Wai-Wang Chau

Purpose: Health-related quality-of-life (HRQOL) assessment provides insight into patient’s subjective experiences that complement traditional clinical and radiological indicators. This study aims to characterize individual variability in long-term HRQOL recovery trajectories after spinal fusion for severe adolescent idiopathic scoliosis (AIS) and to identify preoperative and surgical factors associated with baseline HRQOL and the rate of improvement. Methods: This retrospective longitudinal cohort study included 388 patients with severe AIS (Cobb angle ≥ 45°) who underwent spinal fusion (mean age at surgery 15.3 ± 2.1 years). A total of 1,539 longitudinal SRS-22r and Spinal Appearance Questionnaire (SAQ) records with up to > 20 years of follow-up were analyzed. Hierarchical multilevel growth models with random intercepts and random slopes (cubic time polynomial) were used to model recovery trajectories. Preoperative patient-reported outcome measures (PROM) level, age at surgery (continuous), sex, and curve magnitude were evaluated as trajectory moderators. “Good recovery” was defined as final-visit SRS-22r composite score ≥ 4.0 or SAQ mean score ≤ 4.2. Marginal and conditional R ² quantified explained variance; partial-effects plots illustrated predicted probabilities. Results: Substantial individual variability existed; the population-average trajectory explained only 18% of variance in SRS-22r and 23% in SAQ scores. Preoperative PROM level was the strongest moderator (additional 54–58% variance explained), with patients having moderate baseline disability showing the greatest and most rapid gains. Younger age at surgery significantly hastened recovery ( p < 0.01). Most postoperative HRQOL improvement occurred within the first 4 years (SRS-22r) and 6 years (SAQ), after which scores plateaued at normative levels with no significant long-term decline. Conclusion: Preoperative PROM levels and younger age at surgery are dominant, modifiable moderators of both baseline HRQOL and subsequent postoperative recovery speed. These trajectory-based findings support individualized, patient-centered surgical timing discussions rather than rigid chronological thresholds and facilitate shared decision-making that aligns postoperative HRQOL gains with key psychosocial and educational milestones.

Introduction : Total hip arthroplasty (THA) is a common orthopaedic procedure that significantly alleviates pain and enhances the quality of life for patients with hip osteoarthritis. Precise implant placement is critical for successful outcomes. Robotic-assisted THA has been developed to improve surgical accuracy and predictability, offering three-dimensional computed tomography-based planning and haptic guidance during key steps of surgery such as reaming and cup impaction. This study aims to compare (i) the accuracy of implant positioning between robotic-assisted and conventional THA, and (ii) other intra-operative and post-operative outcomes, including blood loss, operative time, length of stay, and associated complications. Materials and Methods : In total, 97 THA cases performed between November 2017 and October 2023, with a minimum follow-up of one year, were retrospectively analyzed. Fifty patients underwent robotic-assisted THA, while 47 received conventional THA. Demographic data, radiographic outcomes, surgical time, blood loss, length of stay, and surgical complications were evaluated. Intra- and Inter-observer reliability of radiographic measurements was confirmed. Results : Robotic-assisted THA demonstrated significantly greater accuracy and consistency in achieving targeted acetabular inclination and anteversion (p < 0.001). More cases in this group fell within the Lewinnek (p < 0.001) and maintenance of global offset ( p = 0.264) were also observed. More cases achieved balanced limb length discrepancy ( p = 0.047). No significant differences were found in operative time ( p = 0.196), blood loss ( p = 0.775), or length of stay ( p = 0.236). Similar rates of surgical complication were observed in both groups. Discussion and conclusion : Robotic-assisted THA provides more precise and consistent implant positioning without increasing operative time, blood loss, length of hospital stay, or associated complications.

