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Orthopaedic Proceedings
Vol. 106-B, Issue SUPP_8 | Pages 27 - 27
10 May 2024
Chan V Yeung S Chan P Fu H Cheung M Cheung A Luk M Tsang C Chiu K
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Introduction and Aim

Quadriceps strength is crucial for physical function in patients with knee osteoarthritis (KOA). This study aimed to investigate the effect of combining blood flow restriction (BFR) with low-intensity training (LIT) on quadricep strength in patients with advanced KOA.

Methods

Patients with advanced KOA were block randomized by gender into the control or BFR group. The control group received LIT with leg press (LP) and knee extension (KE) at 30% of 1-repetition maximum (1-RM), while the BFR group underwent the same training with 70% limb occlusion.

Physical function and patient-reported outcomes were assessed up to 16 weeks.


The Bone & Joint Journal
Vol. 106-B, Issue 3 Supple A | Pages 110 - 114
1 Mar 2024
Yee AHF Chan VWK Fu H Chan P Chiu KY

Aims

The aim of this study was to evaluate the survival of a collarless, straight, hydroxyapatite-coated femoral stem in total hip arthroplasty (THA) at a minimum follow-up of 20 years.

Methods

We reviewed the results of 165 THAs using the Omnifit HA system in 138 patients, performed between August 1993 and December 1999. The mean age of the patients at the time of surgery was 46 years (20 to 77). Avascular necrosis was the most common indication for THA, followed by ankylosing spondylitis and primary osteoarthritis. The mean follow-up was 22 years (20 to 31). At 20 and 25 years, 113 THAs in 91 patients and 63 THAs in 55 patients were available for review, respectively, while others died or were lost to follow-up. Kaplan-Meier analysis was performed to evaluate the survival of the stem. Radiographs were reviewed regularly, and the stability of the stem was evaluated using the Engh classification.


Bone & Joint Open
Vol. 4, Issue 11 | Pages 859 - 864
13 Nov 2023
Chen H Chan VWK Yan CH Fu H Chan P Chiu K

Aims

The surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI.

Methods

There were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed.


Orthopaedic Proceedings
Vol. 103-B, Issue SUPP_14 | Pages 11 - 11
1 Nov 2021
Cheung A Chan P Fu H Cheung M Chan V Chiu K
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Highly crosslinked polyethylene (HXLPE) has been used with great clinical success in total hip arthroplasty (THA) since its debut in the late 1990's. However, reports regarding this bearing couple in its second decade of service are still scant. The aim of this study was to 1. Determine the long term clinical and radiological results and 2. Investigate what factors affect wear rates using a metal-on-HXLPE bearing articulation.

55 THA's using a single brand of HXLPE liner, cementless cup and 28mm hip ball were performed in 44 patients. Age, sex, and Charlson Comorbidity Index (CCI) and need for revision surgery were recorded. Linear and volumetric wear was determined using the Martell method.

Mean age at operation was 51.2 (29–73 +/− 12.1) years. Mean duration of follow up was 16.9 years (range 15.0–20.1 +/− 1.1 years). Osteolysis was not present in the latest follow up radiographs.

Median linear and volumetric wear rate was 0.035mm/year (95% CI 0.031–0.047) and 7.12mm3/year (95% CI 6.92–17.25) respectively. Acetabular component position was not found to be related to both linear and volumetric wear. No significant difference was found in the linear and volumetric wear rates of thinner and thicker liners (8mm or below and > 8mm) (p=0.827 and p=0.843 respectively).

HXLPE is associated with very low linear and volumetric wear rates which has virtually obviated osteolysis and has translated to excellent survivorship even at long term follow up. In-vivo oxidation does not appear to be of clinical concern at this point in its service cycle.


The Bone & Joint Journal
Vol. 100-B, Issue 9 | Pages 1201 - 1207
1 Sep 2018
Kirzner N Etherington G Ton L Chan P Paul E Liew S Humadi A

Aims

The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma.

Patients and Methods

A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_10 | Pages 149 - 149
1 May 2016
Zhang C Yan C Ng F Chan P Qu G
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Purpose

The success rate of surgical debridement and prostheses retention for acute periprosthetic joint infection (PJI) is controversial. This study aims to report our experience in managing acute PJI following total knee arthroplasty (TKA) with surgical debridement and prostheses retention, and to identify the prognostic factors that may influence the surgical outcomes.

