President-Elect Address 2007 / Allocution du président élu 2007

Marc J. Moreau, M.D., FRCSC

The honoured position of President of the Canadian Orthopaedic Association comes to few. I am honoured and very thankful for the opportunity that this organization has given me to represent it both here in Canada and abroad over the next year. C'est aussi un grand honneur pour moi de terminer mon année spéciale dans la ville ou j'ai reçu mon baccalauréat ès arts, près de la ville ou j'ai complété mon éducation en orthopédie, dans ma province natale.

Getting Up the Down Escalator
to tame the TJR queue will require a doubling of efforts

Dennis Jeanes
Special to the Canadian Orthopaedic Association

On any given day during 2004-05 in Ontario, 26,725 patients were waiting for total hip or knee arthroplasty, and with each passing month, the number of new decisions for surgery exceeded the actual number of surgeries by more than 20%, adding another 500 patients to the waiting list.

Membership Survey 2007 - Results

Doug Thomson, CEO
Canadian Orthopaedic Association

The COA was formed "to achieve excellence in orthopaedic care for Canadians by: advancing professional fulfillment of orthopaedic surgeons; to promote and provide education of our membership; communicate and inform our members with timely and relevant information, and advocate for national standards of orthopaedic care."

A COA Member's Journey through Orthopaedics and the Manitoba Provincial Election, May 23, 2007

Douglas E. Kayler, M.D., FRCSC
Winnipeg, MB

I will pick up the tale of my journey into a brief run at provincial politics to the Spring of 2001. My colleagues had selected me to lead our provincial association, the Manitoba Orthopaedic Society (MOS) for the next two years. This was a period of ferment in Manitoba medical politics and restructuring, as the Winnipeg Regional Health Authority (WRHA) was beginning its consolidation of services process. This would involve new ground for MOS, and in preparation for our Fall activities, I arranged a meeting with my WRHA surgical programme director to plan how MOS might best work with WRHA on the problems facing orthopaedics.

COA Annual Meeting Reaches New Heights

Doug Thomson, Executive Director
Canadian Orthopaedic Association

A record number of COA members were treated to a very special Annual Meeting in Halifax this past June. In the words of one member in response to the post-meeting survey, "This was an excellent conference. I think congratulations are in order because not too long ago, the COA annual conferences were really not very educational."

COA Awards of Merit, Excellence and Outstanding Services
2007 Recipients

Brendan D. Lewis, M.D., FRCSC
Past President, Canadian Orthopaedic Association
Corner Brook, Newfoundland and Labrador

Each year at the Canadian Orthopaedic Association Annual Meeting, we are given the honour to recognize people who have made significant contributions to orthopaedic surgery in Canada and the care of Canadians.

Taking Flight
Women in Orthopaedics holds its 4^th annual luncheon

Marcia Clark M.D., FRCSC
Calgary, AB

Women in Orthopaedics (WIO) began in early 2003 with the intention of bringing together female orthopaedic surgeons and residents within Canada. By holding events in conjunction with the COA and OOA Annual Meetings, the WIO has provided surgeons working in various areas of orthopaedics a chance to share common interests, challenges and successes within their field.

Impressions of the 62^nd Canadian Orthopaedic Association Annual Meeting
from the oldest member in attendance!

Basil Grogono, FRCS, FRCSC, FACS
Halifax, NS

I have the pleasure of sharing with you a collage of the wonderful recent COA Annual Meeting in Halifax. I think it may convey some of the impressions and feelings I encountered whilst I was enjoying the show. This was indeed a magnificent event - well staged and organized in the true traditions of the COA. It was difficult for me to select the sessions I wished to attend from the plethora of scientific presentation and workshops that filled each day, but I managed to arise each morning for the 7:00am Instructional Course Lectures.

Raising Funds for Research

Debbie Gates
Canadian Orthopaedic Foundation

Orthopaedic surgeons and industry representatives enjoyed an afternoon of golf, fun and prizes at the Old Ashburn Golf Club prior to the COA Annual Meeting in Halifax. "I wanted to help raise dollars for orthopaedic research," says Mark Glazebrook who organized the tournament. "I couldn't have done it without the help of local volunteers - Kathy Glazebrook, Donalda Dickey and Donna Shakespeare - Doug Thomson and Trinity Wittman in the COA office, and Angelique Berg and Debbie Gates in the Foundation office." The Foundation thanks Dr. Glazebrook for organizing the tournament and raising more than $7,500 for the Canadian Orthopaedic Foundation's CORL programme. 

