The laparoscopic Monti procedure for long strictures of the proximal ureter: a novel technique.
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Animals↗
Biomedical subjects
K Y Chiu
Publications and source records attributed to K Y Chiu.
Factors leading to blood transfusion among Chinese patients undergoing total knee replacements: a retrospective study.
PURPOSE: To investigate the risk factors leading to blood transfusion among Chinese patients undergoing total knee replacement. METHODS: From July 2001 to June 2002, a total of 128 primary total knee replacements were performed in 83 Chinese patients (38 unilateral and 45 one-stage sequential bilateral). No pharmaceutical prophylaxis against deep vein thrombosis was used. The risk factors leading to allogenic blood transfusion were analysed. RESULTS: The important predictive factors for postoperative blood transfusion were preoperative haemoglobin level (p=0.005), intra-operative blood loss (p<0.001), and bilateral total knee replacements (p<0.001). CONCLUSION: To reduce the need of allogenic blood transfusion, we suggest administering erythropoietin or iron supplements to increase the haemoglobin level for patients undergoing total knee replacement. Routine use of intra-operative blood salvage can be considered for patients undergoing one-stage bilateral total knee replacement. Use of a postoperative blood salvage system is recommended for surgeries that may result in major intra-operative blood loss.
Aged↗
Extensively coated femoral components in revision hip arthroplasty: follow-up study of 23 patients.
PURPOSE: To review the outcome of revision hip arthroplasty using extensively coated femoral components. METHODS: We reviewed the results of revision involving 24 extensively porous-coated cementless femoral components in 23 patients, whose mean age was 52.4 years (range, 28.0-79.0 years). Most revisions were performed for aseptic loosening of the previously cemented femoral component. All patients were followed up for a minimum period of 24.0 months (mean, 61.1 months). RESULTS: Of the 24 femoral stems, 20 showed bone ingrowth, 3 showed stable fibrous ingrowth, and one was unstable because of deep infection. Intra-operative anterior femoral diaphyseal perforation occurred in 2 hips during the insertion of straight femoral components of 200 mm. Postoperative radiographs displayed marked cortical erosion in 3 other hips and cortical perforation in one. CONCLUSION: The results from the use of extensively coated femoral components were promising. Nevertheless, anterior cortical perforations were also common, which may be related to more bowing of the femora among the Chinese patients. Caution must be exercised when inserting a long, straight, extensively coated femoral component.
Adult↗
The incidence of deep vein thrombosis in elderly Chinese suffering hip fracture is low without prophylaxis: a prospective study using serial duplex ultrasound.
PURPOSE: To investigate the incidence of deep vein thrombosis (DVT) among elderly Hong Kong Chinese patients suffering from acute hip fracture and to analyse the risk factors associated with DVT. METHODS: A total of 100 consecutive Chinese hip fracture patients with a mean age of 80 years were investigated serially using duplex ultrasound scans preoperatively and at 1 week, 3 to 6 weeks, and 3 months postoperatively. No chemoprophylaxis or prophylaxis against DVT was given. RESULTS: 95 patients completed 3 duplex scans during hospitalisation; 5 (5.3%) of them were found to have developed DVT over the ilio-femoral venous segment. Of the 90 patients who had no DVT, 73 were reassessed 3 months after operation; one of them was found to have developed calf DVT. Older patients, chairbound or dependent patients, and patients living in institutions carried a higher risk of developing DVT. CONCLUSION: This prospective study shows that the incidence of DVT developing after acute hip fracture in Chinese geriatric patients was low. We therefore do not recommend routine chemoprophylaxis for elderly patients with hip fracture.
Aged↗
Full weight bearing after non-cemented total hip replacement is compatible with satisfactory results.
Two matched groups of 29 patients underwent hydroxyapatite-coated non-cemented total hip replacement. One group was started on immediate protected-weight-bearing walking and the other group was started on immediate full-weight-bearing walking. They were followed up regularly for 2 years. They were assessed with Harris hip score clinically and Engh's criteria of osteo-integration radiographically. No difference was found between the two groups. All patients had excellent clinical outcome after hip replacement, and all femoral stems were stable radiographically. Patients can walk with full weight bearing safely immediate after hydroxyapatite-coated non-cemented total hip replacement.
Adult↗
Recurrent dislocation of total knee arthroplasty: an unusual cause.
We report an unusual case of recurrent dislocation of posterior stabilized total knee arthroplasty (TKA) secondary to fracture of the polyethylene insert. Recurrent dislocation occurred 21 months after primary TKA. Fractured polyethylene insert was noted as an abnormal radiolucent shadow on postoperative radiographs and was confirmed by an arthrogram. At revision surgery, disintegration of the insert, including the tibial post, was found. We recommend careful scrutiny of the integrity of the polyethylene insert at the time of follow-up evaluation in cases of TKA dislocation.
Arthroplasty, Replacement, Knee↗
Efficacy of a single dose of cefazolin as a prophylactic antibiotic in primary arthroplasty.
