2008 Annual Business Meeting Notice

This year's Annual Business Meeting will be held on Thursday, June 5 at 1015 in 301A of the Québec City Convention Centre.

The Advanced Practice Physiotherapist in Orthopaedic Care

Alice B. Aiken, PhD, PT
Assistant Professor
School of Rehabilitation Therapy
Queen's University
Kingston, ON

Care for persons with orthopaedic problems can be complex. Usually the first health care contact for such a condition is the family physician. More than 60% of the people who suffer from orthopaedic problems will seek attention from their family physician¹ who will typically treat the patient with anti-inflammatory medications and advice on rest². However, family physicians may lack the background knowledge and sufficient contact time to comprehensively manage orthopaedic conditions, and patients may not respond to conservative treatment, leaving referral to a specialist as the typical course of action.

Editor's Note:

The following is the first in a series of articles that will appear in the COA Bulletin over the next few editions. This series will examine some of the bigger issues that are confronting orthopaedics today - PAs & health human resources, wait times for orthopaedic procedures outside of hip & knee arthroplasty, scope of practice, relations with industry, public vs. private practice, etc. We will be gathering the views from members across the country for this series. If you would like to contribute and have your voice heard, please contact Doug Thomson ( This e-mail address is being protected from spam bots, you need JavaScript enabled to view it ) at the COA office.

Our first instalment of this series is an interview with Dr. Ted Rumble form North York, Ontario.

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

Facing the Future
three things the profession could really use

Doug Thomson
Chief Executive Director
Canadian Orthopaedic Association

Dennis Jeanes
Special to the Canadian Orthopaedic Association

Asked to reflect on a changing workplace and the future of orthopaedics, Toronto-area surgeon Dr. Ted Rumble starts by identifying the key issue facing the profession: "My main concern is that the chronic shortage of orthopaedic surgeons will make it impossible for us to meet the needs of Canadians, and will also contribute to surgeon burn-out. Over the years, we've lost a lot of the people we've trained in orthopaedics because they couldn't find suitable work in Canada. We just can't afford to keep losing our orthopaedic surgeons this way."

Bone and Joint Canada
Expands its Mandate

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

Bone and Joint Canada, the "action arm" of the Bone and Joint Decade in this country addressing access to care for hip and knee replacement patients, has been extremely active in the past few months. We have been actively engaged in discussions with orthopaedic surgeons, hospital administration and government officials from Nova Scotia to help develop a programme for the province to address the current wait times for total joint replacement. There has been significant enthusiasm amongst all three parties about the proposals and we hope that our efforts will continue to be favourably received in that province.

Orthopaedic Oncology
sub-specialty forms new society

Doug Thomson
Executive Director
Canadian Orthopaedic Association
Dennis Jeanes

Special to the Canadian Orthopaedic Association

The last time osteosarcoma made headlines was about 30 years ago, when Terry Fox started out from Halifax on his legendary run across Canada. The lack of profile since is hardly surprising, given that this rare cancer (that would famously claim Fox's life in 1981) has an annual incidence rate of roughly one in a million.

Introduction
Cuff tear arthropathy is a devastating condition, which has been traditionally difficult to treat. Drs. Darren Drosdowech and Jeremy Hall will debate the pros and cons of using a reverse total shoulder arthroplasty versus a hemiarthroplasty for this pathology.

In Defense of Primary Reverse Total Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy

Darren S. Drosdowech, M.D., FRCSC
Hand and Upper Limb Centre
St Joseph's Health Centre
University of Western Ontario
London, ON,

The Problem
Patients with rotator cuff tear arthropathy (RCTA) most often present with painful arthritis combined with loss of active forward elevation (AFE) secondary to a massive rotator cuff tear. The principles defining surgical treatment of end-stage RCTA are:

Hemiarthroplasty for Cuff Tear Arthropathy

Jeremy Hall, M.D., FRCSC
Toronto, ON

Cuff Tear Arthropathy
Arthritis in association with rotator cuff tears was first observed and described in 1853 by Professor Adams of the University of Dublin¹. Charles Neer later explained the clinical entity of cuff tear arthropathy and its pathomechanics in 1977². Patients with this condition are plagued with pain and limited function. Cuff tear arthopathy challenges our understanding of the shoulder and is often difficult to treat surgically with success (Figure 1).

 The Swedish Knee Arthroplasty Register

Otto Robertsson M.D., PhD.
The Swedish Knee Arthroplasty Register

The Swedish Knee Arthroplasty Register (SKAR) was started in 1975 and is thus the oldest national arthroplasty register. It was initiated by interested orthopaedic surgeons who realized a combined effort would be needed to assemble knowledge about this then relatively new procedure.

The Swedish Hip Arthroplasty Register

Johan Kärrholm, M.D. PhD
Professor in Orthopaedics,
Head of the Swedish Hip Arthroplasty Register

Göran Garellick, M.D., PhD
Peter Herberts, M.D., PhD
Department of Orthopaedics,
Sahlgrenska University Hospital
Sweden

In 1977 a pilot study was initiated to record all primary and revision hip arthroplasties in Swedish hospitals. Experiences from this study resulted in the Swedish Hip Arthroplasty Register founded in 1979. From the very beginning, all individual revision arthroplasties were identified with a social security number. Demographic data, details about surgical technique, implant used, operating unit and the type and history of the previously used implant or implants were recorded. Until 1992 data about primary hip arthroplasties were recorded on a hospital basis. This meant that it was not possible to connect each individual implant to a social security number which resulted in some uncertainties in the outcome analyses. Implant survival was calculated by use of information from other governmental register and statistically based models¹. In a thorough evaluation it did; however, turn out that the recorded results were valid⁶. From 1992, all primary total hips were also recorded in more detail. This meant that each surgical procedure could be connected to patient demographics, type of incision, a specific implant and technique of fixation. In 1999 the recording was further expanded by including more details about the implants. Information about sizes, offset, and implant materials became available. These registers cover the entire country i.e. all public and private hospitals in Sweden participate.