Background: Rotator cuff tears can result in pain which can be debilitating. The etiology of failed repair or retears is multifactorial. Multiple risks factors were proposed, with critical shoulder angle (CSA) being one of the factors of emerging interest. Other radiological parameters including glenoid inclination (GI), lateral acromial angle (LAA), and acromial index (AI) were also suggested for a possible correlation. Methods: A retrospective review of 397 rotator cuff repairs on January 1, 2000 to December 31, 2023 recruited from two major hospitals was carried out. Primary outcome measure of radiographic shoulder angles (CSA, GI, LAA, and AI) was measured. Results: There is no statistical difference in radiographic shoulder angles measured in the rotator cuff retear group and the no retear group. Retear patients were more likely to have Goutallier grade 3 and 4 (p = 0.01). Goutallier grade 4 was the potential predictor of retear regardless of sex (Odds ratio=5.25 (1.38, 20.02); p = 0.02). Conclusion: There is no definite association of rotator cuff retear and radiographic parameters including CSA, GI, LAA, and AI in this study.

Introduction: The Self-Locking Finger Joint (SLFJ) prosthesis is a cementless surface implant that can be used to treat inflammatory or degenerative osteoarthritis of the proximal interphalangeal (PIP) joint. The aim of this study was to report the mid-term outcomes and to validate a radiological parameter for bone resorption and loosening. Methods: Sixteen patients (17 prostheses) who were treated with a SLFJ implant were retrospectively included, with a mean follow-up of 7 years (range 2–14). Outcomes included pain, range of motion of the PIP joint and complications. Implant subsidence and osteointegration were assessed on postoperative radiographs. A radiological bone resorption index, ranging from grade 0 to grade 3, was developed. It was scored in 20 zones per prosthesis, and the reliability was tested. Results: The mean visual analogue scale score for pain decreased from 5.3 preoperatively to 1.7 postoperatively, and mean active PIP joint motion improved from 34 to 62°. Three prostheses needed a re-operation (one implant exchange and two arthrodeses). Radiologically, mean implant subsidence was 0.2 mm for both proximal and middle phalanges, without resorption at the joint anchor. Osteointegration occurred in 15 implants. Reliability of the bone resorption classification was moderate to excellent. On average, seven of 20 zones had a mean resorption index >1, indicating bone resorption, and resorption was noted around six of the protheses. Conclusion: With the SLFJ arthroplasty, proximal interphalangeal joint pain decreased, motion preservation was comparable with that for other implants and good osteointegration and radiological outcomes were obtained at mid-term follow-up. A validated scoring system for bone resorption was created, which can be used in other studies. Level of evidence: IV

Background/Objectives: Deformational plagiocephaly (DP) is defined as an asymmetrical flattening of infants’ occipital skull. Helmet therapy is one of the treatments reported that can reduce skull deformity by guiding the growing direction of the head. However, its effectiveness remains insufficiently validated in the literature due to variability in treatment protocols and regimes. This study aims to evaluate the clinical outcomes of helmet therapy in infants with deformational plagiocephaly. Methods: This single-center retrospective study was conducted at a tertiary university hospital and included 30 consecutive infants (mean age 7.83 ± 2.51 months) who attended a pediatric orthopedic outpatient clinic between 2022 and 2025. Infants without craniosynostosis and with cranial vault asymmetry index (CVAI) ≥ 5% were prescribed a course of helmet therapy (mean duration 3.77 ± 2.37 months). The primary outcome was the change in CVAI. Results: The mean CVAI (%) significantly decreased from 7.57 ± 2.45 to 6.10 ± 2.63 (p = 0.002). The effect of helmet therapy was dose-dependent, with greater improvement observed in infants wearing the helmet for at least 6 h per day. Poor compliance and predominantly daytime helmet use were associated with less improvement. Increased sweating and mild skin redness were the most common reported adverse effects, but the skin redness can be relieved by proper donning of the helmet. Conclusions: Helmet therapy is effective for infants with plagiocephaly when initiated early and with high compliance of helmet use. Greater improvements were observed in infants using the helmet during sleeping. Further multi-center studies with a larger sample size and longer follow-up are recommended.

