The largest country in the Western Hemisphere, Canada is known for its Maple Leaf flag, abundant natural resources, and parliamentary system of government.
Courtesy of Canadian Tourism Commission


Published 11/1/2012
Maureen Leahy

Canada Selected as 2013 Guest Nation

The AAOS is pleased to announce that Canada will be honored as the Guest Nation at the 2013 Annual Meeting in Chicago.

“Canadian and American orthopaedic surgeons have a great deal in common. This is a wonderful opportunity for the two countries to take better advantage of each other’s strengths and work toward cross-border collaboration,” said Geoffrey H. Johnston, MD, FRCPSC, FACS, MBA, president of the Canadian Orthopaedic Association (COA).

Formed in 1945, the COA is dedicated to fostering excellence and unity in orthopaedics to improve the quality of life for people with musculoskeletal disorders. The COA maintains close ties with the Royal College of Physicians and Surgeons of Canada, which oversees the training, education, and certification of orthopaedic surgeons. The COA also maintains close affiliations with international orthopaedic institutions.

“With only 16 orthopaedic residency programs in the country, all graduates have the opportunity to rub shoulders and work with Canada’s orthopaedic leaders in clinical care, teaching, research, and clinical innovation,” said Dr. Johnston. “Canadian orthopaedic surgeons’ skills are broadly recognized as consistently of the highest quality.”

Meeting challenges
Canada has approximately 1,300 orthopaedic surgeons serving a population of 34.5 million—a ratio of 3.2 surgeons per 100,000 people—and demand for orthopaedic services is increasing exponentially.

“Canadian medical schools expanded their capacity in the last decade; as a result the orthopaedic surgical workforce in Canada has recently started growing. At the same time, however, hospital-based resources tightened to such an extent that few new full-time positions are available. We now face a conundrum wherein the number of new orthopaedic surgeons exceeds the number of practice opportunities available, despite persistent and growing demand by Canadians for timely orthopaedic consultation and surgical care,” Dr. Johnston said.

According to the COA, the biggest challenge currently facing Canada’s public healthcare system, including orthopaedics, is how to contain costs and deliver timely care to a diverse, aging population. In response, the orthopaedic community is focusing on efficiency, models of care, and knowledge exchange.

For example, to address the large number of misdirected patient referrals to orthopaedic surgeons, several Canadian provinces have developed total joint assessment centers that triage musculoskeletal patients and direct them to appropriate care. In the Vancouver Coastal Health Region, patients in the OsteoArthritis Service Integration System (OASIS) are initially assessed by nurse practitioners, who then work with referring family physicians to ensure patients receive the necessary diagnostic or follow-up care. OASIS patients have access to pain management experts, occupational therapists, physiotherapists, and dieticians. If a patient’s clinical situation becomes acute, he or she is referred to a rheumatologist or orthopaedic surgeon.

The largest country in the Western Hemisphere, Canada is known for its Maple Leaf flag, abundant natural resources, and parliamentary system of government.
Courtesy of Canadian Tourism Commission

The Canadian division of the Bone and Joint Initiative, Bone and Joint Canada (BJC), works to improve system performance and care for musculoskeletal patients throughout the country’s 10 provinces. The BJC has instituted procedure-specific models of care for hip arthroplasty, knee arthroplasty, and hip fracture, and is currently working on a national model of care for arthritis and related musculoskeletal disorders. In partnership with the United States Bone and Joint Initiative, the BJC also participates in the Young Investigators Initiative, a twice yearly mentoring program for early-career orthopaedic researchers.

The COA recognizes that orthopaedic surgeons are often in a unique position to identify and initiate an intervention for patients who are victims of abuse. COA’s Intimate Partner Violence Working Group is currently seeking funding to institute active and passive screening for intimate partner violence in orthopaedic fracture clinics. Under the active screening model, social workers would be available to screen and refer all women in the fracture clinic; with the passive screening model, clinic staff would perform the screenings and provide referrals.

As in the United States, the number of joint replacement surgeries in Canada is growing. The ability to assess patient outcomes following arthroplasty, therefore, has become increasingly important. Established in 2001, the Canadian Joint Replacement Registry (CJRR) is the country’s leading source of comparative information on hip and knee replacement surgeries. Although participation in the CJRR is voluntary, the COA is pushing to make it mandatory for hospitals to submit a minimum amount of joint replacement data to the registry.

“The relatively small number of orthopaedic surgeons in Canada in general, and the even smaller number active in research, necessitates networking and partnerships,” said Dr. Johnston. “The CJRR is a prime example of this, as is the Canadian Orthopaedic Trauma Society, which regularly publishes Level 1 orthopaedic surgical evidence on behalf of its numerous contributors.”

International efforts
Canada has a long history of providing humanitarian assistance abroad. Over the last decade, Canadian orthopaedic surgeons have been treating combat casualties at the Multinational Medical Unit at Kandahar Air Field in Afghanistan. Since 2001, Canadian orthopaedic surgical teams have conducted annual medical missions to Quito, Ecuador, and, in the wake of the January 2010 earthquake, numerous orthopaedic teams from Canada traveled to Haiti to provide emergency trauma care and long-term follow-up. In addition, thanks in large part to Shafique P. Pirani, MD, recipient of the 2012 AAOS Humanitarian Award, more than 4,000 healthcare professionals and students in Uganda have been trained in the Ponseti method for treating clubfoot.

About the Guest Nation program
The AAOS Guest Nation Program was inaugurated in 2005 to foster greater recognition and awareness of the contributions made to the practice of orthopaedics by orthopaedic surgeons from around the globe and to enhance the robust international flavor and excitement of the AAOS Annual Meeting. Previous Guest Nation honorees have included Argentina, Brazil, Spain, Thailand, Mexico, and Japan.

Check the Annual Meeting program, available online at, for special events and activities related to Canada and the Guest Nation program. Be sure to stop by the Guest Nation booth located in McCormick Place South, Academy Hall B and welcome our colleagues to the north!

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at