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  • 1
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    Online Resource
    Patient-specific instrumentation (PSI) Referencing High Tibial Osteotomy Technological Transfer and Education: protocol for a double-blind, randomised controlled trial (PROTECTED HTO Trial)
    BMJ ; 2021
    In:  BMJ Open Vol. 11, No. 2 ( 2021-02), p. e041129-
    Details
    In: BMJ Open, BMJ, Vol. 11, No. 2 ( 2021-02), p. e041129-
    Abstract: High tibial osteotomy (HTO) is a treatment of choice for active adult with knee osteoarthritis. With advancement in CT imaging with three-dimensional (3D) model reconstruction, virtual planning and 3D printing, patient-specific instrumentation (PSI) in form of cutting jigs is employed to improve surgical accuracy and outcome of HTO. The aim of this randomised controlled trial (RCT) is to explore the surgical outcomes of HTO for the treatment of medial compartment knee osteoarthritis with or without a 3D printed patient-specific jig. Methods and analysis A double-blind RCT will be conducted with patients and outcome assessors blinded to treatment allocation. This meant that neither the patients nor the outcome assessors would know the actual treatment allocated during the trial. Thirty-six patients with symptomatic medial compartment knee osteoarthritis fulfilling our inclusion criteria will be invited to participate the study. Participants will be randomly allocated to one of two groups (1:1 ratio): operation with 3D printed patient-specific jig or operation without jig. Measurements will be taken before surgery (baseline) and at postoperatively (6, 12 and 24 months). The primary outcome includes radiological accuracy of osteotomy. Secondary outcomes include a change in knee function from baseline to postoperatively as measured by three questionnaires: Knee Society Scores (Knee Scores and Functional Scores), Oxford Knee Scores and pain visual analogue scale (VAS) score. Ethics and dissemination Ethical approval has been obtained from the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (CREC no. 2019.050), in accordance with the Declaration of Helsinki. The results will be presented at international scientific meetings and through publications in peer-reviewed journals. Trial registration number NCT04000672 ; Pre-results.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-041129
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2599832-8
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  • 2
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    Rotational alignment of the femoral trochlea in Asians: Implication on implant choice and position for managing isolated patellofemoral osteoarthritis
    SAGE Publications ; 2022
    In:  Journal of Orthopaedics, Trauma and Rehabilitation Vol. 29, No. 1 ( 2022-06), p. 221049172210857-
    Details
    In: Journal of Orthopaedics, Trauma and Rehabilitation, SAGE Publications, Vol. 29, No. 1 ( 2022-06), p. 221049172210857-
    Abstract: Maltracking of the patella is a key contributor to early failure of patellofemoral arthroplasty (PFA). Native femoral trochlear morphology dictates implant rotation and patella tracking of in-lay PFA implants. This is the first study amongst Asians designed to assess the normal rotational alignment of the trochlear groove and evaluate its implication on PFA implant choice and position. Methods Trochlear inclination angle (TIA) was measured from 211 magnetic resonance images of Asian knees retrieved from a single centre in Hong Kong. TIA assesses rotation of the femoral trochlear groove relative to the axis perpendicular to Whiteside’s line (anteroposterior axis of the femur). Results The mean trochlear inclination in normal Asian knees was 11.5°  ±  2.5° (mean  ±  standard deviation) internal rotation. High-grade dysplastic knees, according to Dejour classification, were significantly more internally rotated with a mean of 12.8°  ±  3.6° (p = 0.025). Conclusion Trochlear inclination in Asians is comparable to Caucasians. In-lay PFA implants do not alter native pathological bony trochlear anatomy, and may result in patella maltracking in patients with high grade trochlear dysplasia or excessive trochlear inclination. These patients may benefit from on-lay implants, which allows restoration of normal trochlear inclination, as well as lateralisation and deepening of the trochlear groove. Patella tracking is however, dynamic and multi-factorial. Further clinical studies are therefore warranted to reconcile our anatomical findings with clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 2210-4917 , 2210-4925
    URL: Article
    DOI: 10.1177/22104917221085718
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2588336-7
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  • 3
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    Can accuracy of component alignment be improved with Oxford UKA Microplasty® instrumentation?
