published_or_final_version / Orthopaedics and Traumatology / Master / Master of Medical Sciences

Introduction Total hip arthroplasty is one of the most effective interventions to treat patients with end-stage hip arthritis. Although the outcomes of total hip arthroplasty have already been widely studied and most of the published results are positive, the dominant outcomes measures are focused on implant survivorship, patient mortality and complication rates. Quality of life assessment is regarded as a gold standard for outcomes measurement nowadays and was more frequently adopted in researches. However, in most of the study assessing the quality of life of patients undergoing total hip arthroplasty ignored the importance of quality of sexual life. Moreover, none of them are studying the Chinese population. In order to assess the quality of life of patients holistically, a study that focused on the quality of sexual life among Chinese population undergoing total hip arthroplasty is recommended. The aim of the present study is to investigate the changes in quality of sexual life in young Chinese patients undergoing primary total hip arthroplasty. Methodology The present study is a descriptive survey adopted a retrospective design and was conducted either as a phone interview or interview in person. 118 Patients who have undergone total hip arthroplasty at the Queen Mary Hospital are recruited from March 2012 to June 2012. Questionnaires assessing the pre-operation and post-operation sexual life and quality are administered. 118 subjects participated in the study finally. Results 118 subjects participated in the present study. 35 of them reported to have no sexual life due to reasons other than the condition of their hip and were analyzed separately. 83 of the subjects were included in the analysis of changes in sexual life. Preoperatively 50.6% of subjects reported having severe to extreme sexual difficulty. 64 (78.0%) and 16 (19.5%) subjects reported the cause of sexual difficulty to be joint pain and joint stiffness respectively. 61 (73.5%) subjects believed the condition of their hip caused some degree of distress in the relationship with their partner preoperatively. 83.2% of subjects rated their level of sexual difficulty from minimal to mild after having total hip arthroplasty. 23 (28%) and 47 (57.3%) of subjects reported their post-operation sexual life experience to be better and much better respectively. It is shown that greater joint pain (p<0.001) and stiffness (p=0.003) and lower Harris hip score (p=0.001) are significantly correlate with greater pre-total hip arthroplasty sexual difficulty, while only the range of motion of hip remained to be negatively correlated with sexual difficulty post-operatively (p=0.022). Subjects with ankylosing spondylitis are having significantly greater sexual difficulty than participants with other diagnosis post-operatively (p<0.001). None of the subjects have discussed post-total hip arthroplasty sexual life issue with the health care professional. 24 (28.9%) subjects reported their need of more sexual life related information and the most wanted information is safe position for sexual intercourse (75%). Conclusion Total hip arthroplasty can significantly improve the quality of sexual life experience of Chinese patients. Further studies are necessary to be done in order to obtain more relevant information and modify the current patient routine assessment and education. / published_or_final_version / Orthopaedics and Traumatology / Master / Master of Medical Sciences

Introduction: This study aimed to assess the outcomes and implant survivorship in Chinese patients aged 55 years or younger. Methods: We reviewed our local joint replacement registry on a total of 102 knees from 68 Chinese patients aged 55 years or below at the time of surgery. All patients were operated on from January 2000 to July 2007. The mean followup was 8.3 years (range, 5 ? 12.5 years). We included patients with osteoarthritis (70 knees), rheumatoid arthritis (24 knees), hemophilia (4 knees), psoriatic arthropathy (1 knee), post?traumatic (1 knee) and tuberculosis (2 knees). All implants were cemented. 53 were posterior cruciate ligament (PCL) sacrificing, 47 were posterior stabilized implants and 1 was constrained implant. The preoperative and latest Knee Society Knee Scores, Knee Society Functional Score, knee range of motion and lower limb mechanical alignment on long film measurement were obtained. The postoperative occurrence of radiolucent lines, complications, revision operation and deaths were noted. Each knee was analyzed separately. Results: Mean Knee Society Knee Score improved from 41 (range: 13?79, SD 12.9) to 88 (range: 30?100, SD 13.3)(p <0.0001), while the mean Knee Society Functional Score improved from 41 (range: 0?80, SD 19.2) to 69 (range 0?100, SD 26.5 ) (p<0.0001). 70% achieved a postoperative coronal mechanical axis of within 3 from neutral alignment. Implant survivorship was 97% at 5 years and 85% at 10 years. 11 knees from 9 patients had complications requiring revision surgery. Aseptic loosening occurred in 10 knees of 8 patients. Among those with aseptic loosening, 3 knees from different patients had coexisting osteolysis. Heterotopic ossification occurred in 1 knee. There were no cases of infection. Rheumatoid arthritis patients when compared with osteoarthritis patients had a more valgus preoperative lower limb alignment (p<0.001), a lower mean preoperative KSFS (30 and 45 respectively, p=0.004) and a lower mean postoperative KSFS (53 and 74 respectively, p=0.006). There were no significant differences in mean improvement of KSFS, KSKS, radiological outcomes and implant survival. There were no statistically significant differences in clinical outcomes, radiological outcomes and implant survival between PCL sacrificing and PCL substituting implants. There were no statistically significant differences between the postoperatively neutrally aligned group and the outlying group in terms of clinical outcomes, radiological outcomes and implant survival. Conclusion: Total knee arthroplasty provides good clinical and functional outcomes in young Chinese comparable to those of international standards. Careful patient selection is crucial to avoid complications. / published_or_final_version / Orthopaedics and Traumatology / Master / Master of Medical Sciences