We analyzed the wound infection rate of 1,367 primary total hip and knee arthroplasties performed between 1991 and 1999. Two hundred and fifteen arthroplasties were performed with 3 doses (3 x 750 mg) of cefuroxime, and 1,152 arthroplasties were performed with a single preoperative dose (1 x 1 g) of cefazolin as antimicrobial prophylaxis. All wound infections that occurred within 2 years of the index surgery were analyzed. The deep wound infection rate of total hip arthroplasty was 1.1% (95% confidence interval [CI], 0%-3.3%) in the cefuroxime group and 1.1% (95% CI, 0%-2.2%) in the cefazolin group (Fisher's exact test, P = 1.0). The deep wound infection rate of total knee arthroplasty in the cefuroxime group (1.6%; 95% CI, 0%-3.8%) was not significantly different from the cefazolin group (1.0%; 95% CI, 0.3%-1.7%) (Fisher's exact test, P =.63). We concluded that a single dose (1 g) of cefazolin given at anesthetic induction offered similar protection to 3 doses (3 x 750 mg) of cefuroxime in preventing infection in primary total joint arthroplasty.
Aged↗
Practicing cementing technique with a toy: Play-Doh.
Cementing technique has direct impact on the longevity of a total hip arthroplasty, and the proper technique can only be acquired by practice. Using acrylic bone cement to practice cementing technique in a bioskill workshop is expensive and can cause occupational hazards. In this article, we describe a toy that can replace acrylic bone cement in a bioskill workshop. Play-Doh (Hasbro Inc, Pawtucket, RI) is an inexpensive, reusable and non-toxic modeling toy that mimics the doughy phase of acrylic bone cement.
Arthroplasty, Replacement, Hip↗
The shape and size of femoral components in revision total hip arthroplasty among Chinese patients.
OBJECTIVE: 39 sets of preoperative hip X-rays were studied to find out whether Chinese patients need revision femoral components with a different shape and size from western patients. METHODS: From July 1998 to June 2001, the pre-revision X-rays of 39 revision total hip replacements among 38 Chinese patients (21 men and 17 women) were studied. The component size that produced the best distal canal-filling in the anteroposterior X-ray was determined by using templates of 200-mm femoral components used commonly for Caucasian patients. RESULTS: The diameter of the component needed was 13.5 mm or less in 54% of cases, compared with only 17% for Caucasian patients as reported in the literature (p<0.01). When lateral templates of the corresponding size were put over the lateral X-rays, the anterior cortex of the 200-mm straight stem was shown to have thinned by 2.0 mm or more in 36% of hips; for 200-mm bowed stem, there was thinning of the anterior cortex by 2.0 mm or more in only 5% of hips (p<0.01). CONCLUSION: Chinese patients are likely to need smaller femoral components than Caucasian patients, and may benefit from bowed-stem components in femoral revision.
Adult↗
Review article: knee flexion after total knee arthroplasty.
Many factors affect or predict the flexion range achieved after total knee arthroplasty. While the knees that have good preoperative flexion have better final flexion, knees with good preoperative flexion do lose some flexion whereas those with poor preoperative flexion can gain flexion. Although studies of different prosthetic designs have produced conflicting results, recent studies appear to favour posterior cruciate ligament (PCL)--substituting over PCL-retaining prostheses. Several factors related to surgical techniques have been found to be important. These include the tightness of the retained posterior cruciate ligament, the elevation of the joint line, increased patellar thickness, and a trapezoidal flexion gap. Vigorous rehabilitation after surgery appears useful, while continuous passive motion has not been found to be effective. Obesity and previous surgery are poor prognostic factors; certain cultural factors, such as the Japanese style of sitting, offer 'unintentional' passive flexion and result in patients with better range. If the flexion after surgery is unsatisfactory, manipulation under anaesthesia within 3 months of the total knee arthroplasty can be beneficial.
Arthroplasty, Replacement, Knee↗
Nephroid metaplasia of a graft kidney.
BACKGROUND: Nephroid metaplasia is a benign and rare lesion that is confined to the lamina propria of the urinary tract. The leading cause of these lesions is previous trauma to the urothelium. METHOD: We report a case of nephroid metaplasia of a graft kidney from a living-unrelated donor. This patient presented to our clinics due to painless gross hematuria 1 month after renal transplantation. RESULT: Although malignancy was suspected in the beginning due to a filling defect demonstrated by urography, only percutaneous excision of the tumor was performed to preserve the renal function. However, the pathological result disclosed nephroid metaplasia. CONCLUSION: Hematuria warrant aggressive evaluation because underlying malignancy in a immunocompromised patient might be relatively progressive.
Carcinoma, Papillary↗
Primary total hip arthroplasty in patients with rheumatoid arthritis.
Twenty-eight (11 cemented and 17 noncemented) total hip arthroplasties (THA) were performed in 20 patients with rheumatoid arthritis (RA). The average age at operation was 42.1 years and the average follow-up was 10.8 years. There were two deep infections requiring removal of the prosthesis. Three cemented acetabular cups and one cemented femoral component were revised due to aseptic loosening. One cemented cup was loosened radiologically. One PCA polyethylene liner was revised because of significant wear. Both cemented and noncemented femoral components are capable of providing respectable results in RA patients. The relatively inferior results of THA among RA patients is due not only to the fixation method, but also to the poorer bone quality.
