The segment highlighted how the initiative is opening doors for high school students—particularly those from underrepresented communities—by offering early, hands-on exposure to orthopaedic surgery.

Students rotated through four practical stations including:

• Casting for fractures
• Surgical fixation using plates and screws (sawbones)
• Suturing
• Arthroscopic surgery

Leadership and Mentorship in Action

Residents played a central role in guiding students through each station, offering not only instruction but also perspective on training pathways and career development during an hour long “lunch and learn” session.

Expanding Access to Opportunity

By engaging students early, the Division of Orthopaedic Surgery at UofT aims to broaden awareness of a career and training in Orthopaedic Surgery, to foster a more diverse and representative workforce, and to decrease barriers to entry.

Division Chair Dr. Peter Ferguson said:

“Evidence continues to show that diversity in healthcare contributes to stronger patient outcomes, reinforcing the importance of initiatives like this.”

An Experience That Shapes Perspective

For many students, the event is more than an simple introduction—it is a transformative experience that may shape their training choices and career. Chief Resident Dr. Anser Daud explained:

“Hands-on exposure at this stage can be transformative, helping students move from curiosity to possibility.”

Dear all,
Caroline Cristofaro and I had our first publication in the CMAJ today on parental and childbearing surgeon support policies. This article is in conjunction with our upcoming University Wide Rounds focus on support for childbearing trainees.

Positive feedback on the article has been received from surgeons across Canada. Below is the link for our faculty and learners to peruse and we welcome any feedback you would like to share.

The Project Grant program supports ‘ideas with the greatest potential to advance health-related fundamental or applied knowledge, health research, health care, health systems, and/or health outcomes.’

Congratulations to our own Dr. Raman Mundi and Dr. Harman Chaudhry!

Project: Perioperative vitamin C to reduce persistent pain after total knee arthroplasty: a pilot randomized controlled trial
Principal investigator: Dr. Raman Mundi
Sunnybrook co-investigators: Dr. Stephen Choi, Dr. Harman Chaudhry
Funding: $100,000

Foot and ankle orthopaedic surgeons still evaluating the impact of obesity on the procedure’s success

Rosemont, Ill., Oct. 17, 2023 (GLOBE NEWSWIRE) — Total Ankle Replacement (TAR), also known as total ankle arthroplasty, is a surgical procedure that foot and ankle orthopaedic surgeons use to treat ankle arthritis. In the procedure, the ankle joint is removed and replaced with an artificial implant made of metal and plastic. The goal of TAR is to provide pain relief while preserving ankle motion so the patient has less pain and better function during activity. Foot and ankle orthopaedic surgeons continue to investigate the factors that contribute to the success or failure of the procedure, including the impact of obesity.

In a recent study published in the Foot & Ankle International (FAI) scientific journal, researchers from Duke University in Durham, North Carolina, reviewed the impact of obesity on patient-reported outcomes and complication rates after the TAR procedure. The study titled “Total Ankle Arthroplasty: Does Obesity Matter?” reviewed data from 1,093 patients who underwent TAR at Duke between 2001 and 2020. Patients were grouped by body mass index (BMI) including a control group, an obesity class I with a BMI from 30-34.9, and an obesity class II with a BMI of 35 and over.  

Albert T. Anastasio, MD, of Duke University, one of the study’s authors, said the researchers did not see any increase in complication rates or failure rates across all three obesity classes after the TAR procedures. This is one of the largest single-institution studies to date examining the effect of obesity on outcomes after TAR.

Yet, results from other studies have shown that obesity does impact the procedure’s success. In a separate study published in FAI, researchers from the United Kingdom analyzed various risk factors for TAR failure in a retrospective registry-based study of 5,562 patients. They reported that increased BMI significantly increased the risk of TAR failure.

Both studies used larger data samples for their evaluations, yet they had very different findings. In an expert commentary in FAI, independent researchers reviewed these results.

“I was surprised that two studies with large sample sizes came to different conclusions regarding complication rates in obese patients that have undergone a TAR,” said Timothy R. Daniels, MD, FRCSC, chief of the Division of Orthopaedic Surgery at St. Michael’s Hospital in Toronto, Canada, who co-authored the commentary. “These conflicting outcomes suggest that a more in-depth analysis is required in order to identify the reasons for this disparity.”