Introduction: This retrospective comparative study was to define the validity and reliability of a translated, culturally adapted Chinese version questionnaire of the New Knee Society Knee Scoring System (NKSS). This study is aim to investigate the validity and reliability of the translated Chinese version of the NKSS and assess its feasibility of measuring the scale on Chinese patients by performing its cross-cultural adaptation for patients after Total Knee Arthroplasty (TKA) in Hong Kong. Methods: A total of 104 knees from 64 Chinese patients performed TKA were included in the study using the translated, culturally adapted Chinese version of the NKSS. All Patients were operated on from October 2010 to May 2013 at Queen Mary Hospital. Patients who participated in this study have been clinically screened and established a set of including criteria. The outpatients were evaluated by completing the five questionnaires containing the NKSS, the Knee Society Clinical Rating System (KSS), Medial Outcomes Study 36+Item Short Form (SF-36), Bristol Knee Score and Oxford Knee Score. Reliability was evaluated using the Split-half reliability, Chronbach's α coefficient and inter-item correlation. To assess validity, all patients filled in the same NKSS questionnaire, and previously validated Chinese version of the SF-36, Bristol Knee Score and Oxford Knee Score. The validity was determined with Content Validity and Contract Validity. Results: The NKSS showed ideal split-half reliability as evidenced by the high correlation coefficient (R>0.7, P<0.05). Chronbach's α coefficient for five major domains demographics, objective knee score, expectations, satisfaction and function was high (α>0.7. P<0.05). Also, the inter-item correlation was also excellent for all domains. For validity, the NKSS was found to have excellent correlation with Bristol Knee Score and Oxford Knee Score, good correlation with KSS and SF 36 Discussion: The NKSS as a validated approach is adapted to the diverse health-related quality of lives and activities of contemporary patients with TKA. Orthopaedics surgeons are allowed to appreciate differences in the priorities of individual patients and the interplay among function, expectation, symptoms, and satisfaction after TKA using this assessment instrument. Conclusion: The results of this study show that the NKSS as a functional status questionnaire has been translated into Chinese without missing any psychometric properties of the original version. This culturally and linguistics adapted Chinese version of the NKSS outcome assessment has satisfactory internal consistency and good validity. It is an adequate and helpful instrument for the evaluation of Chinese speaking patients after TKA in clinical studies. / published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

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Four systematic literature reviews were undertaken to help define best clinical practice in the management of end-stage renal disease (ESRD). Only randomised controlled trials (RCTs) were included. The areas reviewed were (1) Synthetic versus cellulose/modified-cellulose membranes for haemodialysis in ESRD; (2) Bicarbonate versus acetate dialysate for haemodialysis in ESRD; (3) Short versus standard duration dialysis in haemodialysis in ESRD; and (4) Continuous Cyclic Peritoneal Dialysis (CCPD) versus Continuous Ambulatory Peritoneal Dialysis (CAPD) in ESRD. The paucity of trials made it difficult to determine best practice in relation to many outcome measures. The review identified only a modest benefit from synthetic membranes over cellulose membranes in reducing adverse symptoms during dialysis at considerable extra cost. There was good evidence to support the use of bicarbonate in preference to acetate haemodialysis on the basis of greater effectiveness and similar cost. The single study which considered haemodialysis duration did not produce data to support the equal safety of short duration dialysis compared with standard duration. Finally, though the single study identified tended to favour CCPD in preference to CAPD in terms of fewer peritonitis episodes the extra cost involved was considerable. Though approximately 16,000 abstracts were identified by the search strategy only forty-two RCTs met the inclusion criteria for any of the four reviews. Considering the volume of published work and the critical importance of the policy decisions being reviewed, it was disappointing to identify so few. These reviews have highlighted the need for further, large, multi-centre RCTs in nephrology and dialysis. Systematic literature reviews will play a key role in placing the practice of nephrology on a solid foundation of robust scientific evidence. They may also nurture a culture of clinical research in nephrology where the confusion and conflict of many small methodologically week trials is replaced by the scientific clarify of fewer, large, well conducted, methodologically sound RCTs.