Methods

A retrospective review from our prospective joint replacement register in Queen Mary Hospital, Hong Kong, of patients who were managed with surgical debridement and prosthesis retention for acute PJI after TKA between 1998 and 2013 was performed. The diagnosis of acute PJI was based on the 2011 Musculoskeletal Infection Society (MSIS) PJI diagnostic criteria. Both the early post-operative infections and the late haematogenous infections were included (Tsukayama type 2 and 3). Surgical outcomes were defined as successful if patients’ clinical symptoms had been relieved; inflammatory marker levels including C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR) and White Blood Cell (WBC) count had returned to normal; X-rays showed no prosthetic loosening; and no lifelong antibiotic suppression was required. Outcomes were defined as failed if patients required any further surgeries (e.g., re-debridement, one or two-stage revision), or needed lifelong antibiotic suppression. All Patients’ perioperative data, i.e., age, primary diagnosis, pre-operative CRP, ESR, WBC, haemoglobin, albumin, glucose level, time lag from symptoms onset to debridement, synovial fluid total cell count and bacteriology were traced and recorded. SPSS 22.0 was used to calculate and compare the statistical differences between surgically successful group and failed group regarding the factors above.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_15 | Pages 362 - 362
1 Mar 2013
Yaffe M Patel A Luo M Chan P Cayo M Stulberg SD
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Introduction

Patient specific instruments (PSI) and computer-assisted surgery (CAS) are innovative technologies that offer the potential to improve the accuracy and reproducibility with which a total knee arthroplasty (TKA) is performed. It has not been established whether clinical, functional, or radiographic outcomes between PSI, CAS, and manual TKA differ in the hands of an experienced TKA surgeon. The purpose of this study was to evaluate clinical, functional and radiographic outcomes between TKA performed with PSI, CAS, and manual instruments at short-term follow-up. Our hypothesis was that at early follow-up, we would be unable to elucidate any significant differences between the groups using the most commonly utilized outcomes measures.

Methods

40 PSI, 38 CAS, and 40 manual TKA were performed by a single surgeon. The groups were similar in regards to age, sex, and preoperative diagnosis. The Knee Society Scoring System was used to evaluate patient clinical and functional outcome scores preoperatively and at 1 and 6 months postoperatively. Long-standing AP radiographs were obtained pre and postoperative to evaluate mechanical axis alignment.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 237 - 237
1 Mar 2010
Dakhil-Jerew F Chan P Guy R Lau S Shepperd J
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Introduction: In this study we describe Modic changes within treated-lumbar disc levels and levels adjacent-to-Dynamic Neutralisation System for the Spine (Dynesys).

Modic changes(M) have been described in association to Degenerative Disc Disease(DDD). Type-I represents the inflammatory phase whereas Type-II describes fatty changes within the vertebral marrow and endplate. Type-III is more advanced degeneration and it indicates marked sclerosis adjacent to endplates.

Material & Methods: Postoperative MRI has been compared to preoperative scan in 28 symptomatic patients treated with Dynesys. Parameters assessed were Modic changes within treated disc levels and their adjacent segments. Average time to postoperative MRI was 36 months with a range of 17–66 months.

Results: Within Dynesys-treated levels; 16 levels had no Modic change preoperatively of which 13 remained unchanged while 3 developed M2 with treatment. 15 had M2, of which, 7 worsen to M3, 6 continued as M2 and 2 improved to M0. 12 had M3, of which 1 improved to M1 and the rest did not change.

Adjacent endplate levels showed worsening of M0 to M2 in 11 patients while no change was seen in 35 levels. Only 4 levels with M2 were seen, of which 3 levels did not change and 1 level continued to M3. 2 M3 improved to M2.

Discussion & Conclusion: Compared to recently published studies by Danish group, Modic changes have the tendancy to worsen on conservative treatment. In this study we could show that following Dynesys progress of Modic changes at the treated level(s) was not remarkable though few cases continued with the process of degeneration.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 39 - 39
1 Mar 2006
Chan P Brenkel I Aderinto J
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An analysis on prospective data collected on our hip database was carried out on all patients undergoing primary cemented unilateral total hip arthroplasty in the last 5 years comparing the short term outcomes between diabetics and non-diabetics. There were 1220 non-diabetics and 77 diabetics identified from the database with at least 3 years follow up. (average 3.6 years). We found no significant difference with respect to age, sex and diagnosis between the 2 groups. Diabetics did have a significantly higher BMI (30.2 versus 27.7, p< 0.001) and higher incidence of coronary artery disease (31% versus 15%, p< 0.001) We found no increase in the rate of deep periprosthetic infection, superficial wound complications, dislocation, blood loss and DVT between diabetics and non-diabetics even after adjusting for potential confounders of age, sex, diagnosis, BMI and the presence of coronary artery disease. The only factor that was found to be significantly different between the 2 groups was length of stay (10.73 versus 9.56 days, p< 0.05). Further analysis of the diabetic group only showed no difference with regard the same outcomes between insulin-dependent, diet-controlled and diet and oral hypoglycaemic-controlled patient subsets. From this study we conclude that at the time of taking informed consent from diabetic patients undergoing total hip arthroplasty the only potential difference from non-diabetics is that the length of stay may be longer.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 7 | Pages 934 - 936
1 Jul 2005
Aderinto J Brenkel IJ Chan P