“Dr. Daniels’ commentary is a fantastic interpretation of the literature,” Dr. Anastasio said.  “Simply, we do not yet know the answer on whether obese patients fare worse after the TAR procedure. The data is clearer with other forms of total joint replacement like hip and knee replacement – we are still learning a lot about ankle replacements.”

Dr. Anastasio added, “My take-home point would be to offer folks hope that TAR can be as successful in patients with elevated BMIs. We really saw an impressive reduction in pain and improvements in function in both normal BMI and elevated BMI patients in our study.”

Drs. Anastasio and Daniels agree that future studies with larger samples are required to fully understand the impact of obesity after TAR.

Both studies and the expert commentary appeared in the July 2023 issue of Foot & Ankle International, the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). FAI is published by SAGE Journals.

As President of CORS, Dr. Ravi will help to facilitate and support interdisciplinary research between scientists and clinicians, foster strong relationships with other musculoskeletal research societies in Canada and worldwide, support excellence in musculoskeletal research through recognition, knowledge translation and funding initiatives, and inspire the pursuit of musculoskeletal research in scientists and clinicians in training.

“CORS serves a unique and important role in the orthopaedic research community, and I’m excited by the possibilities!” he says.

“Dr. Ravi exemplifies the leadership our people in the Holland Program continue to bring not only to Sunnybrook, but beyond,” says Dr. Albert Yee, chief of the Holland Bone and Joint Program at Sunnybrook.

Source: https://sunnybrook.ca/research/media/item.asp?c=2&i=3613&f=ravi-Canadian-Orthopaedic-Research-Society

Surgeons from Sunnybrook and Michael Garron hospitals plan to do 1,300 more hip and knee replacements over the next year by operating on Saturdays, Sundays.

Two Toronto hospitals have partnered to open operating rooms on weekends to perform more joint replacement surgeries — the latest move by Ontario hospitals to try to address a surgical backlog that soared during the pandemic.

Source: https://www.thestar.com/news/gta/waiting-for-a-hip-or-knee-replacement-toronto-hospitals-join-forces-to-offer-weekend-surgeries/article_50992c14-fb7b-5306-8542-3aea02bf93e5.html

VANCOUVER, BC, March 7, 2023 /PRNewswire/ – PrecisionOS®, a leading medical education simulation provider announced today a novel virtual reality curriculum for orthopedic training. The company has put together an extensive guide aimed at all residency programs in North America and beyond. The curriculum, compiled through consultation and input from a number of surgeon educators, is set to augment the way surgical residents are trained while making it not only relevant, but support skill acquisition and benchmarks in surgical training.

“This virtual reality curriculum represents a true game-changer in surgical education,” said Dr. Peter Ferguson, Albert and Temmy Latner Chair of the Division of Orthopedics, Department of Surgery, University of Toronto. “It follows the framework of the Accreditation Council for Graduate Medical Education (ACGME) and the Royal College of Physicians and Surgeons of Canada (RCPSC) and allows residents to experience highly realistic and immersive simulations of surgical procedures in a safe and controlled environment. This will now provide them with a guide and level of training that was previously unattainable with traditional methods.”

“To truly harness the power of VR, we needed to offer a guide on how to seamlessly integrate VR within academic programs,” said Danny P. Goel, MD, CEO of PrecisionOS. “This curriculum covers all orthopedic disciplines and provides learners with relevant and actionable data to becoming an integral part of their current educational pathway, understanding when to use which medical devices all while enhancing performance in the operating room.”

“I have been impressed with the effort and dedication to resident education during the development and expansion of the PrecisionOS system. Precision’s new curriculum is based on sound educational principals and provides a roadmap for steps to integrate modules into training programs with a view to augment skills training of our residents,” said Dr. Larry Marsh, MD, Department Head, Professor and Carroll B Larson Chair of the Department of Orthopedics and Rehabilitation at the University of Iowa Hospitals and Clinics.

