr. David Nelson, a recent speaker at the AAOS Technology Pavilion caught the audience’s attention by comparing his practice web site (www.davidlnelson.md) to his entry in the Yellow Pages. Most people would agree with his assumption that every North American orthopaedic surgeon pays $250 for an ad in the Physicians’ section of the Yellow Pages. Many of those same people would hesitate before committing themselves to a practice web site. Here is the table of comparison:

Dr. William Hay Kirkaldy-Willis
1914 – 2006

Dr. William Hay Kirkaldy-Willis died at the age of 92 on May 7, 2006. KW, as he was fondly known to his friends and colleagues, was born in Kingston, Surrey, England on February 26, 1914. He attended medical school at Trinity Hall, Cambridge and The London Hospital. In 1941 he became a Fellow of the Royal College of Surgeons of Edinburgh and moved to a remote part of Kenya to work as a missionary surgeon. His own description of himself as “a self-taught orthopaedic surgeon” hides the determined manner in which he made himself an academic surgeon. In those days before instructional videos were available, KW learned advanced orthopaedic surgery from the most eminent surgeons in North America and Britain by visiting their operating rooms and inviting them to Kenya to teach there. He became Senior Surgeon, Ministry of Health, Kenya; and Lecturer, Makerere Medicine School, Kampala, Uganda. His claim that he was “the best orthopaedic surgeon between Cairo and Cape Town” was well deserved – for he was the only orthopaedic surgeon there for many years.