“Why You Wait for Surgery”

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

Dr. Hans Kreder recently wrote an opinion piece as titled above, for the Toronto Star daily newspaper on the profound effect that waiting lists are having on patients and health care providers. He correctly pointed out that “expanding indications for orthopaedic procedures, an aging population that requires more such operations and an aging, declining workforce of orthopaedic surgeons means waiting lists will get longer in the years to come.”

This opinion piece was followed by an eight-part series featured in the Toronto Star on waits endured by patients for various procedures. Dr. Kreder and Dr. Ted Rumble, who co-chair the COA’s National Standards Committee, were quoted in this series about the need to increase operating time to address this issue. They should be congratulated for their efforts. Their Committee has produced a report that explores this issue in detail. To improve the situation, they suggest that orthopaedic surgeons require a minimum of four more hours per week in the operating room.

Dr. Rumble and Dr. Kreder have made a solid case that is easily understood by thousands of readers. Without this kind of public advocacy, we will not be able to affect change. Although the creation of reports and interaction with the media are costly and time consuming, they are absolutely necessary. With circulation in the hundreds of thousands, it is likely that this issue has received tremendous exposure. We as members of the COA should support these efforts and continue to try and spread this message.

Introduction

Treatment for hallux valgus has been controversial and includes various re-alignment and fusion procedures. Inadequate treatment of hallux valgus can lead to significant sequelae. Longer-term results have included a fair proportion of failures, which have required further surgical treatment. Failed hallux valgus surgery has been associated with a high incidence of litigation. The failures and the increasing demand for normal function in most patients have led to increasing enthusiasm for various treatment options. Our Themes section will discuss these important issues in detail.

Proximal Realignment:

Introduction

Distal Osteotomies and Soft Tissue Procedures for Treatment of Hallux Valgus

N. Craig Stone, M.D., FRCSC
St. Johns, NL

When surgical management is indicated, most cases of symptomatic hallux valgus can be managed with realignment procedures in the distal portion of the first ray¹. If the first intermetatarsal angle (IMA) is not excessive (<14°) and there is no degenerative change in the first metatarsophalangeal joint, distal osteotomies and soft tissue procedures can effectively correct the deformity².

Proximal Fusions

Alastair S.E. Younger, M.D., FRCSC
Vancouver, BC

Paul Lapidus popularized the first tarsometatarsal (TMT) fusion and distal realignment, although he was not the first to describe this operation. The procedure is therefore also known as a Lapidus procedure¹.

Surgeons treating hallux valgus must determine precisely where the foot hurts, and then decide on a logical rationale as to why that part of the foot hurts. Most forefoot pain is due to pressure, and if the pressure point can be reduced - the pain will be resolved. Patients with hallux valgus often complain of pain under the second metatarsal head (metatarasalgia), because of loss of weight bearing through the deformed and possibly elevated first ray. The operation chosen must address the second metatarsal head overload. A Mitchell osteotomy may increase the second metatarsal load as it achieves correction at the expense of metatarsal length².

Fusion of the 1^st MTPJ

Johnny T.C. Lau, M.D., FRCSC
Toronto, ON

Patients with severe hallux valgus with or without inflammatory or degenerative arthritis can be successfully treated with 1^st MTPJ fusion. Fusion of the 1^st MTPJ reliably corrects deformity, and eliminates pain in cases with arthritis. The success of fusion of the 1^st MTPJ depends on the approach, preparation of bony surfaces, proper alignment, and stable internal fixation.

Report from the 2003 J.J Fahey North American Travelling Fellowship – A Canadian Perspective

Brian K. Kwon, M.D., FRCSC
Clinical Assistant Professor, Department of Orthopaedics
University of British Columbia
Vancouver, BC

“The American Orthopaedic Association established the North American Travelling Fellowship (NATF) in 1970. The AOA renamed the programme the John J. Fahey, MD, Memorial North American Travelling Fellowship in 1991 in honor of former AOA president John J. Fahey, MD, who contributed $20,000 to the fellowship. The NATF is designed to provide young orthopaedic surgeons who have just completed residency training the opportunity to spend four weeks travelling to orthopaedic centres in the United States and Canada. Five fellows - four U.S. and one Canadian - participate in the programme each tour. Regional tours take place in odd years in the fall. Today the NATF remains one of the most prominent travelling fellowships in orthopaedics and serves to identify the future leaders of the specialty. Since its origination, 150 fellows have participated in the programme.”