    Springer Science and Business Media LLC ; 2020
    In:  Journal of Orthopaedic Surgery and Research Vol. 15, No. 1 ( 2020-12)
    Details
    In: Journal of Orthopaedic Surgery and Research, Springer Science and Business Media LLC, Vol. 15, No. 1 ( 2020-12)
    Abstract: One factor in the long-term survivorship of unicompartmental knee arthroplasty is the accuracy of implantation. In addition to implant designs, the instrumentation has also evolved in the last three decades to improve the reproducibility of implant placement. There have been limited studies comparing mobile bearing unicompartmental knee arthroplasty with contemporary instrumentation and fixed bearing unicompartmental knee arthroplasty with conventional instrumentation. This study aims to determine whether the Microplasty instrumentation in Oxford unicompartmental knee arthroplasty allows the surgeon to implant the components more precisely and accurately. Methods A total of 150 patients (194 knees) were included between April 2013 and June 2019. Coronal and sagittal alignment of the tibial and femoral components was measured on postoperative radiographs. Component axial rotational alignment was measured on postoperative computer tomography. The knee rotation angle was the difference between the femoral and tibial axial rotation. A rotational mismatch was defined as a knee rotation angle of 〉  10°. Statistical analysis was performed using Student t test and Mann-Whitney nonparametric test. A p value 〈  0.05 was considered statistically significant in each analysis. Results Between April 2013 to June 2019, 112 patients (150 knees) received Oxford unicompartmental knee arthroplasty, one patient (2 knees) had Journey unicompartmental knee arthroplasty, and 37 patients (42 knees) received Zimmer unicompartmental knee arthroplasty. All femoral components in the Oxford group were implanted within the reference range, compared with 36.6% in the fixed bearing group ( p 〈 0.001). 88.3% of Oxford knees had tibial component falling within the reference range, whereas 56.1% of knees in the fixed bearing group fell within the reference range ( p 〈 0.001). 97.5% of Oxford knees had tibial slope that fell within reference range, whereas 53.7% fell within range for fixed bearing group ( p 〈 0.001). Femorotibial rotational mismatch of more than 10° was noted in 13.8% in Oxford group and 20.5% in fixed bearing group ( p = 0.04). Conclusion In conclusion, Microplasty instrumentation for Oxford mobile bearing unicompartmental knee arthroplasty is more accurate and precise compared to conventional fixed bearing unicompartmental knee arthroplasty in sagittal, coronal, and axial alignment. Prospective studies with long-term follow-up are warranted to investigate the clinical implications.
    Type of Medium: Online Resource
    ISSN: 1749-799X
    URL: Article
    DOI: 10.1186/s13018-020-01868-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2252548-8
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  • 4
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    The Effect of Low Dose Extracorporeal Shock Wave Therapy (ESWT) on Plantar Fasciitis: A Trial Study in Queen Mary Hospital
    SAGE Publications ; 2015
    In:  Journal of Orthopaedics, Trauma and Rehabilitation Vol. 19, No. 2 ( 2015-12), p. 60-65
    Details
    In: Journal of Orthopaedics, Trauma and Rehabilitation, SAGE Publications, Vol. 19, No. 2 ( 2015-12), p. 60-65
    Abstract: To assess the efficacy of low-energy extracorporeal Shockwave therapy (ESWT) for the treatment of plantar fasciitis. Methods This was a prospective case series study that was performed at the Department of Orthopaedics, Queen Mary Hospital, Hong Kong. Twenty-one symptomatic feet in 16 patients with persistent symptoms of plantar fasciitis despite 3 months of conservative treatment were recruited in November 2008. All patients received five sessions of low energy ESWT and their corresponding 10-point visual analogue scale scores were recorded before and after each treatment sessions for each symptomatic foot. The patients were assessed for up to 6 months post-treatment. Results The mean visual analogue scale scores reduction for pain on first step in the morning, daily activities, and heel compression test were 2.62 (44.3%), 3 (38.3%), and 1.6 (36.8%), respectively, post-treatment. The analgesic effect was maintained in 52.3% (n = 11) of the patients at 6 months post treatment. Conclusion Low energy ESWT was shown to be an effective outpatient treatment option for patients with plantar fasciitis.
