Patient Referrals
Hip & Knee Replacement Referrals
All patients with moderate to severe hip osteoarthritis will be assessed through Central LHIN’s Musculoskeletal (MSK) Rapid Access Clinic (RAC). The RAC offers patients an expedited and comprehensive assessment with an Advanced Practice Physiotherapist (APP). If the patient is a surgical candidate, they will be scheduled for an appointment with Dr. Cayen on a different day. RAC provides patients with timely access to care and helps reduce wait time (Wait 1).
Please fill out and fax the referral form provided along with recent standing X-rays and any other pertinent information (i.e. specialist notes, recent blood work) to 1-855-346-9138.
General Orthopaedic Referrals
For general orthopaedic referrals, such as meniscus tear, ACL tear, and not yet diagnosed joint derangement, please fill out and fax the referral form provided along with any relevant diagnostic imaging reports to 416-981-7675. Please include the patient’s past medical and surgical history, current medications, specialist notes and recent blood work (if relevant).
All referrals will triaged upon receipt and processed within 14 business days. We will contact patients directly with an appointment.
Patients are expected to bring a copy of their X-ray, MRI, and/or CT images on disc or film on the day of their appointment. Reports alone are typically insufficient. Patients who have had their studies ordered at Humber River Hospital need not arrange for pick up. We will access the films for them. Patients must bring a valid health card, shorts (hip/knee issues) or sleeveless top (shoulder issues).
Please note, Dr. Cayen does not specialize in spine, foot, ankle, wrist or elbow issues. For referrals such as these, please refer to appropriate specialty.
Guidelines and Evidence
- Hyaluronic acid and PRP injections
- Arthroscopy of the Knee Joint
- CPSO Opiate Reduction
- DMARDs and Orthopaedic Surgery
- Dental Procedures and Joint replacement
Intra-articular injections for the treatment of arthritis are a good non-operative option. See Arthroscopy Association of Canada Position Statement.
The currently available types of injections include steroid (cortisone), Hyaluronic Acid and Platelet Rich Plasma. For the treatment of knee arthritis, PRP seems to have the longest duration of action, followed by HA and then cortisone.
Dr. Cayen is happy to receive your referrals for:
– PRP injections for knee arthritis or other tendonitis (lateral epicondyle etc),
– HA injections of the knee or Hip (done under ultrasound guidance)
Knee arthroscopy for the treatment of meniscus tears is reserved for:
• Young patients with a locked knee (flipped bucket-handle tear preventing full extension of the knee) or intermittent locking (crepitus is not included in this definition)
• Older patients with degenerative tears who do not have underlying arthritis on standing knee X-rays (Kellgren-Lawrence Stage 2 or less) AND who have had a minimum of 6 months of an active-based physiotherapy program.
These stipulations have been brought upon by recent changes in the OHIP fee schedule.
The brief position statement from the Arthroscopy Association of Canada can be found here.
In general, for your older patient with a degenerative meniscus tear without arthritis on standing X-rays, please send them for a trial of an active based physiotherapy program before referring on the orthopaedic surgeon.
With an opiate crisis developing, all physicians are in a position re-evaluate their opiate prescribing practices. Opiates typically have poor performance for the treatment of chronic musculoskeletal pain.
For information on managing chronic musculoskeletal pain, please click here.
Patients who are on opiates pre-operatively have a more difficult time with pain control after surgery
https://pubmed.ncbi.nlm.nih.gov/21970125/
Canadian guidelines on opiate prescribing for non-cancer pain can be found here and here.
Dr. Cayen suggests that patients taking opiates for chronic non-cancer pain work with their prescribing physician to taper narcotic doses to as low as possible prior to surgery. This effort should start as soon as a patient has agreed to proceed with surgery.
Some biologic DMARDs have been implicated in adversely affecting wound healing, increasing the risk of superficial and deep infection after surgery. The American College of Rheumatology and the American Association of Hip and Knee Surgeons have published joint Guidelines for the perioperative management of anti-rheumatic drugs with elective hip and knee replacement in 2017 and updated in 2022. The guideline summary with a chart suggesting which medications to stop peri-operatively can be found here.
The Canadian Orthopaedic Association in combination with the Canadian Dental Association suggests that no extra antibiotics are required for routine dental work in a patient who has had a hip or knee replacement. Evidence suggests that bacteria that cause periprosthetic hip or knee infection are rarely mouth flora. The position Statement can be found here.
It is suggested that patients be in optimal dental health prior to hip or knee replacement and be up to date on their teeth cleaning prior to surgery. Infected teeth should to be treated fully prior proceeding with hip or knee replacement.
Dr. Barry Cayen
Dr. Barry Cayen is an orthopaedic surgeon specializing in adult hip and knee replacements, sports surgery of the knee, and trauma.
Friendly Staff
Our team is friendly and professional and here to help you navigate the sometimes confusing process of scheduling surgery.
Latest Technology
Dr. Cayen performs Total Hip Replacement Surgery using the Direct Anterior approach with a Hana table for accelerated recovery.
Excellent Facilities
Dr. Cayen’s practice is located in the Humber River Hospital and is equipped with state-of-the-art equipment.
DISCLAIMER: The information on this website is intended to help current and prospective patients of Dr. Cayen understand joint disease as well as treatment options available. It is also meant to provide background information to prospective patients such that their visit with their doctor is most helpful. This website is not meant to provide specific medical advice, treat or diagnose any medical condition. It is not meant to take the place of a visit with your doctor or Dr. Cayen.
About Dr. Cayen
Dr. Barry Cayen is an orthopedic surgeon at Humber River Hospital, specializing in adult hip and knee replacements, sports surgery of the knee, and trauma. He performs Total Hip Replacement Surgery using the Direct Anterior approach with a Hana table.