Closing Wedge High Tibial Osteotomy for Medial Compartment Osteoarthritis

Opening Wedge High Tibial Osteotomy

1. Dr. Laurie Hiemstra is awarded The Alexandra Kirkley Young Investigator Award for her research proposal entitled: "Crossover Nociception and Contralateral Limb Strength Changes after Acute Anterior Cruciate Ligament Surgery."
   
2. Dr. Florina Moldovan is awarded the Carroll A. Laurin Award for her research proposal entitled: "Does Endothelin and Metalloproteases Interplay Contribute to Osteosarcoma Malignancy?"
   
3. Dr. Peter MacDonald is awarded the Robert B. Salter Award for his research proposal entitled: "Arthroscopic Rotator Cuff Repair with and without arthroscopic acromioplasty in the treatment of full thickness rotator cuff tears."
   

Congratulations to each of the winners!

Thank You to the COA Member Donors / Remerciements aux membres donateurs de l’ACO

What Legacy Will You Leave to Your Profession?

The Canadian Orthopaedic Foundation has a long and proud history of fostering orthopaedic research through its grants and awards programmes – from the first J. Édouard Samson Award of $250 presented in 1967, to the array of awards that total in the tens of thousands in 2004. Through its funding, the Foundation has retained researchers in Canada, and helped many researchers initiate work leading to much larger grants and significant discoveries – effectively contributing to improved innovation for better patient outcomes.

Arthroplasty Revisited: Hip and Knee Revisions in Canada

Excerpts from the 2004 CJRR Analytical Bulletin

Sukanya Gopinath, Senior Analyst
Dereck Cyrus, Senior Analyst
Nicole de Guia, Consultant
Canadian Joint Replacement Registry
Canadian Institute for Health Information
Toronto, ON 

In June 2004, the Canadian Joint Replacement Registry (CJRR) released an analytical bulletin entitled ‘Revisions of Hip and Knee Replacements in Canada’. This bulletin contained information on revisions to replacements – by province, age and gender, associated length of stay, reasons for revision, components replaced, and also compared Canadian statistics with revisions reported by other international registries. Highlights of the bulletin are presented here.

Presidential Award for Excellence Recipient

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COA Presidential Award for Excellence Recipient

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COA Award of Merit Recipient

Dr. Geoffrey H. Johnston

Robert M. Hollinshead, M.D., FRCSC
Calgary, AB

The COA Award of Merit is presented to orthopaedic surgeons who work behind the scenes to make the Association a success. They are leaders in their field, contributing to all aspects of bone and joint care.

Dr. Geoffrey H. Johnston has been a leader in upper extremity surgery since joining the Faculty at the University of Saskatchewan in 1985, then being promoted to tenured Professor in 1995. He has made extensive contributions to clinical research and teaching and for the last three years has been Joint Chief of Surgical Services for Saskatoon District Health. Presently completing his MBA, he has held medical licenses in Massachusetts, Kentucky, California and Michigan but fortunately for the COA, he has stayed here in Canada. Geoff has served as Chair of the Exchange Fellowship Committee and been a member of our Specialty Committee since 1993, serving as its Chair for the last six years.

Congratulations!

COA Award of Merit Recipient

Dr. Robert É. Turcotte

I am very pleased to see Dr. Robert É. Turcotte receive this recognition, and I hope our professional relationship will continue for a very long time.

Dr. Robert É. Turcotte is presented with the Award of Merit by Dr. Robert M. Hollinshead.