We investigated fixed flexion deformity (FFD) after total knee replacement (TKR). Data relating to 369 cruciate-retaining unilateral TKRs performed at a single institution were collected prospectively. Fixed flexion was measured pre-operatively and at one week, six months, 18 months, three years and five years after surgery.

Using binary logistic regression, pre-operative FFD was a predictor of post-operative FFD > 10° at one week (p = 0.006) and six months (p = 0.003) following surgery. Gender was a predictor at one week (p = 0.0073) with 24% of women showing a FFD > 10° compared with 37% of men.

We have shown that a gradual improvement in knee extension can be expected up to three years after surgery in knees with FFD. By this time residual FFD is mild or absent in the majority of patients, including those who had a severe pre-operative FFD.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 340 - 340
1 Mar 2004
Rooney B Chan P Hems T
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Aims: The results of open reduction and internal þxation of 24 unstable dorsally displaced fractures of the distal radius are reported. Methods: The fractures occurred in 24 patients (mean age 39) and 17 of these fractures were AO Type C. All fractures were treated with open reduction and subperiosteal placement of dorsal 2.0mm or 2.7mm AO mini-fragment plates between 1st and 2nd dorsal compartments and below the 4th compartment. Additional volar plate þxation was required in 6 cases. Patients were examined and X-rays performed. Outcome was assessed using the Modiþed Mayo Wrist Score and Patient Evaluation Measure. Results: At þnal follow-up (mean 36 months), the mean range of movement of the wrist was: extension 78¡, ßexion 64¡, pronation 82¡ and supination 83¡. Grip strength averaged 84% of the unaffected side. Radiographic assessment showed a mean volar angle of 8¡, articular step in 5 cases and evidence of osteoarthritis in 10 wrists.

The þnal outcome, using the Modiþed Mayo Wrist Score was excellent in 13 cases, good in 7, and fair in 4 cases. Complications were seen in 3 patients and metalwork has subsequently been removed in 7 patients for tendon irritation but there have been no cases of extensor tendon rupture. Conclusions: This initial experience has encouraged the use of open reduction and dorsal plating as the treatment of choice in young patients with unstable and/or intra-articular fractures of the distal radius. With time, range of movement and grip strength, continue to improve.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_I | Pages 38 - 38
1 Jan 2003
Kong C Chan P Ngai W Ko C Leung K
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In tibial plateau fracture, anatomical reduction of articular surface with stable fixation can restore the mechanical axis and allow early mobilization. Concomitant management of ligamentous and meniscal injury is essential for preservation of knee function. Open reduction and internal fixation has a significant complication rate.Percutaneous,fluoroscopically and arthroscopically assisted osteosynthesis with special fracture reduction and fixation technique can achieve the purpose of management of tibial plateau fracture, while limiting the soft tissue damage.

18 cases, including all J. Schatzker’s type of tibial plateau fracture, were operated with minimal access surgical technique. Male patients were predominant. The age ranged from 22 to 61 (mean 33.5). Detail pre-operatives planning with CT scan were performed in 16 patients. Fluoroscopy, arthroscopy and special fracture reduction and fixation technique were applied to all cases. All 18 cases could be reviewed. Follow up period ranged from 1 to 4 years (mean 2.3 yr.). Outcome was assessed by HSS Knee Score, standing radiograph and arthroscopy (2 cases).

According to HSS score, 14 patients were rated as excellent (100 to 85), 3 good (84 to 70), 1 fair (69 to 60) and none poor (< 60). Subjectively, 14 patients were satisfied with the treatment. 13 patients were working and participating in sport before injury. 15 took no analgesic, 2 took it once a week and 1 more often. In standing radiograph, only 2 patients showed minimal narrowing of joint space. There was no significant complication directly associated with the procedure.

Percutaneous, fluoroscopically and arthroscopically assisted osteosynthesis is a safe and effective minimal access surgical procedure. Precise pre-operative planning and special fracture reduction and fixation technique are all crucial for success. Short-term clinical outcome is encouraging.