VOL.24 NO.11 November 2019 Orthopaedics OFFICIAL PUBLICATION FOR THE FEDERATION OF MEDICAL SOCIETIES OF HONG KONG ISSN 1812 - 1691 HK-PFI-678.indd 1 2019/1/2 3:29 PM VOL.24 NO.11 NOVEMBER 2019 Contents Contents Editorial Lifestyle n Editorial 2 n How to Take Photos of Lotus? 29 Dr Kwai-ming SIU Dr Hin-keung WONG Medical Bulletin Dermatology Quiz n Update on Surgical Management of End- 5 n Dermatology Quiz 13 Stage Ankle Arthritis CME Dr Chi-keung KWAN Dr Kwai-ming SIU Medical Diary of November 33 n MCHK CME Programme Self-assessment Questions 9 Calendar of Events 34 n Recent Advances in Total Knee Replacement 11 Dr Yiu-chung WONG & Dr Qunn-Jid LEE n Update on Management of Degenerative 15 Lumbar Spine Disease Dr Chong-hing WONG Scan the QR-code n Arthroscopic Management of Shoulder Disorders 20 To read more about Dr Stephen Chor-yat CHUNG The Federation of Medical n Update on Management of Fragility Hip Fractures 25 Societies of Hong Kong Dr Angela Wing-hang HO Disclaimer All materials published in the Hong Kong Medical Diary represent the opinions of the authors responsible for the articles and do not reflect the official views or policy of the Federation of Medical Societies of Hong Kong, member societies or the publisher. Publication of an advertisement in the Hong Kong Medical Diary does not constitute endorsement or approval of the product or service promoted or of any claims made by the advertisers with respect to such products or services. The Federation of Medical Societies of Hong Kong and the Hong Kong Medical Diary assume no responsibility for any injury and/or damage to persons or property arising from any use of execution of any methods, treatments, therapy, operations, instructions, ideas contained in the printed articles. Because of rapid advances in medicine, independent verification of diagnoses, treatment method and drug dosage should be made. The Cover Shot Take a rest 歇息 This photo was taken at Wun Chuen Sin Kwoon on a sunny day. The Dragonfly took a rest on top of a lotus bud. It spread its wings wide and pointed its tail upward. The dragonfly adopted a symmetrical posture in order to achieve stability and balance. You can clearly see the patterns of the dragonfly wings in this view. Dr Hin-keung WONG MBBS (HK), FHKCOS, FRCS Ed (Ortho), FHKAM (Ortho Surgery), MMedSc (HK) President, The Hong Kong Society for Surgery of the Hand Specialist in Orthopaedics and Traumatology Chief of Service and Consultant, Department of Orthopaedics amd Traumatology, Princess Margaret Hospital and North Lantau Hospital 1 VOL.24 NO.11 NOVEMBER 2019 Editorial Published by The Federation of Medical Societies of Hong Kong Editorial EDITOR-IN-CHIEF Dr CHAN Chun-kwong, Jane 陳真光醫生 Dr Kwai-ming SIU MBChB (CUHK), FRCS (Ed), FHKCOS, EDITORS FRCS Ed (Ortho), FHKAM (Ortho) Prof CHAN Chi-fung, Godfrey Specialist in Orthopaedics and Traumatology 陳志峰教授 (Paediatrics) President, The Hong Kong Orthopaedic Association Dr CHAN Chi-kuen Consultant, Department of Orthopaedics and Traumatology, 陳志權醫生 (Gastroenterology & Hepatology) Princess Margaret Hospital and North Lantau Hospital Dr KING Wing-keung, Walter 金永強醫生 (Plastic Surgery) Editor Dr LO See-kit, Raymond 勞思傑醫生 (Geriatric Medicine) Dr Kwai-ming SIU EDITORIAL BOARD Dr AU Wing-yan, Thomas As in other parts of the world, Hong Kong is facing the challenge of 區永仁醫生 (Haematology and Haematological Oncology) an ageing population in the coming years. The prevalence of chronic Dr CHAK Wai-kwong orthopaedic diseases is increasing. Therefore, orthopaedic surgeons 翟偉光醫生 (Paediatrics) are playing an important role in the management of these ageing Dr CHAN Hau-ngai, Kingsley 陳厚毅醫生 (Dermatology & Venereology) associated diseases. Dr CHAN, Norman 陳諾醫生 (Diabetes, Endocrinology & Metabolism) One of the commonest ageing-associated diseases is osteoarthritis of the Dr CHEUNG Fuk-chi, Eric lower limb joints such as the knees, hips and, to a lesser extent, ankles. 張復熾醫生 (Psychiatry) Dr CHIANG Chung-seung With further enhancement of surgical instruments, implants and 蔣忠想醫生 (Cardiology) techniques of arthroplasty of these joints in the past few decades, the Prof CHIM Chor-sang, James surgical outcome has improved significantly. Degenerative diseases 詹楚生教授 (Haematology and Haematological Oncology) of the spine are also getting increasingly prevalent in our population. Dr CHONG Lai-yin 莊禮賢醫生 (Dermatology & Venereology) These patients, particularly those with osteoporosis, will benefit from Dr CHUNG Chi-chiu, Cliff new surgical techniques which attempt to achieve satisfactory operative 鍾志超醫生 (General Surgery) results. Dr FONG To-sang, Dawson 方道生醫生 (Neurosurgery) Dr HSUE Chan-chee, Victor Furthermore, fragility hip fracture, one of the more common fragility 徐成之醫生 (Clinical Oncology) fractures, imposes a major healthcare burden in Hong Kong. A Dr KWOK Po-yin, Samuel comprehensive multidisciplinary management approach should 郭寶賢醫生 (General Surgery) be adopted. Implementation of an appropriate clinical pathway, Dr LAM Siu-keung 林兆強醫生 (Obstetrics & Gynaecology) fracture liaison service to provide rehabilitation in the community Dr LAM Wai-man, Wendy and secondary fracture prevention, and enhanced surgical techniques 林慧文醫生 (Radiology) and implants can achieve better patient outcome and prevent further Dr LEE Kin-man, Philip fractures. 