Masterclass Room 221 invited abstract
May 14, 2019 02:30 PM - 03:45 PM(Asia/Hong_Kong)
20190514T1430 20190514T1545 Asia/Hong_Kong Masterclass 4 - Update in the Management of Knee Osteoarthritis

Update in the Management of Knee Osteoarthritis

M4.1 Management of Knee Osteoarthritis Needs a Paradigm Shift

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M4.2 Neuromuscular Exercise - Key to Success in the Non-Surgical Management of Knee Osteoarthritis.pdf 

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M4.3 Is High Tibial Osteotomy a Buying Time Surgery?.pdf

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M4.4 Can Partial Knee Replacement be a Definitive Surgery ?

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M4.5 Sharing from the First Joint Replacement Centre in Hong Kong: Challenges and Looking Forward.pdf 

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M4.6 Update in Joint Replacement Surgery: What's New?.pdf

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Room 221 HA Convention 2019 hac.convention@gmail.com
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Update in the Management of Knee Osteoarthritis

M4.1 Management of Knee Osteoarthritis Needs a Paradigm Shift


Download presentation file:

M4.2 Neuromuscular Exercise - Key to Success in the Non-Surgical Management of Knee Osteoarthritis.pdf 

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M4.3 Is High Tibial Osteotomy a Buying Time Surgery?.pdf


M4.4 Can Partial Knee Replacement be a Definitive Surgery ?


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M4.5 Sharing from the First Joint Replacement Centre in Hong Kong: Challenges and Looking Forward.pdf 

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M4.6 Update in Joint Replacement Surgery: What's New?.pdf

Management of Knee Osteoarthritis Needs a Paradigm ShiftView Abstract
Speaker 02:35 PM - 02:45 PM (Asia/Hong_Kong) 2019/05/14 06:35:00 UTC - 2019/05/14 06:45:00 UTC
Knee osteoarthritis (OA) is one of the most common degenerative diseases that cause disability in elderly people. An epidemiological study by Felson et al showed that about 30% of all adults have radiological signs of OA; 8.9% of the adult population has clinically significant OA of the knee or hip, of which knee OA was the most common type. The Chinese population has a similar prevalence rate. A nationwide population-based study in China showed an 8.1% total incidence rate of symptomatic knee OA and increasing prevalence of knee OA with age. It is estimated that the percentage of older adults in the Hong Kong population will increase from 16.6% in 2016 to 31.1% by 2036, and the prevalence of knee OA is expected to increase. 
Although clinical guidelines for managing lower limb osteoarthritis (LLOA) in the primary care setting were proposed in Hong Kong in 2004, comparison with recently updated international guidelines shows some differences from management in Hong Kong. Therefore, it is of paramount importance to keep updating OA management guidelines so as to provide the best possible evidence-based management in the primary setting. This may help to delay progression into end-stage OA and thus decrease the need for arthroplasty and alleviate long waiting times (the average waiting time for arthroplasty in public hospitals in Hong Kong is 66 months).
The aim of the presentation is to compare and contrast the LLOA management guidelines proposed in Hong Kong with international guidelines, including the Osteoarthritis Research Society International (OARSI), the American Academy of Orthopaedic Surgeons (AAOS), and the American College of Rheumatology (ACR). The author will present the recent update in the management of osteoarthritis. The importance of patient education, exercise and weight management in the osteoarthritis management will be emphasized. Various controversial areas, including the role of glucosamine and chondroitin supplements, intra-articular viscosupplementation injection, arthroscopy, and joint preservation and replacement surgeries, will also be discussed. 
The present abstract based on an article prepared by the presenting author
 HS Kan, PK Chan, KY Chiu et al. Non-surgical management of knee osteoarthritis. Hong Kong Medical Journal, 2019 Mar 28 | https://doi.org/10.12809/hkmj187600
 
