Abstract
Purpose To determine which patients respond best to viscosupplementation injections for osteoarthritis of the knee.
Methods and Results We undertook a prospective study of all patients undergoing Hylan G-F 20 injections in the knee recording the indication, severity of symptoms, baseline demographic details and the WOMAC score. Outcome data was collected at 3, 6 and 12 months at an independent telephone interview to determine if patients were improved, the same or worse, and by postal WOMAC score.
100 patients were studied. 3 records were excluded, as there was no follow-up recorded. The demographics on 97 were: mean age 67 (range 37–91), male 56%, mean duration of symptoms 8.8yrs and primary OA in 65%.
Overall 43% were improved at 3 months, 31% at 6 months and 29% at 12 months. When the results were analysed according to indication, patients with ‘moderate non-mechanical osteoarthritic symptoms after failed medical management and not severe enough for arthroplasty’ did best (49% at 3 months and 38% at 6 months). Patients with ‘persisting arthritic symptoms after attempted arthroscopic debridement for mechanical type knee symptoms’ had less predictable results (42% improved at 3 months and 23% at 6 months). Patients with ‘severe or deteriorating symptoms while awaiting knee replacement’ or who were ‘too medically ill for TKR’ had a low rate of improvement (18% at 3 months).
Conclusion Viscosupplementation is unreliable in patients with end stage OA awaiting TKR. This study allows for better targeting of this useful expensive treatment modality.
The abstracts were prepared by Mr Roger Smith. Correspondence should be addressed to him at the British Association for Surgery of the Knee, c/o BOA, Royal College of Surgeons of England, 35–43 Lincoln’s Inn Fields, London WC2A 3PN.