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.

Memories from the Pride of Nova Scotia

Ben Smith, M.D.
Nadia Murphy, M.D.
CORA Co-Presidents 2006-2007

Greetings from Nova Scotia!

This year we had another great CORA meeting ending off a very successful year. Beginning in the Fall, we assembled the results from the second Canadian residents survey; these results were circulated to the various CORA representatives and allowed all of the residents to see the differences and similarities between the various programmes across the country. Hopefully this will enable us to lobby for change in any programmes that are significantly behind the others and standardize orthopaedic training across the country.

2007 WINNER OF THE J.A. NUTTER AWARD
FIRST PRIZE - TOP PAPER

A Novel Composite Elastin and Hyaluronan Scaffold for Nucleus Pulposus Tissue Engineering

Isaac Moss, M.D.
Toronto, ON

K. Woodhouse
C. Whyne
A. Yee

2007 WINNER OF THE ALEXANDRA KIRKLEY AWARD
SECOND PRIZE

Protease Activity in the Stromal Cells of Giant Cell Tumour of Bone

Alexander Rabinovich, M.D.
London, ON

R. Cowan
N. Simunovic
N. Colterjohn
G. Singh
M. Ghert

2007 WINNER OF THE COSA AWARD
THIRD PRIZE

Deep Vein Thrombosis Prophylaxis in Distal Lower Extremity Fractures - A Prospective Randomized Controlled Trial

Danny Goel, M.D.
Calgary, AB

R. Buckley
G. deVries
G. Abelseth
G. Fick
A. Ni
R. Gray

Bone and Joint Canada
Making Strides

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

A fourth meeting of Bone and Joint Canada was held at the time of the Annual General Meeting of the Canadian Orthopaedic Association in Halifax. As mentioned in previous updates, we have engaged a number of individuals from patient advocacy groups and government to join our meetings in the past. On this occasion, we were fortunate to have individuals join us from the operational side of health care delivery - Regional Health Care Managers and Chief Operating Officers of two major hospitals.

Optimizing Flexion in Total Knee Replacement

The Canadian Orthopaedic Association has invited our commercial partners to submit articles to the COA Bulletin that describe some of the research and development that is currently being undertaken by industry in search for new and innovative devices in orthopaedics. The following article has been submitted by DePuy, a Johnson & Johnson Company.

The COA does not recommend or endorse any specific products that may be presented or mentioned in this article. 

Introduction
The optimal surgical treatment of an Achilles tendon tear stirs up a great deal of controversy and debate. Dr. Volesky and Dr. Bhandari will debate the merits and pitfalls of open versus percutaneous surgical management of Achilles tendon tears.

Achilles Tendon Rupture: Open Repair

Mohit Bhandari M.D., MSc, FRCSC
Division of Orthopaedic Surgery,McMaster University
Hamilton, ON

What's the Problem?
Rupture of the Achilles tendon is both a serious injury and one of the most common tendinous lesions occurring in 18 per 100 000 persons¹. These injuries have historically been treated by conservative methods (cast immobilization, bandaging)². Since the mid-1900's, however, surgical repair of the ruptured tendon has become popular².

Percutaneous Achilles Repair

Monika Volesky, M.D., FRCSC
Montreal, QC

The optimal treatment for acute Achilles tendon ruptures remains controversial, and recent advances in both operative and nonoperative treatments have not resolved this debate. Advances in operative management have included evolving suture techniques, increased suture strength, as well as methods of percutaneous and mini-open repair.  Although many studies show definite advantages of open over nonoperative repair, historically high wound complication rates and infections reported in open repairs have served as an impetus to try less invasive procedures. Percutaneous repair was first described by Ma and Griffith¹ in 1977  to take advantage of the benefits of both open and nonoperative treatment techniques.

Introduction
DVT prophylaxis in joint replacement arthroplasty is a highly varied, controversial and constantly evolving topic in orthopaedic surgery. To bring us up to date with the current issues, Drs. Dunbar, Mahomed, McCalden, Zukor, and Vendittoli will discuss the use of Heparin, the use of low-molecular-weight Heparin, the use of new oral agents, the use of Warfarin, and the length of prophylaxis respectively.