Neuromuscular Exercise - Key to Success in the Non-Surgical Management of Knee OsteoarthritisView Abstract
Speaker 02:45 PM - 02:55 PM (Asia/Hong_Kong) 2019/05/14 06:45:00 UTC - 2019/05/14 06:55:00 UTC
Conventional non-surgical management of knee osteoarthritis (OA) stresses on improving knee muscle strength and range of motion. However, the results may not be satisfactory. Recent studies show that neuromuscular training is the key to enhance knee control and functional limitations in patients with knee OA. Knee OA management programmes such as the Good life with osteoarthritis in Denmark (Gla:D) and Better management of patients with osteoarthritis (BOA) in Sweden are successful examples. The essential elements of neuromuscular training are: emphasis on quality of movement, knee joint control with normal biomechanics and muscle activation and postural control to perform functional activities. 

Locally,  the Comprehensive Osteoarthritic ManagEment program (COME) of MacLehose Medical Rehabilitaion Centre commenced in January 2016, with 100 patients (30 males and 70 females with age 65.3±13.3 and 64.1±7.4 respectively) recruited and completed a three-month and one-year evaluation in February 2019. All patients had completed a six-week and 12-session intensive training programme, including neuromuscular control, muscle strengthening, flexibility and aerobic training. 
There were statistically and clinically significant improvements (p<0.05) from (a) baseline  to (b) six weeks, (c) three months and (d) one year post training in the following (mean±SD):
1. One-minute chair test in repetitions – (a) 30.3±11.2, (b) 40.5±11.9, (c) 43.2±13.8
2. Stairs management in seconds – (a) 7.1±3.3, (b) 5.4±1.6, (c) 5.4±1.7
3. Pain in weight bearing movement – (a) 4.2±2.6, (b) 2.9±2.5, (c) 2.9±2.5, (d) 3.2±2.5
4. Patient specific functional score (PSFS) – (a) 3.1±2.1, (b) 6.6±1.8, (c) 6.9±1.7, (d) 6.9±1.7

The results are promising and there were no adverse events reported from the patients. It is recommended that neuromuscular exercise be the essential component in the non-surgical management of knee OA.
Presenters Desmond Yeung
Is High Tibial Osteotomy a Buying Time Surgery?View Abstract
Speaker 02:55 PM - 03:05 PM (Asia/Hong_Kong) 2019/05/14 06:55:00 UTC - 2019/05/14 07:05:00 UTC
Osteoarthritis of the knee is a common degenerative disorder affecting the local population. The prevalence of knee osteoarthritis is 13% in female and 7% in male based on a local study. In end stage osteoarthritis, surgical intervention is warranted when conservative measures failed.
High tibial osteotomy is a well-recognized surgical treatment for osteoarthritis of the knee. Osteoarthritis of the knee commonly affects the medial compartment, resulted in varus alignment of the lower extremity. In patients with isolated medial compartment osteoarthritis, osteotomy over the proximal tibia and realignment of the lower extremity to valgus alignment allows unloading of the diseased medial compartment. The mechanical axis shifted from medial to lateral, allowing the spared lateral compartment to bear the load, thus alleviate the knee pain.
Traditionally, high tibial osteotomy is regarded as a buy time procedure to postpone knee replacement in younger patients with isolated medial compartment osteoarthritis. However, in properly selected patients, with meticulous surgical technique, recent studies revealed a favorable long term survivorship of this procedure. High tibial osteotomy may not be simply buying time, but a procedure able to achieve durable result.
Presenters Kwong Yin Chung
Can Partial Knee Replacement be a Definitive Surgery ?View Abstract
Speaker 03:05 PM - 03:15 PM (Asia/Hong_Kong) 2019/05/14 07:05:00 UTC - 2019/05/14 07:15:00 UTC
 
A knee joint is composed of three compartments – medial tibiofemoral, lateral tibiofemoral and patellofemoral joint. When end-stage degeneration affects either one of the compartments, the traditional surgical treatment is total knee replacement with a prosthesis which sacrifices the normal cruciate ligaments and also the other normal joint compartments. More than 95% of prosthesis was reported to survive longer than 10 years. However, about 20% of patients were not satisfied and complained about the abnormal feeling of the replaced knee.
 