    Type of Medium: Online Resource
    ISSN: 2210-4917 , 2210-4925
    URL: Article
    DOI: 10.1016/j.jotr.2014.10.005
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 5
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    A rare and uncommon complication after use of hydrogen peroxide (H 2 O 2 ): A review of use of H 2 O 2 in orthopaedics
    SAGE Publications ; 2020
    In:  Journal of Orthopaedics, Trauma and Rehabilitation Vol. 27, No. 2 ( 2020-12), p. 247-251
    Details
    In: Journal of Orthopaedics, Trauma and Rehabilitation, SAGE Publications, Vol. 27, No. 2 ( 2020-12), p. 247-251
    Abstract: Hydrogen peroxide (H 2 O 2 ) is a commonly used chemical agent in orthopaedic practice for antisepsis, haemostasis and preparation of bone bed for cementation. However, the associated risks of H 2 O 2 usage are not widely known. We report a case of suspected air embolism after use of H 2 O 2 during drainage of a septic arthritis of the shoulder. Upon our literature review, we were able to demonstrate H 2 O 2 to be beneficial in antisepsis and care of chronic wounds. However, it has not been proven to be superior to other antiseptics commonly used in orthopaedic surgery. Regarding its use in cementation, there is evidence to show it is more effective than saline however, the use of pulsatile lavage appears to be the most important factor affecting the quality of cementation. H 2 O 2 has not been shown to be helpful with haemostasis. Prior to the use of H 2 O 2 , one should be cautious and understand its associated risks and precautions.
    Type of Medium: Online Resource
    ISSN: 2210-4917 , 2210-4925
    URL: Article
    DOI: 10.1177/2210491720925089
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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  • 6
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    Total knee arthroplasty: A single centre review at 10 years of follow-up
    SAGE Publications ; 2020
    In:  Journal of Orthopaedics, Trauma and Rehabilitation Vol. 27, No. 2 ( 2020-12), p. 142-147
    Details
    In: Journal of Orthopaedics, Trauma and Rehabilitation, SAGE Publications, Vol. 27, No. 2 ( 2020-12), p. 142-147
    Abstract: Total knee arthroplasty is a common procedure for treatment of various non-infective arthritis. This study reviewed total knee arthroplasty cases up to 10 years of follow-up for the survival rate, reasons of revision and associated perioperative risk factors for revision. Methods: All cases to total knee arthroplasty performed in a single centre in the years 2007 and 2008 were reviewed. A total of 227 cases of total knee arthroplasty were performed during the 2-year period, with 156 cases followed up to 10 years. Perioperative information, follow-up information and information of possible complications were obtained. Results: The survival rate of total knee arthroplasty in this study is 98.2% at 5 years and 94.2% at 10 years of follow-up. The early post-operative complication rate was low, and majority of cases had improvement of function at 1 year after the operation. Early post-operative infection rate was low at 0.4%, and overall infection up to 10 years of follow-up was also low at 4.4%. Ten cases had undergone revision of arthroplasty by 10 years after operation. Conclusion: The survival rate of total knee replacement was high. The revision rate and infection rates were low up to 10 years of follow-up. The most common reasons of revision arthroplasty were infection and aseptic loosening. Cases which required revision arthroplasty had significantly longer operative duration compared with cases without revision at 10 years of follow-up ( p = 0.01).
    Type of Medium: Online Resource
    ISSN: 2210-4917 , 2210-4925
    URL: Article
    DOI: 10.1177/2210491720928472
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2020
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