DVT Prophylaxis for Total Joint Arthroplasty
Heparin

Michael J. Dunbar M.D., FRCSC, PhD
Dalhousie University

Heparin was discovered in 1916 and is one of the oldest drugs currently still in widespread clinical use. It was originally isolated from canine liver cells, hence its name (hepar is Greek for "liver"). Pharmaceutical grade Heparin is commonly derived from mucosal tissues of slaughtered meat animals such as porcine intestine or bovine lung.

DVT Prophylaxis for Total Joint Arthroplasty
Low-Molecular-Weight Heparin

Rajiv Gandhi, M.D., FRCSC
Nizar N Mahomed, M.D., ScD, FRCSC
Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto
Toronto, ON

The incidence of asymptomatic deep vein thrombosis (DVT) in joint replacement surgery ranges from 45 to 57% after total hip replacement (THR), and 40 to 84% after total knee replacement (TKR) in the absence of thromboprophylaxis¹. Prophylaxis with low-molecular-weight Heparin (LMWH) decreases that incidence to about 15% in THR and 30 % in TKR^2-5. The mortality from pulmonary embolism (PE) following joint replacement surgery is estimated at 0.5-2.0 %^6-11.

DVT Prophylaxis for Total Joint Arthroplasty
New Oral Agents

Richard W. McCalden, M.D., MPhil(Edin), FRCSC
Associate Professor, University Western Ontario
Department of Surgery
London Health Science Centre
London, ON

There is a general agreement that some form of DVT prophylaxis is required for patients undergoing a total joint arthroplasty. However, many questions remain concerning the best method of prophylaxis and the appropriate duration of treatment.

DVT Prophylaxis for Total Joint Arthroplasty
Warfarin

David J. Zukor, M.D., FRCSC
Associate Professor Surgery, McGill University
Chief, Department of Orthopaedic Surgery,
Sir Mortimer B. Davis - Jewish General Hospital,
Montreal, QC

Warfarin (Coumadin^©) was until recently the most common form of prophylaxis in North America following total hip arthroplasty¹. As the gold standard for orthopaedic surgery has been thromboprophylaxis for greater than 15 years, it is reasonable to assume that most orthopaedic surgeons in practice for more than a few years have considerable experience in the use of Warfarin.

DVT Prophylaxis for Total Joint Arthroplasty
Length of Prophylaxis

Muthu Ganapathi, MSc, FRCS(Ortho), Fellow in Joint Reconstruction
Pascal A. Vendittoli, MSc, FRCSC
Maisonneuve-Rosemont Hospital
Department of Surgery, Université de Montréal
Montréal, QC

Although prophylaxis to prevent DVT following THA and TKR is universal in North America, there is a wide variation in the choice of the prophylaxis used as well as the duration of prophylaxis. With increasing trends towards shorter duration of hospital stay and emphasis on cost benefit relationship, it is important to base one's DVT prophylaxis regimen on the available scientific evidence.

Canadian Orthopaedic Foundation Turns Attention to Stemming Demand

Stuart Foxman
Special to the Canadian Orthopaedic Foundation

Looking ahead 20 years, can we significantly reduce the anticipated demand for orthopaedic surgeries? Angelique Berg thinks so. Berg is Executive Director of the Canadian Orthopaedic Foundation, which plans an increased focus on public education and awareness, including injury prevention, nutrition and fitness strategies. How can the Foundation be a catalyst for change? To learn more, we talked with Berg.

First Prize
the CORL award goes to...

Dennis Jeanes
Special to the Canadian Orthopaedic Foundation

Like all conscientious lead investigators, Halifax's Dr. Mark Glazebrook is quick to mention his colleagues and is modest to a fault: "I'm a cog in a big wheel. For the kind of numbers we need to prove what we're trying to prove, I couldn't do it alone, nor could Tim Daniels in Toronto, nor could Alastair Younger in Vancouver. We're very lucky to have a cohesive, collaborative group [see sidebar] that allows us to do this work."

Powerful PowerPoint

Myles Clough, M.D., FRCSC
Clinical Instructor, UBC, Department of Orthopaedic Surgery
Kamloops, BC

Computer graphics presentation programmes aka PowerPoint are now the standard for presentation of orthopaedic papers and teaching sessions. Apart from being cheaper to prepare than slides, it is faster and more flexible. Most of us now have familiarity with the process of preparing a presentation in this format and would strongly resist a return to photographic as opposed to computer graphics (CG) "slides".

We regret to advise that we have lost the following members.  Our sincere condolences are extended to their families and friends.

William F. Donaldson
1921-2006

Marcel Cloutier
1923-2007