A Canadian Orthopaedic Oasis in the Arabian Desert

R. Merv Letts, M.D., FRCSC
Abu Dhabi
United Arab Emirates

Halfway around the world from Canada is a group of Canadian orthopaedic surgeons delivering high quality health care to the citizens of the United Arab Emirates (UAE). The UAE is a very young country, a federation of seven sheikdoms known prior to 1971 as the Trucial States: Abu Dhabi, Dubai, Fujairah, Ajman, Umm Al Quwain, Ras Al Khaimah and Sharjah (Figure 1). The capital is the very modern city of Abu Dhabi often referred to as ‘the Manhattan of the Middle East’ (Figure 2) in which the Shaikh Khalifa Medical Centre (SKMC) is located. A modern 300-bed hospital built four years ago under the auspices of Inter Health Canada and staffed largely by Canadian professionals (Figure 3).

Getting on the Provincial Agenda

An Update from the Ontario Orthopaedic Association

David A. Wismer, M.D., FRCSC
President, Ontario Orthopaedic Association
Toronto, ON

The Ontario Orthopaedic Association (OOA) has been very active the past several months in its quest to improve the economic position of its members and the access to quality orthopaedic care for our patients. Our strategy has been to engage a government relations firm and an economic consultant. This two-pronged approach has been helpful to the OOA in refining its priorities and better positioning our Association for productive negotiations.

We are still early in the process but there are some encouraging signs that our efforts are bearing fruit. The Ontario government has been heavily criticized in the media and public for lack of delivery on pre-election promises and, particularly, for the implementation of a health tax that is to be directed totally to health care in the province.

Full Speed Ahead

The National Action Network (NAN) for the Bone & Joint Decade is moving full speed ahead in terms of planning for the meeting being held in Toronto from October 29-30, 2005. This meeting is taking on an added dimension as we attempt to partner with the US National Action Network for the Bone & Joint Decade in holding a joint meeting for young investigators. The first meeting of this group will be held under the auspices of the American Bone & Joint Decade in April of 2005 and a subsequent meeting we hope will be held in conjunction with the NAN world-wide meeting in Toronto. This collaborative effort between the two National Action Networks involving young investigators from all fields of musculoskeletal health will hopefully bring a new dimension to collaboration in research between the NIH and the CIHR as well as universities and individual researchers.

COA Annual Financial Report 2003

Brendan D. Lewis, M.D., FRCSC
COA Treasurer
Cornerbrook, NL

At the recent Annual Meeting of the Canadian Orthopaedic Association (COA), the audited financial statements for the year ending February 28, 2004 were presented and approved by the Board of Directors.

Revenue for the year was slightly ahead of budget due to better than expected past dues collections and to an Annual Meeting deficit from last year that was smaller than expected. The deficit for the year of $21K is a substantial improvement over our original estimates for 2004, given the unprecedented challenges of 2003.

Patrick J. Donnelly, M.D., FRCSC - 1935 -2004

The COA extends its deepest sympathies to the family and friends of Dr Donnelly who passed away June 2nd, 2004

William Harvey Bailey B.A., M.D., FRCSC, FACS - 1933-2004

At London Health Sciences Centre, Victoria South Street Campus on Thursday, June 10, 2004, in his 72^nd year. Dearly beloved husband of Lois. Loved father of Lee and his wife Trish Arsenauld of Toronto, Leanne Cristall and her husband Todd of Rose Bay, Nova Scotia, Lynn Clarfield and her husband Dr. Michael Clarfield of Toronto, Michael and his wife Helen of Toronto, and Libby Basek and her husband Drew of Toronto. Loved grandfather of Dominique and Sam Cristall, Mathew and Lauren Clarfield, and Alexander Bailey. Brother of Dr. Stewart Bailey and his wife Beth of London, Alan and his wife Jane Boudreau-Bailey of Mt. Brydges. Also survived by many nieces and nephews and 1 grand nephew. Dr. Bailey was a distinguished orthopaedic surgeon and outstanding teacher during his 33 years of clinical practice at London Health Sciences Centre. During this time he served as President of the Medical Advisory Committee, Victoria Hospital, Chief of the Division of Orthopaedic Surgery, University of Western Ontario and also was Chair of both the Ontario Orthopaedic Association and the Ontario Medical Association Section on Orthopaedic Surgery. Memorial contributions to the Stroke Rehabilitation Program, Parkwood Hospital Foundation would be gratefully acknowledged. His family wishes to thank all the staff at the Parkwood Hospital Stroke Rehabilitation Programme and LHSC for their kindness and care.