We made a diagnosis of advanced osteoarthritis of the patellafemoral compartment and based on the advanced nature and pattern of the cartilage loss recommended a resurfacing procedure for effective and durable pain relief. Arthrosurface implants were used for the resurfacing ( image 1,2). Note the implants and how they are surgically implanted to match the complex curved geometry of the knee. She achieved an excellent result from the procedure with no further symptoms of pain or swelling.

The following video is at her most recent visit to schedule the identical procedure for the opposite knee. The video shows the cosmetic incision as well as restoration of full knee motion (video).

Watch Video

I have been suffering with arthritis and joint pain since l966, when I had a childhood accident and dislocated my hip.  After two years of doctors “practicing medicine” and finally taking a simple xray which showed the dislocation, I had my hip joint hastily put back in place with pins.

After evaluating his problem we recommended a shoulder resurfacing procedure as an effective surgical intervention that would eliminate his pain and still allow a return to sports activity including golf. Based on our reassurances and the confidence we had built as a result of the successful hip surgery he decided to proceed. The following video shows his motion at 4 weeks from the surgery. He is extremely pleased with the results and looking forward to returning to the golf course this spring.

Shoulder resurfacing is a new procedure and is a substitute for shoulder replacement surgery. The procedure is radically less invasive and  allows for a much more complete restoration of function and return to sports.

Watch Video (Shoulder Resurfacing)

Read Client’s Testimonial (after hip replacement)

On the basis of our diagnosis we recommended a total hip replacement (Image 2) which almost immediately resolved the pain she was experiencing. At 3 weeks from the procedure she is walking independently and is very satisfied with the results of the procedure (video) She is also extremely grateful that we correctly identified and treated her problem effectively.

Hip arthritis symptoms can manifest as buttocks pain or even knee pain. Also the loss of motion from hip osteoarthritis can transmit substantial stress to the lower back and significantly aggravate a lower back condition. The correct diagnosis of hip osteoarthritis and effective treatment can prevent unnecessary and ineffective surgery on secondary or non- symptom generating conditions. (watch video)

A British study in JBJS–A found that skin-derived fibroblasts offer a safe treatment modality for Achilles tendinosis. In the randomized, double-blind study, patients with unilateral involvement were randomized into the treatment group (12 patients) and the control group (12 patients); eight patients with bilateral involvement were individually randomized into treatment and control groups, with eight Achilles tendons in each group. The Achilles tendons of those in the treatment group were injected with laboratory-expanded, skin-derived fibroblasts and an equal amount of autologous centrifuged plasma under ultrasound guidance. At 6 months, researchers found significant differences in the mean Victorian Institute of Sport Assessment and Visual Analog Scale scores between the treatment and control groups of patients with unilateral involvement (P < 0.001 for both). The researchers note that larger studies with longer follow-up are needed before wider clinical application of this treatment is considered. Read more…

Abstract

Three studies presented at the AAOS Annual Meeting support the use of viscosupplementation for patients with osteoarthritis (OA) of the knee. In Scientific Presentation 259, researchers consistently observed pain relief and improvement of function following repeat treatment of symptomatic OA of the knee with hylan G-F 20. In Scientific Presentation 261, patients with OA who were randomized to receive 5 weekly hyaluronic acid injections had significantly less pain as early as 1 week after the first injection, and continuing for at least 6 months. Scientific Presentation 264, a prospective, blinded, longitudinal cohort study, found that viscosupplementation with hylan G-F 20 was an efficacious and safe treatment option for patients with symptomatic knee OA. Read More…