This virtual reality curriculum is now available for all orthopedic surgical residency programs in North America and will be released at the American Academy of Orthopedic Surgeons Annual Meeting in Las Vegas March 7-11, 2023. With over 60 residency and fellowship programs on the platform, the company will be adding significantly more content to the curriculum over the coming months. Program directors and residents can find more information and request access to the curriculum here.

Dr. Michael Zywiel says device helps with faster recovery, more predictable outcomes for patients

Dr. Michael Zywiel from the Schroeder Arthritis Institute recently performed the first knee replacement surgery in Canada assisted by a robotic device that helps the surgeon plan the surgery with more accuracy. (Submitted by Schroeder Arthritis Institute/UHN)

When Steven Gotal was having difficultly enjoying his European vacation last year due to agonizing knee pain, he knew it was likely time for surgery.

The 75-year-old Mississauga man had problems with his left knee decades ago, but now it was affecting his ability to do simple tasks like walking and going up and down the stairs.

“It was starting to be very painful,” he explained, saying he also could no longer participate in some of his favourite activities like cycling and swimming.

Gotal paid a visit to Dr. Michael Zywiel, an orthopedic surgeon and clinician investigator with the Schroeder Arthritis Institute at Toronto’s University Health Network.

Zywiel had an interesting proposal: Gotal could be the first patient in the country to undergo knee replacement surgery with a new robotic device at Toronto Western Hospital, where hundreds of knee replacement procedures are performed every year.

Gotal agreed, and said he jokingly told the surgeon he hoped he had practised. He underwent a successful operation last Friday, and is on the road to recovery.

The robot, known officially as the VELYS robotic assisted device, was funded entirely through a donation.

Built by Depuy Synthes, a U.S. medical device company, Zywiel says the robot allows the team to more accurately plan and execute the surgery. He explains this is important because every patient’s knee is a little different and needs implants in a slightly different position. He says a fairly large percentage of patients aren’t satisfied with the outcome of their knee replacements and this new device can potentially save them a lot of pain and additional surgery. 

“The robot lets us very accurately perform the exact cuts we want to perform,” he said.

Source: https://www.cbc.ca/news/canada/toronto/toronto-surgeon-performs-first-knee-replacement-in-canada-using-new-robot-1.6719335

Premier Doug Ford has unveiled his plan to use private and not-for-profit community surgical centres to clear waiting list backlogs and give patients access to faster care.

Amit Atrey MD, MSc, MRCS, FRCS
Assistant Professor of Orthopedics University of Toronto, Staff Trauma & Arthroplasty surgeon, St Michael’s Hospital

“As a surgeon, I feel any measure that will allow for more surgeries and cut wait times should be considered. Expanding the scope of Community Surgical Centres is a measure that could potentially help reduce wait times across the province. With the proper safeguards that ensures staffing in hospitals won’t be impacted and IHFs are affiliated with existing hospitals to support patients throughout their care journey, this could benefit many patients and families in Ontario. We look forward to working with the Ontario government to develop this model to best serve Ontarians.”

Source: https://torontosun.com/news/provincial/heres-what-doctors-and-hospital-officials-are-saying-about-doug-fords-plan-to-expand-surgery-to-community-clinics

By Sarah Ward
Contributors
Jesse Wolfstadt
Corwyn Rowsell

Thu., Aug. 25, 2022

The COVID-19 pandemic has amplified inefficiencies and lack of access to resources that have stressed Ontario’s health care system to the brink. Many Canadians have seen or heard about potential ICU closures, shuttering of emergency rooms and cancelled elective surgeries.

There is growing concern from both providers and patients about the backlog of postponed surgeries, especially as hospitals struggle with daily operations due to enormous staffing challenges.

In Ontario, a large part of the backlog in surgeries consists of patients awaiting hip and knee replacement operations. Ontario performs almost 50,000 hip and knee replacements each year, and the demand for these surgeries continues to rise.

With hospitals understaffed and overloaded with patients who are anxiously awaiting long-delayed surgeries, now is the time to ensure that all our processes are as efficient as possible.

As orthopedic surgeons and pathologists, we see an opportunity for improvement that can help free up time and limited resources.

But several studies show routine pathology testing does not help or change patient care for those undergoing hip and knee surgeries.

