Incidence and Risk Factors for Implant Failure in Spinal Metastasis Surgery

Wong Yu Chung,Chau Wai Wang Jacky,Kwok Kin On,Law Sheung Wai 대한척추외과학회 2020 Asian Spine Journal Vol.14 No.6

Study Design: Retrospective study.Purpose: To investigate the incidence of symptomatic and asymptomatic implant failure in spinal metastasis surgery and identify potential risk factors.Overview of Literature: Surgical stabilization with instrumentation is an established method for the treatment of spinal metastasis. However, very few studies have investigated the incidence and risk factors for implant failure after spinal instrumentation surgery for the treatment of spinal metastasis.Methods: This study recruited 88 patients who received surgical stabilization with instrumentation for the treatment of spinal metastasis. Their medical records and postoperative X-rays were reviewed for evidence of implant failure. Statistical analysis with logistic regression was performed to assess nine potential risk factors for the development of implant failure, including patient’s age at operation, gender, survival, primary tumor, spinal level involved, construct length, decompression levels, fusion material utilization, and radiotherapy application either before or after surgery, to identify potential contributing risk factors.Results: Implant failure was identified in nine out of 88 cases (10.2%) with two cases requiring implant removal: one case included a progressive kyphosis that resulted in nonhealing sore and the other involved a deep-seated wound infection that spread to the implants. Another case required wound debridement due to superficial wound infection. The remaining six cases were asymptomatic, despite postoperative X-rays demonstrating evidence of implant failure. No patient required implant revision. Logistic regression analysis demonstrated that patients who received radiotherapy either before or after surgery were less likely to develop implant failure.Conclusions: The development of radiological implant failure following surgical treatment of spinal metastasis is common. However, symptomatic implant failure leading to revision surgery is uncommon. Our findings suggest that radiotherapy, either before or after spinal surgery, is not associated with the development of implant failure.

Triple Negative Status is a Poor Prognostic Indicator in Chinese Women with Breast Cancer: a Ten Year Review

Ma, K.K.,Chau, Wai Wang,Wong, Connie H.N.,Wong, Kerry,Fung, Nicholas,Lee, J.T. Andrea,Choi, L.Y. Catherine,Suen, Dacita T.K.,Kwong, Ava Asian Pacific Journal of Cancer Prevention 2012 Asian Pacific journal of cancer prevention Vol.13 No.5

Background: Ethnic variation in tumor characteristics and clinical presentation of breast cancer is increasingly being emphasized. We studied the tumor characteristics and factors which may influence the presentation and prognosis of triple negative breast cancers (TNC) in a cohort of Chinese women. Methods: A prospective cohort of 1800 Chinese women with breast cancer was recruited in a tertiary referral unit in Hong Kong between 1995 and 2006 and was followed up with a median duration of 7.2 years. Of the total, 216 (12.0%) had TNC and 1584 (88.0%) had non-TNC. Their clinicopathological variables, epidemiological variables and clinical outcomes were evaluated. Results: Patients with TNC had similar age of presentation as those with non-TNC, while presenting at earlier stages (82.4% were stage 1-2, compared to 78.4% in non-TNC, p=0.035). They were likely to be associated with grade 3 cancer (Hazard Ratio(HR)=5.8, p<0.001). TNC showed higher chance of visceral relapse (HR=2.69, p<0.001), liver metastasis (HR=1.7, p=0.003) and brain metastasis (HR=1.8, p=0.003). Compared with non-TNC group, TNC had similar 10-year disease-free survival (82% vs 84%, p=0.148), overall survival (78% vs 79%, p=0.238) and breast cancer-specific mortality (18% vs 16%, p=0.095). However, TNC showed poorer 10-year stage 3 and 4 specific survival (stage 3: 53% vs. 67%, p=0.010; stage 4: 0% vs. 40%, p=0.035). Conclusions: Chinese women with triple negative breast cancer do not have less aggressive biological behavior compared to the West and presentation at a later stage results in worse prognosis compared with those with non triple negative breast cancer.

Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

Man Sheryl Lok-Chi,Chau Wai-Wang,Chung Kwong-Yin,Ho Kevin Ki Wai 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Background: Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Methods: A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications. Results: The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from periprosthetic joint infection. Conclusions: Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.

No difference in long-term functional outcomes or survivorship after total knee arthroplasty with or without computer navigation: a 17-year survivorship analysis

( Ng Jonathan Patrick ),( Lau Lawrence Chun Man ),( Chau Wai-wang ),( Ong Michael Tim-yun ),( Cheung Kin Wing ),( Chiu Kwok Hing ),( Chung Kwong Yin ),( Ho Kevin Ki-wai ) 대한슬관절학회 2021 대한슬관절학회지 Vol.33 No.-

Background: The literature comparing the long-term outcomes and survivorship of computer navigation-assisted and conventional total knee replacement (TKR) is sparse. Moreover, of the available comparative studies with followup duration of more than 10 years, the results seem to be conflicting. The purpose of this long-term study was to compare the clinical and radiological outcomes, and implant survivorship, of TKR performed with and without computer navigation. Methods: We retrospectively compared the results of 49 computer-navigated TKRs and 139 conventional TKRs. The mean age of the patients was 67.9 (range 52-81) years for the navigation group and 67.1 (range 50-80) years for the conventional TKR group. The mean duration of follow-up for the conventional and navigation TKR groups was 12.9 and 13.2 years, respectively. Clinical and radiographic follow-up examinations of the patients were performed at 2 weeks, 1 month, 3 months and 6 months post-operatively, and at 1-year intervals thereafter. Results: There were no significant differences in the post-operative Knee Society knee and function score between the two groups. The mean overall deviation from neutral alignment and the radiological outliers were significantly higher in the conventional TKR group. The overall survival rates at 17 years were 92.9% for the navigation group and 95.6% for the conventional TKR group (p = 0.62). Conclusions: Navigated TKR resulted in fewer radiological outliers; however, this did not translate to better long-term functional outcomes or implant survival.

Prospective randomized trial comparing efficacy and safety of intravenous and intra-articular tranexamic acid in total knee arthroplasty

Li Moses Man-Lung,Kwok Jojo Yan-Yan,Chung Kwong-Yin,Cheung Kin-Wing,Chiu Kwok-Hing,Chau Wai-Wang,Ho Kevin Ki Wai 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Total knee arthroplasty (TKA) is associated with significant perioperative blood loss and postoperative allogenic blood transfusion. Tranexamic acid (TXA) reversibly blocks lysine binding sites on plasminogen molecules and inhibits plasmin formation. Comparisons of the efficacy and safety of intra-articular and intravenous TXA in primary TKA have not previously been reported.A prospective randomized trial was conducted in 150 patients who underwent TKA, and these patients were randomized into three groups. Patients in Group A were injected by intra-articular TXA according to body weight (20 mg/kg). Patients in Group B received a standard dose of intra-articular TXA (2000 mg), and those in Group C were infused with TXA according to body weight (20 mg/kg) before tourniquet deflation and again 3 h later. Baseline characteristics and data collected at blood transfusion were compared. Differences among four time points (baseline, day 0, day 2, and day 5) were carried out using ANOVA. The hemoglobin levels at postoperative day 5 were 10.6 g/dL for Group A, 10.6 g/dL for Group B, and 10.7 g/dL for Group C. The drain output was 399 ml for Group A, 314 ml for Group B, and 305 ml for Group C ( p = 0.03). Group C had significantly less drain output than Group A after post hoc comparisons ( p = 0.05), whereas no significant difference was observed between Group A and B ( p = 0.09) or between Group B and C. The weight-adjusted dose of TXA administered intravenously significantly reduced the drain output but not the total blood loss when compared with the weight-adjusted dose of TXA administered intra-articularly. No significant difference was observed in the other parameters among the three groups. The Joint CUHK-NTEC CREC, CRE-2013.644-T . Registered 1 March 2014.