Activities of Daily Living↗
The performance of three vacuum-mixing cement guns--a comparison of the fatigue properties of simplex P cement.
We tested three commercially available cement-mixing systems (Howmedica, Summit and Stryker). After mixing the cement was allowed to cure in metal moulds under standard conditions. Sixty-nine cement blocks were produced. The fatigue behavior of the blocks was tested until failure. A wide scattering of results was observed in all the three systems. Uneven mixing of the polymer and monomer was observed in the Howmedica system. A significantly stronger cement (P=0.018) was produced with the Stryker system.
Bone Cements↗
Charnley total hip arthroplasty in Chinese patients less than 40 years old.
Forty-seven total hip arthroplasties were reviewed in 33 Chinese patients who were <40 years old at the time of operation. The preoperative diagnosis was avascular necrosis in 40% of the hips. A Charnley prosthesis was inserted using early cementing techniques in every hip. The average follow-up was 14.9 years (range, 6.9-21.1 years). The mean preoperative Harris hip score was 43.8 (range, 26-74), and the mean score at latest follow-up was 87.7 (range, 74-99) for the surviving hips. Thirty hips (63%) were revised, and 1 hip was removed because of late deep infection. The main cause of failure was aseptic loosening of the acetabular component. Using revision and radiologic loosening as endpoints, the cumulative survival rate for the acetabular component was 86.3% at 10 years and 27.0% at 15 years. The survival of the femoral components was 81.3% at 15 years. Patients with avascular necrosis had a higher failure rate than patients with other diagnoses (P =.001). An area of cement mantle that was <2 mm thick affected adversely the survival rate of the acetabular components (P =.04).
Adolescent↗
Unusual complication associated with femoral intramedullary alignment guide in total knee arthroplasty.
The few reported complications related to the use of a femoral intramedullary alignment guide in total knee arthroplasty include increase in perioperative bleeding and fat embolism. We report 3 patients suffering from an unusual complication, concerning trapping of the tibial locking pin inside the intramedullary canal of the femur secondary to the use of an intramedullary alignment guide. Methods of retrieving the locking pin from the medullary canal are discussed.
Aged↗
Use of continuous passive motion after total knee arthroplasty.
Sixty primary total knee arthroplasties in 43 Chinese patients were included into a prospective study. Twenty-six patients who had unilateral knee arthroplasty were randomized to receive continuous passive motion (CPM) or immobilization in the first week. The 2 groups of patients were comparable in demographic data and preoperative knee range of motion (ROM). In 17 patients who had 1-stage sequential bilateral arthroplasties, one side had CPM and the other side was immobilized. The active knee ROM was assessed regularly until 1 year after the operation. For all patients, the early active knee ROM in the CPM group was significantly better than the immobilization group. There was no difference after 7 days, however. For patients who had 1-stage bilateral total knee arthroplasties, the active knee ROM was significantly better on the CPM side until day 28. After 4 weeks, there was no difference between the CPM group and the immobilization group. Immobilization after total knee arthroplasty does not preclude good ROM.
Adult↗
Cementless total hip arthroplasty in young Chinese patients: a comparison of 2 different prostheses.
Sixty-one primary cementless total hip arthroplasties were performed in 45 Chinese patients <40 years old. There were 27 Anatomic Medullary Locking (AML, Depuy, Warsaw, IN) prostheses and 34 Porous Coated Anatomic (PCA, Howmedica, Rutherford, NJ) prostheses. The average follow-up was 7.6 years (range, 3-11 years). Ten hips (16%) were reoperated; the reason was polyethylene wear with or without osteolysis in 7 hips. Osteolytic lesion was present in 34 hips (56%). The cumulative successful rate at 10 years was 67% using reoperation for any reason as the endpoint. The cumulative successful rate was 98%, however, if revision for aseptic loosening was used as the endpoint. The 2 prostheses did not show significant differences in most parameters except that the PCA hips had significantly more acetabular loosening (P =.02) and periprosthetic osteolysis (P =.01).
Adult↗
Bilateral total knee arthroplasty: One mobile-bearing and one fixed-bearing.
We compared the early results of mobile-bearing knee prosthesis with fixed-bearing knee prosthesis in 16 patients who had one-stage, sequential, bilateral replacements. In each patient, a Low Contact Stress (LCS, Depuy) rotating-platform prosthesis was inserted in one side, and an Anatomic Modular Knee (AMK, Depuy) posterior-stabilised prosthesis was inserted in the other side. The same surgical routines were adopted for both sides in each patient. There were significant improvements in the Knee Society knee score and functional score, as well as the Oxford Knee score after both mobile-bearing and fixed-bearing knee replacements (p<0.001). However, we could not find any significant difference between the clinical results of the two prostheses. The authors early experience with the mobile-bearing total knee prosthesis was as favourable as the medium-term experience of the fixed-bearing total knee prosthesis in this prospective, match-pair study.
Journal Article↗