In fact, in other provinces, there are major efforts underway to reduce this practice. Manitoba reduced pathology testing for hip and knee surgeries by 93 per cent without negatively impacting patient care.

In Ontario, this routine practice remains entrenched due to many hospitals legal department’s interpretation of regulation 965 of the Public Hospitals Act, which mandates that such tissues removed during an operation be sent together with a short history of the case to a laboratory for examination and report.

Pathology testing requires time and effort from staff, including technologists, pathologists’ assistants and pathologists, as well as the use of hazardous chemicals and storage space. It also diverts finite resources from patients who need timely diagnosis, such as those undergoing cancer treatment.

Many groups, including Choosing Wisely Canada, in collaboration with the Canadian orthopedic Association and the Canadian Arthroplasty Society, have recommended against the routine use of pathological examination for these surgeries. In fact, in July 2019, Choosing Wisely Canada and the Ontario Orthopedic Association sent a joint letter to the Ontario government requesting a simple amendment to the act to remove the requirement for hip and knee tissues to be sent to the pathology lab for routine testing.

Unfortunately, as it currently stands, hospitals that choose to practice according to scientific evidence would be breaking the law. We are seeing firsthand the cracks in our system unfold that have forced hospitals into crisis mode. Now is the time to find improvements and end redundant practices so Canadians can have timely access to the care they need.

Dr. Sarah Ward is an orthopedic surgeon at St. Michael’s Hospital. Dr. Jesse Wolfstadt is an orthopedic surgeon at Mount Sinai Hospital. Dr. Corwyn Rowsell is a staff pathologist at St. Michael’s Hospital.

Source: The Toronto Star

March of Dimes’ Northern Medical Clinics regularly brings specialists to the community to provide medical care for patients in the region. Pictured here at the Cochrane Airport in April are, from left: Dr. Hasaan Chaudhry, fellow – orthopaedic spine surgeon; Alicia Alvares, clinical research coordinator from Sunnybrook Health Sciences Centre; Diana Bertrand, Supervisor of Northern Medical Clinics; Dr. Jeremie Larouche, orthopaedic spine surgeon; and Dr. Harsha Malempati, orthopaedic spine surgeon.

Source: https://www.cochranetimespost.ca/news/local-news/visiting-surgeons-help-fill-the-gap-with-march-of-dimes

“I was amazed at how realistic it was,” said Dr. Peter Ferguson, the head of orthopedic surgery at the University of Toronto’s Temerty Faculty of Medicine, who first tried the goggle-based VR system in his living room.

“I went to our faculty and I said this is something that we really have to get on board with.”

The medical school soon bought a dozen of the made-in-Canada virtual reality systems, allowing surgical residents to practice knee replacements, resetting broken legs, or drilling into bone to install supportive screws, all through a simulated process Dr. Ferguson describes as “a blast.”

He sees the system as an opportunity to reduce risk, even beyond COVID-19. For instance, in hospitals where medical students are taught, studies have shown patients are more likely to experience problems post-surgery.

“That’s a fact,” says the surgeon for the largest health network in Canada. “So if we can decrease that incidence of complications by allowing these individuals to become more competent in this low-stakes environment, it will theoretically improve patient outcomes.”

Full article: CBC

The chat focuses on MOI’s vision, mission and goals, and why long term sustainability should be at the core of volunteer medical services delivering care in emerging countries.

https://theorthoshow.com/3-mobility-outreach-international/

Dr. Paul Kuzyk, one of two orthopedic surgeons who operated on Noguchi, explained that not all patients who need hip replacements are candidates for day surgery. It works best on those who are otherwise healthy, highly motivated and have loved ones at home to help them recover…

Kuzyk and fellow surgeon, Dr. Oleg Safir, replaced Noguchi’s hip with ceramic, plastic and titanium parts. Their work was physically demanding.

Full article:

https://www.thestar.com/news/gta/2018/10/04/one-solution-to-hallway-medicine-outpatient-hip-replacements.html

Dr. Raj Rampersaud launched a pilot project that drastically cut wait times for treatment of lower back pain and changed how Ontario tackles the chronic complaint. He is one of 12 Canadians the Star is profiling who are making our lives better.

