A kerfuffle has developed at Brantford General Hospital in Brantford, Ontario, over the hospital’s practice of charging $800 for patients who request a custom-fitting procedure for a new knee over the basic package. The Ontario Ministry of Health has issued a cease and desist order to the hospital, according to a report July 4 in the Brantford Expositor.
Patient’s Charged $800; Ministry Says “Cease and Desist”

“We have been giving patients who required knee-replacement surgery an option, ” James Hornell, president and CEO of the Brant Community Healthcare System, said. “They could have the standard knee-replacement surgery or the custom-fitting surgery. If they wanted the custom-fitting procedure, we asked them to pay $800 and most of the patients were happy to do it.”
Hornell said that the specialized custom-fitting procedure is more expensive and is not entirely covered by the province’s health insurance plan. The hospital does not have money to absorb the extra costs and if the hospital cannot charge patients it can no longer provide the service. The standard procedure for knee replacement is covered entirely by the Ontario Health Service.
Brantford General Hospital has been performing the custom procedure since 2010. At the time it was the only hospital in Canada using the technique, considered to be revolutionary because it removed any guesswork in the operation and gave patients a custom-fitted knee.
Prior to surgery doctors took an MRI to provide accurate measurements of a patient’s knee. The MRI was then sent to OtisMed in California where technicians use specialized computer software to make a three-dimensional model of the knee. They then shipped customized cutting blocks to the hospital that the surgeon used to provide the patient with a custom-fitted knee. Brantford General Hospital has suspended its new knee-replacement surgical procedure after receiving the cease and desist order from the Ontario Ministry of Health.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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