Joint replacement surgery in the treatment of arthritic disease is now commonplace and on the whole very successful. Research into the design and development of prostheses has made major advances since the 1940s resulting in complex devices for almost all articulating joints of the body. In this thesis, a programme of work to design and test a surface replacement prosthesis for the metacarpophalangeal joint is presented. The anatomy and kinematics of the MCP joint are discussed for both normal and abnormal joint function and, based on these considerations, the design of a new surface replacement prosthesis is described. Various materials are explored with respect to their biocompatibility, durability and ease of fabrication with special attention being paid to one material - a new cross linked ultra-high molecular weight polyethylene - which is tested for wear and assessed for durability in long-term prototype tests. A finger function simulator is detailed which was designed and developed during this research programme, and results of tests on bone replicas, Swanson Silastic implants and prototypes of the new design are presented. The simulator can be easily modified to accept any MCP joint prosthesis for bench testing. Finally the stress response of the prototype design is studied using finite element analysis and modifications to the implant design and bone preparation are suggested.

Cement replacement materials are by-products used to produce high performance concrete. Published data on the effects of combinations of mineral admixtures in concrete on the microstructural and performance-related properties under different curing regimes are comparatively little. Further the correlation of strength of concrete to its permeability and pore structure is also not clear. The main objective of this research is to study the performance of various combinations of fly ash/silica fume and slag/silica fume concretes under three different curing regimes, viz. continuous moist curing, no moist curing after demolding and air drying after 7-days of initial moist curing. Six different concrete mixes were prepared with ordinary portland cement and a blend of portland cement and combinations of fly ash+silica fume and slag+silica fume The water-to-cementitious materials ratio of all the concrete mixtures was kept constant at 0.45. The properties investigated included workability of the fresh concrete, engineering properties such as cube and modified cube compressive strength, flexural strength, dynamic modulus of elasticity, pulse velocity, shrinkage and swelling, permeability and microstructural properties such as porosity and pore size distribution. The results show that prolonged dry curing results in lower strengths, higher porosity, coarser pore structure and more permeable concretes. It was found that the loss in early age compressive strength due to incorporation of fly ash or slag can be compensated for by the addition of small amounts of silica fume. The engineering and microstructural properties and permeability of concretes containing fly ash or slag appear to be more sensitive to poor curing than the control concrete, with the sensitivity increasing with increasing amounts of fly ash or slag in the mixtures. The incorporation of high volumes of slag in the concrete mixtures refined the pore structure and produced concretes with very low porosity and threshold diameters. The results emphasize that a minimum 7-day wet curing is needed for concrete with mineral admixtures to develop the full potential, and that continued exposure to a drying environment can have adverse effects on the long-term durability of inadequately cured slag or fly ash concretes. The results also confirm that compressive strength alone is not an adequate index to judge the performance of concrete, and the knowledge of the strength, pore structure and permeability are required for this purpose. Slag/silica fume concrete mixtures showed better performance than fly ash/silica fume concrete mixtures as regards the development of engineering and microstructural properties.

Concrete has the largest production of all man-made materials. Compared with other construction materials, it possesses many advantages including low cost, general availability of raw materials, low energy requirement and utilization under different environmental conditions. Therefore, concrete will continue to be the dominant construction material in the foreseeable future. However, durability of concrete and reinfored concrete structures are still of worldwide concern, so producing a good quality concrete which impedes the ingress of harmful substances into it is of paramount importance. Cement replacement materials have been introduced into concrete mixtures for the purpose of improving the durability performance. Hence, the aim of the present investigation is to study the durability of concrete with and without cement replacement materials under various initial curing conditions. In this thesis various concrete mixes with and without cement replacement materials were considered. The cement replacement materials were, pulverised fuel ash, condensed silica fume, and ground granulated blast furnace slag. Superplasticiser was added to the majority of the mixes considered and air entraining agent to some of the mixes. Various curing regimes were employed which comprised hot dry curing to simulate concrete in the hot arid areas in the world and curing at normal temperature. Curing involved air curing, membrane curing and moist curing for fourteen days followed by air curing. A number of tests were conducted at either one particular age or at various ages. These included tests on porosity and pore structure of pastes obtained by mercury intrusion porosimetry technique, water absorption which covers the water absorption of concrete obtained by shallow immersion and the water absorbed by capillary action when the concrete surface is in contact with water, sulphate resistance of concrete which is performed by immersing the concrete specimens in sulphate solution, and monitoring the change in length at various periods of immersion, chloride penetration profiles of concrete at various ages of exposure. In addition to these tests on durability related properties, tests on compressive strength were also performed. Throughout the study a correlation between pore structure and durability related properties is investigated. A comprehensive compilation of chloride penetration data is made and an empirical expression is derived for the prediction of long term diffusion coefficients. At the end of the investigation, limitations of the present study, conclusions and suggestions for future research are made.