It was sheer frustration that drove Dr. Raj Rampersaud to develop a better way to care for people with lower back pain.

A decade ago, the Toronto spine surgeon — hailed as one of the best in the world — found himself apologizing to up to 90 per cent of patients referred to him by family doctors for consultations. “There is really nothing I as a surgeon can do for you,” Rampersaud, 50, recalls telling patient after patient.

Full article: https://www.thestar.com/news/gta/2018/09/27/renowned-spine-surgeon-is-transforming-the-way-ontario-deals-with-back-pain.html

What Dr. Urbach discovered, along with fellow group leader and orthopedic surgeon Dr. David Backstein and their team, was that joint replacement surgeries were the most common planned operations that landed patients in hospital beds unnecessarily for days following the procedure.

More than 100,000 hip and knee replacement surgeries take place in Canada every year and, with patients staying an average of four days for knees and seven days for hips, the procedures are responsible for occupying a significant number of hospital beds that could be used to provide more care and shorten wait times.

Full article: https://www.thestar.com/sponsored_sections/wearewomens/2018/07/03/making-strides.html

Broken hips are the most common reason for urgent surgery in Canada, but only one-third of patients in Ontario receive surgery within what researchers call the safe 24-hour guideline.

A hip fracture affects the femur, the largest bone in the body, and it needs to be repaired quickly. Studies suggest waiting more than a day after the patient arrives in hospital, as well as being uncomfortable, is associated with a higher risk of complications such as pneumonia, blood clots, heart attacks and death.  

Dr. Daniel Pincus, a resident orthopedic doctor at Sunnybrook Health Sciences Centre in Toronto, and his colleagues analyzed data on 42,000 patients with an average age of nearly 81 who had hip fractures repaired across Ontario from 2009 to 2014.

In Monday’s issue of the Canadian Medical Association Journal, Pincus found the average wait for the surgery was nearly 39 hours. Only 34 per cent of patients were operated on within a day. 

“Twenty-four hours is the cutoff we identified when the risk of complications started to increase,” Pincus said in an interview.

The complications occur not necessarily as a result of the fracture, Pincus said, but as a result of waiting for surgery. The wait means patients lie in bed, not able to eat. 

Full article: https://www.cbc.ca/news/health/hip-fracture-surgery-1.4701461

A career in medicine can be gruelling, and harassment is making the job even tougher for women, says an editorial in The Lancet.

Long hours and heavy workloads make the job physically and emotionally demanding, the medical journal says, as it highlights a damning 300-page report on sexual harassment of women in academia.

The report, “Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine,” reveals that more than half of women in the fields of science, engineering and medicine in the U.S. — 58 per cent of female faculty and staff — have experienced sexual harassment.

It found female medical students are sexually harassed at much higher rates than their peers in science and engineering. Sexual harassment undermines women’s mental and physical health, say the authors, resulting in job dissatisfaction, increases in job stress, and declines in productivity and job performance.

Risky environment for medical trainees

In medicine, the report singles out the nature of mentoring and training as unique risks for trainees. “The mentor-mentee relationship can involve much time spent alone together, in the lab, in the field, or in the hospital, and sometimes in isolated environments,” says the report.

“In the medical field, training specifically takes place in hospital settings, over 24-hour “call” periods. Interns and residents … provide much of the patient care, under the direction of faculty attending physicians who may or may not be physically present in the hospital for the educational benefits.”

Caring for sick patients, the report says, is intense, tiring and stressful. Rooms with single or multiple beds are close by if interns and residents need sleep after extended duty hours. “The risk they pose for sexual harassment and sexual assault should be obvious,” says the report.

Taken as a whole, these conditions mean that there are increased opportunities for sexual harassment, it concludes.

Although work on the report started back in 2016, it was published this month, at a time when there’s been a focus on the issue of sexual harassment of women because of the #MeToo movement.

Among the long list of academics, scientists, and other specialists who were involved in crafting the report was Cristina Amon, the sole Canadian, who is the first female dean of the University of Toronto’s Faculty of Applied Science and Engineering.

Amon said she was “honoured” to serve on the standing Committee on Women in Science, Engineering and Medicine, one of the groups participating in the research into harassment.