Scottish Arthroplasty Project

Mr. Gavin C.A. Wood
MBChB, FRCS,
Royal Infirmary Edinburgh

Mr. Colin Howie FRCS
Consultant Surgeon
Royal Infirmary Edinburgh

The Scottish Arthroplasty Project (SAP) was established in 1999 with the following aims.

• To instigate change through continual feedback.
• To set individual results in a local and national context.
• To use outcomes which the public could identify with (death, dislocation, infection, DVT/PE and re-operation).

The Canadian Joint Replacement Registry: Gaining Momentum

Robert B. Bourne, M.D., FRCSC
London, ON

The Canadian Joint Replacement Registry (CJRR), operated through the Canadian Institute for Health Information (CIHI), serves as Canada's leading source of information on hip and knee replacement surgeries. The CJRR captures national data on elective primary and revision hip and knee replacement surgeries and subsequent patient outcomes. The goal of the CJRR is to improve the quality of care in clinical outcomes of joint replacement recipients in Canada.

The Australian Orthopaedic Association National Joint Replacement Registry

Professor Stephen E. Graves
Director
AOA National Joint Replacement Registry

The Australian Joint Replacement Registry is owned and managed by the Australian Orthopaedic Association and is fully funded by the Australian Federal Government. The Registry commenced data collection from a small number of hospitals in September 1999. It then underwent a staged implementation to all remaining hospitals nationally. This was completed in mid 2002. All hospitals, both government and private, undertaking joint replacement surgery, contribute data to the registry. This totals almost 300 hospitals nationwide. There is 100% surgeon participation.

Special Québec City Annual Meeting Feature

Pierre Mercier, M.D., FRCSC
Local Arrangements Committee Chair
Québec City 2008 Annual Meeting

We look forward to seeing you all in Québec City this June.  This year's combined Annual Meeting between the Canadian Orthopaedic Association and the American Orthopaedic Association (AOA) promises to be a fantastic event.

A Québec City and Area Overview

The Québec City and Area tourist region is a living historical illustration of a people unique to this continent, strong and proud of their Aboriginal, French, and British ancestry. Québec City, Côte-de-Beaupré, Île d'Orléans, as well as the Jacques-Cartier and Portneuf communities are included in the Greater Québec Area territory.

In 2008, come celebrate!

On July 3, 1608, Samuel de Champlain founded a settlement at Kébec, an Algonquin word meaning "place where the river narrows." In doing so, he established what would become the first permanent French settlement in North America and one of the world's most enchanting cities. From January to October 2008, Québec City will be pulling out all the stops to celebrate its 400^th anniversary, and we want you at the centre of it. Come celebrate with us and make our joie complete!

Activities and Tours
This programme is tentative; please refer to the Final Programme for confirmed dates and times. Periodic changes will be made to the Annual Meeting web site at http://www.aoacoa2008.org/. 

Travel Information

Québec City, Québec
In 2008, historic Québec City will be celebrating its 400^th anniversary, and you are invited! From home-grown boutiques and classic Québecois gastronomy to outdoor sports and festivals, Québec offers something for everyone. The region boasts unequalled historical and cultural heritage interest, with its architecture, cobblestone pedestrian streets and fortifications, unique in North America. Visit the Plains of Abraham and Vieux-Québec (Old Québec), a UNESCO World Heritage travel destination. For more information about Québec City, please visit http://www.quebecregion.com/ or http://www.monquebec2008.com/.

Because We Can!
Sustainability through health promotion and disease prevention

Angelique Berg
Executive Director
Canadian Orthopaedic Foundation

Dr. Kevin Orrell, Chair of the Canadian Orthopaedic Foundation, has witnessed first-hand the impact that social-marketing campaigns can have on population health. "When I first started as an orthopaedic surgeon 19 years ago," he recalls, "it was not unusual to see victims of motor vehicle accidents where alcohol was involved. Over last Christmas season at the Cape Breton Regional Health Care Complex in Sydney, NS, where he's chief of orthopaedic surgery, Orrell doesn't recall "seeing anybody who was involved in that kind of accident. It's quite incredible."

Open Access Orthopaedics

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

One of the most common questions asked at informatics workshops across the world is how to get free access to journal articles. Orthopaedic surgeons recognize that ‘the literature' is one of the most valuable information resources and are getting increasingly frustrated at the difficulties and cost of access. One cannot afford to subscribe to all the interesting journals and one cannot afford the $25 price of access to a single article. There used to be only three useful ways to obtain free access, 1) to belong to a major medical library which has most of the journals online, 2) to do a Google search for the title (inside quotes) in case the full text has been posted somewhere or 3) to send an e-mail to the author requesting a copy. Now there is a fourth - to join the pressure groups demanding Open Access and wait until the battle is won. It won't be very much longer.