History

Written by: Dr. J. Huckell
Presented: Sunday, May 26, 2002
Fort Edmonton Park, Edmonton, AB, Canada
During the visit of the ABC Fellows Tour of 2002
 


The History of Orthopaedic Surgery in Edmonton
  1. Beginnings
  2. The 1930s and 40s
  3. The 1950s – Post World War II Growth
  4. The Establishment of a Formal Training Program
  5. Technology Explosion
  6. Sub-specialization
Beginnings

Orthopaedic surgery, as a defined specialty, had its awakenings in World War I in the development of orthopaedic units in Great Britain directed at the care of injured servicemen. Frank Hamilton Mewburn, a pioneer surgeon in Alberta, went to war in 1914 as an army surgeon. His son, Frank Hastings (Hank) Hamilton Mewburn, on his graduation from McGill University in 1915, enlisted in the regular army as an artillery officer. It was not until 1917 that he pursed his medical training and joined his father at Taplow, a Canadian Army Medical Corps facility, dealing with casualties of war.

Following the armistice, Dr. Hank Mewburn returned to North America and spent time in Boston with M.N. Smith-Peterson. He returned to Edmonton following this and opened a practice in orthopaedic surgery.

At that time, Dr. Mewburn Sr. was the Professor of Surgery at the University of Alberta and it was through this relationship that Hank Mewburn was able to establish Orthopaedic Surgery as a separate department and was named its chief in 1923.

The major area of interest at that time was the management of crippled children and the care of disabled veterans. The areas of primary concern at that time were congenital abnormalities and infectious diseases, both tuberculous and other bacterial infections. The management of fractures in the era did not include internal fixation to any extent.

Dr. R.G. Huckell, who graduated from McGill in 1924, was in his second year of surgical internship in 1929, when he met and married my mother, Jean Traviss, a nurse at the University of Alberta Hospital. Since this violated the fraternization principles held at that time, they were both terminated.

They went off to work in traveling clinics for the Provincial Government and then a rural practice in a small town, Waskatenau.

In 1926 and 1927 there was a major polio epidemic. In 1928 Dr. Mewburn contacted Dr. Huckell to come in and participate in the solution of this major orthopaedic problem. This was the beginning of Dr. Huckell’s training in orthopaedic surgery under a preceptorship program with D. Mewburn.

He continued in this capacity. In 1930 he was judged to be trained in orthopaedic surgery and was declared so by the Senate of the University of Alberta.

At this time, there was not formal qualifying process for orthopaedic surgery. It was not until 1934 that the American Board of Orthopaedic Surgery developed such a program. Dr. Huckell was allowed to write this examination in 1936 and became qualified in orthopaedic surgery by the American Board of Orthopaedic Surgery. He continued in practice with Dr. Mewburn subsequently.

The 1930s and Early 40s
The major area of interest at that time continued to be crippled children, both congenital abnormalities and polio. Infection continued to be a major problem, both tuberculous and other bacterial infections.

I can recall vividly, as a young boy, making rounds with my father at the old Edmonton General Hospital, where there was a tuberculosis ward, and the University of Alberta Hospital, where osteomyelitis affecting both children and adults was a major component of the patient population.

It was during this time that internal fixation in the management of fractures began to be feasible, resulting in the growth of operative orthopaedics.

In 1937, Dr. Olav Rostrup graduated from the University of Alberta Medical School and went into training under a preceptorship in orthopaedic surgery with Drs. Mewburn and Huckell. After completing his training, he joined Drs. Mewburn and Huckell in practice. In 1941 he joined the Canadian Army Medical Corps and went overseas.

The 1950s – Post World War II Growth
After the end of WWII, the City of Edmonton grew. There were 5 hospitals in Edmonton. These included the University, Royal Alex, General, Misericordia and the Camsell. In the earlier years, it was the practice of orthopaedic surgeons to attend patients in all units.

As time went on, each facility developed its own orthopaedic representation. The surgeons in these facilities practiced general orthopaedics. Of particular interest was the Camsell Hospital, which was under the auspices of the Indian Health Service.

Each unit developed its strengths and was used in the orthopaedic training program.

With regionalization, which developed in the mis-90s, the various hospitals underwent changes in role.

The Establishment of a Formal Training Program
Following World War II, Dr. Mark Marshall, a specialist in ophthalmology, was instrumental in developing formal training programs in specialties at the University of Alberta. A program in orthopaedic surgery was developed and it was Dr. D.C. Johnston (Coop), Bill’s father, who was the first trainee to enter this program following his discharge from the Canadian Army.