In an email to CBC News, she said the most important action institutions and people in science, technology, engineering and math (STEM) fields can take to prevent and address harassment is to foster a culture of intolerance to it.

“I hope this report represents an important first step toward ending gender-based, sexual harassment and discrimination within the STEM disciplines,” Amon said. “Engineering, science and medicine are global fields whose practice transcends political boundaries.”

The findings of this report are just as important for institutions worldwide, she said.

“Now the challenging work begins … to get the evidence-based ideas out for discussion and, most importantly, action.”

Dr. Sharon Straus, a professor in the Department of Medicine at the University of Toronto, has studied the gender gap in teaching hospitals in Canada.

“We don’t have a similar, national Canadian study looking at sexual harassment of medical trainees,” said Straus, who was not involved in the report looking into harassment in academia in the U.S. “In our systematic review of the literature, almost 60 per cent of medical trainees reported experiencing some form of harassment and a recent physician study showed that over 30 per cent of physicians cited weekly exposure to rude, dismissive or aggressive behaviour.” 

She says people have tolerated this behaviour in medicine for many years, but credits movements like #MeToo for empowering people to come forward with their concerns. But there’s still work to be done, says Straus.

“We need to ensure that victims are protected from retribution and supported to deal with the trauma of facing toxic behaviours. We also need to ensure that leaders are given the training and resources to act on reported lapses in professionalism.” 

You can read the full report by the National Academies of Sciences, Engineering and Medicine here. 

Dr. Markku Nousiainen, our Program Director, was recently a guest speaker on Key Literature in Medical Education (KeyLIME), a Royal College continuing education initiative.

Unlike more traditional hip replacements, with incisions to reach the joint through either a patient’s side or back, Dr. Amir Khoshbin is performing the operation through the front and using a special surgical table to aid that approach.

The benefit is that patients begin recovering more quickly and are able to go home the same day as the surgery, instead of needing to be admitted for at least a day or two, as is usually the case.

“There’s a different ideology,” said Khoshbin, who was trained in the technique in New York. Same-day discharge surgery is still a novel approach, but it’s increasingly used by doctors in Canada.

Full article: https://www.thestar.com/news/canada/2018/05/27/new-hip-replacement-technique-at-st-michaels-hospital-allows-for-speedier-recovery.html

Hospital stays have been getting shorter over time because of advances in surgical techniques and anesthesia. Just a decade ago, knee-replacement surgery would have involved a hospital stay of up to a week.

Same-day joint-replacement surgery was pioneered in the United States where insurance companies were looking to cut health-care costs. But this kind ambulatory surgery is not for everyone, cautioned orthopedic surgeon Dr. David Backstein who operated on Nemez.

“It is a very select patient population we can do this on,” he said, explaining it best performed on active, healthy, fit patients and not on those who are frail, inactive or obese. “There is always going to be a need for in-patient joint replacement.”

Full article: https://www.thestar.com/news/gta/2018/04/11/he-got-his-knee-replaced-at-a-toronto-hospital-a-few-hours-later-he-was-climbing-stairs.html

https://torontolife.com/culture/art/photographer-takes-astonishing-underwater-portraits-athletes-dancers/

“Despite extensive research already conducted on the topic, an optimal time for surgical treatment remains a point of contention. In identifying a specific risk threshold, our hope is that this will help inform guidelines worldwide and improve unnecessary delays in treatment for patients with these devastating injuries,” says Dr. Daniel Pincus, study author, orthopaedic resident physician at Sunnybrook, PhD student at the University of Toronto who works with ICES data and researchers.

Sunnybrook Media

https://sunnybrook.ca/media/item.asp?c=1&i=1695&f=hip-fracture-surgery-study

HealthDay

https://consumer.healthday.com/bone-and-joint-information-4/fracture-health-news-322/don-t-delay-hip-fracture-surgery-here-s-why-728840.html

CTV News

https://toronto.ctvnews.ca/video?binId=1.3378527&clipId=1277222&playlistPage

https://www.thestar.com/life/health_wellness/2017/07/31/a-continuum-of-treatment-for-knee-pain.html