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.

Pensez-y!
Les bourses de voyage de l’Association Canadienne d’Orthopédie ne sont pas choses du passé

Emil H. Schemitsch, M.D., FRCSC
Rédacteur en chef

On a beaucoup parlé dernièrement du manque d’intérêt suscité par les bourses de voyage commanditées par l’Association Canadienne d’Orthopédie (ACO).

Ces bourses comprennent la bourse de voyage américaine-britannique-canadienne (ABC), la bourse de voyage nord-américaine (VNA), la bourse de voyage autrichienne-suisse-allemande (ASA) et d’autres bourses prestigieuses. On a par ailleurs constaté ce manque d’intérêt malgré les efforts incroyables de promotion déployés par le président du Comité des bourses de voyage.

Le conseiller fédéral sur les temps d’attente publie son rapport final

Doug Thomson
Directeur, Association Canadienne d’Orthopédie (ACO)

Ce n’est probablement pas le fruit du hasard si vous n’avez pas beaucoup entendu parler du Rapport final du conseiller fédéral sur les temps d’attente, rédigé par le D^r Brian Postl. Il est maintenant devenu une tradition pour le gouvernement de publier un rapport un vendredi précédant une longue fin de semaine de congé lorsqu’il souhaite éviter de le mettre en lumière. C’est ce qui s’est passé avec ce rapport fort utile étant donné qu’il a été publié juste avant la longue fin de semaine de la fête du Canada. Certains signes montrent clairement que le gouvernement Harper commence à délaisser discrètement son unique priorité annoncée en matière de soins de santé, soit les fameux temps d’attente garantis.

Les médecins spécialistes du Québec se sont fait imposer leurs conditions de travail par une loi spéciale

Pierre Lavallée, M.D., FRCSC
Président de l'Association d’Orthopédie du Québec
Québec (Québec)

Le Gouvernement du Québec a adopté à la hâte en fin de session parlementaire dans la nuit du 13 juin 2006 la loi 37. Cette loi spéciale fixe non seulement les conditions de travail des médecins spécialistes du Québec jusqu'en 2010 mais elle prévoit également des pénalités importantes pour toutes actions concertées nuisant à la continuité des soins.

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.

C’est grâce à l’appui de tous nos commanditaires que nous pouvons offrir un réunion de aualité et à un coût raisonnable. Nous croyons que le partenariat entre industrie des soins médicaux et les professionnels de la santé est fondamental afin d’atteindre nos objectifs.

Nous voulons donc souligner la participation de l’industrie quant à leur appui au programme scientifique et lors des activités sociales, tout en faisant la promotion de leurs produits à notre Réunion annuelle. Merci.

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.

Nicolas Duval, M.D., FRCSC
Clinique orthopédique Duval
Laval (Québec)

La chirurgie du LCA avec un ligament artificiel n’est pas populaire parmi les chirurgiens orthopédistes canadiens. Divers facteurs sont responsables du manque d’intérêt pour cette option. Le principal facteur est le grand nombre d’échecs des ligaments par rupture ou par synovite documentés dans les publications des années 1990^1,2.

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.