Session: 18-Practice Management/Rehabilitation I Date/Time: Wednesday, Feb 08, 2012, 1:54 PM – 2:00 PM Presentation Number: 259 Title: Long Term Management of Knee Osteoarthritis with Hylan GF-20: Efficacy, Safety of Repeat Treatments Over Four Years Classification: Rehabilitative Medicine Keywords: Viscosupplement; Outcomes Author(s): Raghu Raman, MRCS, Swanland, United Kingdom
Arup Dutta, FRCS, -, Illinois, United States
Geoffrey V. Johnson, FRCS, Hull, United Kingdom
Christopher Shaw, FRCS, United States
Nicky Day, rosemont, Illinois, United States
Abstract: INTRODUCTION
Osteoarthritis (OA) is a chronic disease and its management is a constant process. Pain and symptom relief from viscosupplementation is variable ranging from three to 12 months necessitating repeat courses of treatment. The aim of this study was to assess the safety and efficacy of multiple repeat intra-articular injections of hylan GF-20 in the treatment of osteoarthritis of the knee
METHODS
Patients with OA of the knee were offered initial treatment with hylan GF-20 and repeat courses after a minimum of six months from the previous injection(s). The inclusion criteria was pain score of >6 on a VAS (0-10) in the target knee. Patients with at least two treatment courses were included in the study. This is a prospective, longitudinal independent study over six years in the same institution, where all patients were reviewed by blinded assessors at pre injection, one week, six weeks, three months, six months after every treatment course. The primary outcome variable was knee pain on VAS at six months. Secondary outcome measures were WOMAC, Oxford knee score and SF-12. All adverse events (AE) were recorded.
RESULTS
From our arthritis database, we identified 1,103 patients who had repeat treatments (two to eight courses, median-three) with hylan GF-20. The mean time to repeat treatment was 45.6 weeks (27-104,weeks). Knee pain on VAS improved from 6.6 to 3.7 at six months (p=0.02) over all courses. Mean improvement in knee pain was 51% after the first repeat course and 49% at the last repeat course. Significant improvements from the baseline in the WOMAC pain and function subscales and Oxford knee scores were observed during all repeat courses. Overall incidence of AE was 13.4% (11.9% in initial course) from the pooled data. The incidence of AE had no correlation to the number of repeat treatments.
DISCUSSION AND CONCLUSION
Pain relief and improvement of function are consistently observed following repeat treatment of symptomatic OA of the knee with hylan G-F 20. Longevity and magnitude of symptom control are similar to the first course of treatment. Repeat courses are well tolerated with low adverse events. This study demonstrates that viscosupplementation with hylan GF-20 is an invaluable tool in the multimodal treatment and forms part of the armamentarium of OA management

Session: 18-Practice Management/Rehabilitation I Date/Time: Wednesday, Feb 08, 2012, 2:30 PM – 2:36 PM Presentation Number: 264 Title: Safety, Efficacy and Outcome of 4,400 Patients Treated with Viscosupplementation for Osteoarthritis of Knee Classification: Rehabilitative Medicine Keywords: Viscosupplement; Knee / Hip / Osteoarthritis / Total Hip Arthroplasty; Rehabilitation Author(s): Raghu Raman, MRCS, Swanland, United Kingdom
Rohit Rambani, MS, Sheffield, United Kingdom
Geoffrey V. Johnson, FRCS, Hull, United Kingdom
Christopher Shaw, FRCS, United States
Jagwant Singh, MRCS, Colchester, United Kingdom
Nicky Day, rosemont, Illinois, United States
Abstract: INTRODUCTION
Viscosupplementation is used widely to provide symptomatic relief to patients with knee osteoarthritis (OA). This study is aimed to assess the safety, analgesic efficacy and functional outcome of hylan GF-20 in a large cohort of patients.
METHODS
This is an independent, prospective, blinded (reviewers), longitudinal cohort study over six years in a single instituton. Inclusion criteria was OA knee pain of at least 60mm on a 100mm VAS; no prior intra articular (IA) injection. Patients received 3 x 2mL hylan G-F 20 or 1 x 6mL (from 2009). Follow up at one, six, 12 and 26 weeks by blinded reviewers. Analgesics prohibited for 24 hours prior to follow-up assessments and NSAIDs for 26 weeks. All adverse events (AE) were recorded. Primary outcome measure: target knee pain (VAS) at 26 weeks. Secondary outcome measures included WOMAC, Oxford knee score, SF12, Euroqol Eq 5D.
RESULTS
A total of 4,400 patients were recruited from 2004-2010. All patients received hylan GF-20 (3 x 2 mL N=3352, 1 x 6mL N=1048). Mean age was 61.2 yrs and 71% had Grade III (K-L) disease. Injection and/ or treatment-related AE in the target knee were reported in 11.2% (3 x 2 mL) and 9.8% (1 x 6 mL) of patients. Significant pain reduction (>40%) was observed in both groups at 26 weeks (3 x 2 mL: 57% (mean) decrease from baseline, 1 x 6mL: 51%). Overall knee pain on VAS improved from 69 to 37 at six months (p=0.02). Significant improvements from the baseline in the WOMAC pain and function subscales (65% improvement at 26 weeks) and Oxford knee scores at three and six months were observed. There were no significant differences between groups in demographics or for any of the primary or secondary outcome measures at 26 weeks.
DISCUSSION AND CONCLUSION
Viscosupplementation with hylan GF-20 is an efficacious and safe treatment option for patients with symptomatic OA of knees. Pain relief lasts for at least six months after a first course of treatment. Single dose of 6 mL hylan G-F 20 offers comparable safety and efficacy to 3 x 2 mL at 26 weeks. It provides both the patients and physicians a choice with the potential additional benefits of reduced operational costs.

A study of patients undergoing total knee arthroplasty (TKA) found that those who smoked had a higher overall revision rate and a higher incidence of other complications. The results are reported in Poster Presentation 198, presented at the AAOS Annual Meeting. At a mean follow-up of 46 months, implant survivorship in smokers was 91 percent, versus 96 percent in nonsmokers. Although all patients who smoked were encouraged to participate in a smoking cessation program, most were noncompliant. Read More…