 
Partial knee replacement is minimally invasive with smaller surgical incision, and more importantly, preserves normal bone, normal cruciate ligaments and normal knee function. The speed of recovery and rehabilitation is faster than the total knee counterpart. It’s, however, not suitable when degeneration affects all three compartments or the cruciate ligaments are ruptured. Isolated medial compartment osteoarthritis is the most common indication. Many international studies reported the good outcome of partial knee prosthesis in the medial compartment. In a particular model of prosthesis, Oxford Knee, because of the design of congruent articulation with mobile bearing, it was found to have good result even in over-weight and young patient with high activity level. This could survive up to 90% in 20 years. This disproves the old belief that partial knee replacement is used to buy time for definitive total knee replacement.
 

When disease only affect lateral or patellofemoral compartment of knee, partial replacement of either of these compartments is also possible, although with less frequent occurrence. It was found the longevity of lateral partial knee replacement is similar to medial counterpart from the international experience. As for the patellofemoral replacement, the implant survivorship is not as good, but it’s expected to improve with better patient selection and better development of prosthesis.
Presenters Jason C H Fan
Sharing from the First Joint Replacement Centre in Hong Kong: Challenges and Looking ForwardView Abstract
Speaker 03:15 PM - 03:25 PM (Asia/Hong_Kong) 2019/05/14 07:15:00 UTC - 2019/05/14 07:25:00 UTC
The first Joint Replacement Centre was set up in Hong Kong in December 2010 at Buddhist Hospital. Aim is to better manage growing demand, more efficient utilization of resources and ensure service quality and safety. It’s targeted to perform extra 500 arthroplasty surgery in Kowloon Central Cluster per year. During the first 5 years, we managed to reduce the surgery waiting time from 50 months to about 10 months. More Joint Replacement Centers are being set up in other clusters. However, as more people are aware of the benefits of joint replacement surgery, in term of pain control and functional improvement, and the population continues to aged, there is a three-fold increase in the waiting list in Hospital Authority from 7065 in 2011 to 21481 in 2018. Therefore, the challenge has become HA-wide.
Presenters John Wong
Update in Joint Replacement Surgery: What??s New ?View Abstract
Speaker 03:25 PM - 03:35 PM (Asia/Hong_Kong) 2019/05/14 07:25:00 UTC - 2019/05/14 07:35:00 UTC
Since its invention more than a half century ago, total joint replacement surgery has become one of the most successful surgeries in orthopaedics. With advancing techniques, patients at younger and older age are benefitted from this surgery. The advance in fast-track surgery is unstoppable with the popularity of local infiltrative analgesics, blood saving surgery and even out-patient surgery. Patient satisfaction has become one of the most important outcome measures, and new measuring tools such as the Forgotten Joint Score have emerged. Despite this, there are still 15-20% of patients dissatisfied with their surgery. One of the main goals of recent research and development in joint replacement surgery is to tackle the dissatisfaction, particularly in knee replacement. Dissatisfaction could be caused by surgical technique and implant design. The last decade search for a perfect mechanical alignment by the use of navigation in total knee replacement has met some twists and turns. Newer targets could be patient-specific “kinematic” alignment or a deliberate varus alignment and the use of robotics may help not just in navigation but also in execution. New researches on the kinematic of a normal and replaced knee have raised some interest on knee prostheses which are aimed to reproduce normal kinematics. Examples are medial pivot knee, ultra-congruent insert and bicruciate-retaining or bicruciate-stabilized knee. Since more young patients are receiving knee replacement, there are recent researches on cementless tibial monoblock which has been designed for better fixation and implant longevity. Dislocation in total hip replacement is always a concern. One area of research is in the direct anterior approach. Despite the concern of possible higher intraoperative complication rate, there is increasing popularity of such surgical approach, particularly in US. Another area of interest is the spinopelvic sagittal balance. The research on this makes some rethinking on the conventional “safe zone” in acetabular cup orientation. The use of robotics may also help putting the cup in an optimum position with fewer outliers. How all these new interests translate into clinical benefits remain to be seen in a longer term.
Presenters Qunn Jid Lee
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