He completed the program at the University of Alberta in 1949 and spent a year’s fellowship in St. Louis with John Albert Key, returning to practice in Edmonton in 1950.

It was the custom for the resident to complete his training in Edmonton and then go on to do a Fellowship in other centers for a year or more. A relationship was developed with George Washington University in St. Louis, where at least four of the Alberta trainees went on to spend time with John Albert Key, Relton McCarroll and Fred Reynolds.

Subsequent to this, the residents, on completion of their training, went on to many areas in Great Britain, United States and Australia.

In the early 50s, Dr. Rostrup established a seminar program, in which a variety of subjects would be studied and residents would be required to make presentations. This became more formalized when Dr. L.A. Davis took over a director of orthopaedic surgery in 1974.

Further enrichment of the program was established in 1961 when the Children’s Hospital in Calgary became part of the rotation. Each resident would spend six months in paediatric orthopaedics in this facility. This program continued until the early 1980s, when Dr. Marc Moreau returned to Edmonton as a trained sub-specialist in paediatric orthopaedics at the Dupont Institute in Wilmington Delaware. He, with others, developed a solid paediatric orthopaedic program to complete educational opportunities in the Edmonton area.

Fred Day, who had trained in Liverpool, had a program in orthopaedics at the Royal Alexandra Hospital for several years. This went on to be combined with the program at the University on the advice of the Royal College of Physicians and Surgeons of Canada.

As an aside, it was Fred Day who established the CP Clinic, directed specifically at this area of paediatric care. This went on to develop into the Glenrose Children’s Program, which became a comprehensive crippled children’s facility. This included both clinical and research programs.

The Technology Explosion
With the advent of antibiotic management of infectious disease and polio vaccines, these two areas of major involvement became less prominent. Developments of improved methods of internal fixation of fractures and the management of trauma became a major component of operative orthopaedics.

In the 1950s and early 60s, interest in hip arthroplasty, initially cup arthroplasty and hemiarthroplasty, became increasingly important.

With the development of the total hip replacement arthroplasty, a major explosion occurred.

Our first efforts were with the McKee-Ferrar metal-on-metal implants, which had unfortunate design problems. The metal-polyethylene combination, developed by Sir John Charnley, opened the floodgates in the early 1960s.

Shortly after this, the development of total knee arthroplasty, pioneered by Frank Gusten, a student of Charnley’s had impact. The first device, a technically difficult design, led to interest and development of a more viable procedure.

Major advanced in the management of scoliosis developed under Dr. Paul Harrington from Texas. An early interest in this work occurred in Calgary in Dr. Gordon Townsend in his relationship with Dr. Harrington. Out of this, developed a program in Edmonton. Several surgeons were specifically trained in this skill. Out of this beginning developed programs with the interest of Dr. Greenhill and Dr. Marc Moreau. This went on to both a clinical management and research program in this area of interest.

In the late 1960s, Dr. Robert Jackson of Toronto was on a McLaughlin fellowship in Japan and became aware of the developments there in the use of the arthroscope. He brought this back to North American and interest developed. The early devices were technically difficult and initially this was more of a curiosity. It took developments in fiber optics and the micro-video camera and specialized instruments to set the scene for the phenomenal growth in this area.

Sub-specialization
It must be recognized that the surgeons in Edmonton had areas of special interest, but it was not until Dr. Marc Moreau returned to Edmonton and indicated that he would limit his practice to paediatric orthopaedics that restricted sub-specialization became more of a factor. General orthopaedists in the city, by this time, became more and more sub-specialized.

Dr. L.A. Davis elected to limit his practice to spine surgery entirely. This caused a little friction at the University of Alberta Hospital in that, up to this point, by custom, the neurosurgeons did disc surgery. During this time, the orthopaedic surgeons at the Misericordia, General and Royal Alexandra did not have to work under this restriction and developed their own area of interest in this subspecialty.

In the early 1980s, concerns developed regarding the trauma management program. It was elected to develop a trauma unit. Dr. Bill Johnston, who had trained in Toronto, went on to spend time in fellowship training in Dallas and Germany under the auspices of the AO group, returning in 1984. He, along with Dr. Stewart Hamilton, was encouraged to start a program of formal trauma care. This has developed into a more comprehensively organized program under the supervision of Dr. Don Weber.

We had concerns about the management of the oncologic problems and Dr. Guy Lavoie was encouraged to train in this area. Following the completion of this fellowship in Toronto, he returned and was instrumental in improving this area of management.

Sub-specialization in sports medicine, joint replacement surgery, upper and lower extremity and foot and ankle has also occurred.

The orthopaedic training program at the University of Alberta continues to be active and viable.