Background Total knee replacement is a commonly adopted surgical intervention to reduce physical limitations and pain in advanced-stage knee osteoarthritis. However, these patients may experience physical dysfunction to limit their access during conventional rehabilitation after total knee replacement. The use of telemedicine may be the promising solution. This study aims to compare the effectiveness of telerehabilitation with conventional in-person rehabilitation in patients who underwent a total knee replacement. Methods For this systematic review on randomized controlled trials, PubMed, Medline, EMBASE, Cochrane Library, ScienceDirect and CINAHL databases were searched for eligible articles published between 1 January 2003 and 28 February 2022. The eligibility criteria were patients who underwent total knee replacement, randomized controlled trials and publications in English. The main outcome measures were focused on pain and physical function. Reference lists of relevant studies were also manually checked to find additional studies. Two independent reviewers conducted study selection separately. PEDro scale was used to assess the methodological quality of the included randomized controlled trials. A meta-analysis was performed on the collected data. Review Manager (RevMan, version 5.3) was used for all analyses. Results A total of 11 studies met the eligibility criteria and included 1825 participants in the systematic review. Overall, the results revealed that the effectiveness of telerehabilitation is comparable to conventional in-person rehabilitation in improving various pain and functional outcomes in patients who underwent a total knee replacement. In the meta-analysis with the fixed-effects model, no significant difference was found in the improvement of pain and physical function in patients with knee osteoarthritis compared with conventional rehabilitation (Standardized Mean Difference (SMD)  –0.15, 95% CI  −0.47 to 0.16, P = 0.34 and SMD –0.04, 95% CI −0.19 to 0.12, P = 0.62, respectively). In addition, the utilization of hospital resources and costs were significantly lower in telerehabilitation when compared with in-person rehabilitation. Conclusion Telerehabilitation was comparable to conventional in-person rehabilitation in improving clinical outcomes following total knee replacement. However, it might be a more preferable alternative rehabilitation intervention for patients following total knee replacement given the significantly lower cost of telerehabilitation.

Introduction Coronavirus disease 2019 (COVID-19) had spread to over 200 countries and regions across the world since early 2020. Travel bans had been implemented in Hong Kong to control the spread of virus. Despite the burden to the healthcare system brought by COVID-19, there was also an increase in number of hiking-related injuries requiring inpatient care. The aim of this study is to report the incidence of hiking-related injuries admitted to the orthopaedic wards during the COVID-19 pandemic and comparison with statistics from the past years. Methods Data was retrieved from the admission books of the orthopaedic wards and Electronic Patient Records. The number of admissions, patients’ demographics and details of hospitalisation were compared between February to May 2020 (COVID-19 study period) and 2019. Secondary analysis was performed on admissions for tibia and/or fibula fractures with or without operation during the study period and compared with the past five years. Results 48 patients were admitted due to hiking-related conditions during the COVID-19 study period, which was 2.4 times more than 2019. 23 patients suffered from tibia and/or fibula fractures and was higher than the past five years (average 5.8, p = 0.0001). Among patients operated for tibia and/or fibula fractures, the percentage of hiking-related injuries was 41.9% in 2020 and 6.9% in the past five years (p = 0.0002). Conclusions An increase in incidence of hiking-related orthopaedic injuries was observed during the COVID-19 pandemic. Healthcare workers, public health experts and government officials should work together to raise awareness on safety in hiking for effective prevention of injury.

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A 76 year old female, with a background history of eczema and iatrogenic Cushing syndrome, received a right total knee replacement for her knee osteoarthritis. In the early post-operative period, a small amount of discharge was noted from the surgical wound. The wound swab culture of the discharge yielded candida species. It was regarded as contamination initially. Half year later, she presented with a subcutaneous abscess around the right knee. Aspiration and culture confirmed infection of Candida parapsilosis. The patient was treated conservatively with fluconazole because she had initially refused operative treatment. The infection progressed to abscess formation afterward. A two-stage revision arthroplasty with cement spacer was performed subsequently. In addition, we have reviewed the literature regarding fungal periprosthetic joint infection.