李健民醫生 (Oral & Maxillofacial Surgery) Dr LEE Man-piu, Albert 李文彪醫生 (Dentistry) The issue of an ageing population has made a significant impact on Dr LI Fuk-him, Dominic the orthopaedics service. Hence, in order to update the releivant 李福謙醫生 (Obstetrics & Gynaecology) knowledge, ‘Rebuild and Rebrighten Ageing Orthopaedics to the Prof LI Ka-wah, Michael, BBS Next Century’ is taking centrestage as the main theme of the Annual 李家驊醫生 (General Surgery) Dr LO Chor Man Congress of the Hong Kong Orthopaedic Association in November this 盧礎文醫生 (Emergency Medicine) year. I firmly believe that our orthopaedic fraternities will benefit from Dr LO Kwok-wing, Patrick the sharing and discussion of our overseas and local faculties. 盧國榮醫生 (Diabetes, Endocrinology & Metabolism) Dr MA Hon-ming, Ernest 馬漢明醫生 (Rehabilitation) In particular, I would like to thank all the following experts for their Dr MAN Chi-wai great contribution to this issue. Dr Yiu-chung Wong and Dr Qunn- 文志衛醫生 (Urology) jid Lee has enlightened us on the recent advances in knee replacement. Dr NG Wah Shan Dr Chong-hing Wong has given an update on the management of 伍華山醫生 (Emergency Medicine) Dr PANG Chi-wang, Peter degenerative lumbar spine diseases. Arthroscopic management of 彭志宏醫生 (Plastic Surgery) shoulder disorders has been illustrated by Dr Stephen Chor-yat Chung. Dr TSANG Kin-lun Dr Angela Wing-hang Ho has addressed us on the management of 曾建倫醫生 (Neurology) fragility hip fractures. I must also thank Dr Hin-keung Wong for Dr TSANG Wai-kay 曾偉基醫生 (Nephrology) sharing with us his expertise on photography of ‘lotuses’ and his Dr WONG Bun-lap, Bernard splendid photos. 黃品立醫生 (Cardiology) Dr YAU Tsz-kok Finally, I hope you will enjoy reading this issue on orthopaedics and 游子覺醫生 (Clinical Oncology) Prof YU Chun-ho, Simon find our articles informative. 余俊豪教授 (Radiology) Dr YUEN Shi-yin, Nancy 袁淑賢醫生 (Ophthalmology) Design and Production www.apro.com.hk 2 VOL.24 NO.11 NOVEMBER 2019 Medical Bulletin Update on Surgical Management of End- Stage Ankle Arthritis Dr Kwai-ming SIU MBChB (CUHK), FRCS (Ed), FHKCOS, FRCS Ed (Ortho), FHKAM (Ortho) Specialist in Orthopaedics and Traumatology President, The Hong Kong Orthopaedic Association Consultant, Department of Orthopaedics and Traumatology, Princess Margaret Hospital and North Lantau Hospital Dr Kwai-ming SIU This article has been selected by the Editorial Board of the Hong Kong Medical Diary for participants in the CME programme of the Medical Council of Hong Kong (MCHK) to complete the following self-assessment questions in order to be awarded 1 CME credit under the programme upon returning the completed answer sheet to the Federation Secretariat on or before 30 November 2019. INTRODUCTION SURGICAL TREATMENT End-Stage ankle arthritis can be a decapacitating and In symptomatic end-stage ankle arthritis, surgical painful condition. Post-traumatic osteoarthritis is treatment should be considered if the symptoms persist the most common cause of end-stage ankle arthritis. despite non-operative treatment. The mainstay of Idiopathic osteoarthritis, post-infection arthritis, surgical treatment for end-stage ankle arthritis includes rheumatoid arthritis and arthritis resulting from ankle arthrodesis and total ankle replacement. chronic ligamentous instability are other causes of ankle arthritis. Ankle Arthrodesis (Fusion) CLINICAL PRESENTATION AND Ankle arthrodesis is considered the gold standard RADIOLOGICAL INVESTIGATION treatment for end-stage ankle arthritis. The first open ankle arthrodesis was performed in 1879. Along with Pain is the usual presenting symptom in end-stage ankle a better understanding of ankle anatomy, enhancement arthritis. It is characteristically deep in the ankle. On of the arthroscopic instruments and the development physical examination, tenderness, swelling and stiffness of arthroscopic techniques of joint preparation and in the ankle are the typical findings. It is also associated stabilisation for arthrodesis, arthroscopic ankle with deformity of the ankle and hindfoot. arthrodesis (AAA) is increasingly used to treat end- stage ankle arthritis. Radiographs should include weight-bearing anteroposterior and lateral views of the feet and ankles. Compared with open fusion, AAA, as