Background/Purpose: Enhanced recovery after surgery (ERAS) for total knee replacement (TKR) is a multi-modal and multi-disciplinary approach designed to enhance patient outcomes. ERAS was first introduced in 1997 and further refined with published guidelines for TKR in 2020. Our institute has been adopting ERAS for TKR since 2017. This study aimed to outline our local ERAS protocol for TKR and assess its outcomes in terms of length of stay (LOS). Methods: A retrospective cohort study was carried out comparing total knee arthroplasty patients treated by ERAS (2021–2023) with conventional cohort (2013–2016). Data from pre-operative, immediate after TKR, and 3 months post-TKR were collected through clinical and medical records through hospital electronic record system. Results: A total of 1283 patients who underwent TKR (708 patients in ERAS group and 575 in conventional group) were recruited. Both median pre-operative (0.00 vs 1.00 day; P < 0.001) and total LOS (6.00 vs 8.00 days; P < 0.001) were significantly reduced in the ERAS group. Mean interval between hospital admission and surgery was significantly shorter in the ERAS group (0.01 months) compared to the conventional group (0.04 months) ( P = 0.049). Notable higher proportion of conventional group underwent surgery without navigation was reported (13.0% vs 1.4%, P < 0.001). In terms of deep vein thrombosis (DVT) prophylaxis, Pradaxa was predominantly prescribed in the ERAS group (83.7%), while Clexane was more commonly used in the conventional group (56.9%). Regarding the type of anaesthesia, percentage of patients who received spinal anaesthesia was significantly higher in the ERAS group than the conventional group (87.3% vs 76.9%; P < 0.001). In a step-wise linear regression analysis, applying ERAS remained a statistically significant predictor for a reduced LOS ( r ² = 0.064; coefficient (95% confidence interval) = −1.01 (−1.89, −0.13); P = 0.024) after controlling for surgical side, using navigation, DVT prophylaxis and anaesthesia. Conclusions: After implementation of ERAS in patients after TKR, length of hospital stay was significantly decreased, with or without using navigation, the choice of DVT prophylaxis or choice of anaesthesia. Further investigations were warranted to implement a multi-centre large-scale long-term study to explore long-term outcomes and quality-of-life measures post-TKR.

Introduction: Graft re-rupture is a devastating complication after revision ACLR surgery. The literature regarding the risk factors of graft re-rupture is sparse and not definitive. Studies have suggested that a smaller graft diameter is associated with poorer outcomes after primary ACLR, however there is a paucity of literature regarding the effects of graft size on revision ACLR outcomes. This study aims to determine the risk factors for graft re-rupture after revision ACLR, and investigate the optimum graft diameter for revision ACLR. Methods: The records of all patients who underwent revision ACLR from 2013 to 2021 were reviewed. Data collected included patient demographics, operative variables, and demographic details. To determine the optimal graft diameter, receiver operating characteristic (ROC) analysis was performed. Associations between re-rupture rate and return to pivoting sport, intra-articular knee pathologies, and graft diameter were assessed using contingency tables. Data were examined using univariable logistic regression models to explore the association between graft re-rupture after revision ACLR and prognostic variables. Co-variates with a p value p < 0.100 were included in a multivariable logistic regression model to identify independent associations with graft re-rupture. Results: In total, 132 revision ACLR were identified with a mean follow-up time of 3.22 ± 3.26 years. The graft re-rupture rate was 16.7% ( n = 22). There were 91 (68.9%) males and 41 (31.1%) female with a mean age of 27.4 years (range 17.3–50.8 years) at revision. 87.9% ( n = 116) were involved in one or more types of pivoting sports. Kaplan–Meier analysis showed that the mean survival time for revision ACL grafts was 148 months (95% CI 130–166). The mean graft diameter during revision ACLR was 9.26 mm (range 7.0–10.5 mm) and mean graft length was 43.6 mm (range 22.0–60.0 mm). No associated procedure such as anterolateral (ALL) reconstruction were performed. At the time of revision ACLR, MRI detected concomitant knee pathologies: medial meniscus pathology ( n = 45; 34.1%), lateral meniscus pathology ( n = 41; 31.1%), chondral pathology ( n = 26; 19.7%). None were associated with an increased rate of re-rupture. Risk factors determined by the multivariable logistic regression model were graft diameter < 9 mm (OR: 3.873; 95% CI 1.128–13.293; p = 0.031) and return to pivoting sport after revision ACLR surgery (OR: 4.105; 95%CI 1.008–16.721; p = 0.049). Conclusion: A graft diameter < 9 mm and return to pivoting sports after revision ACLR are risk factors for graft re-rupture. Meniscus pathology and chondral lesion were not associated with graft re-rupture. The findings of this study can be used to improve revision ACLR results for patients, but needs to be expanded in multi-centre trials with larger sample sizes.