Aims. It is common practice for patients to have postoperative blood tests after total joint replacement (TJR). However, there have been significant improvements in perioperative care with arthroplasty surgery, and a drive to reduce the length of stay (LOS) and move towards day-case TJR. We should reconsider whether this intervention is necessary for all patients. Methods. This retrospective study included all patients who underwent a primary unilateral TJR at a single tertiary arthroplasty centre during a one-year period. Electronic medical records of 1,402 patients were reviewed for patient demographics, LOS, and American Society of Anesthesiologists (ASA) grade. Blood tests were examined to investigate the incidence of postoperative anaemia, electrolyte abnormalities, and incidence of acute kidney injury (AKI). Results. For total knee arthroplasties, preoperative (R = −0.22) and postoperative haemoglobin (R = 0.2) levels were both negatively correlated with LOS (p < 0.001). For all patients who had undergone a TJR, 19 patients (0.014%) required a blood transfusion postoperatively due to symptomatic anaemia. Risk factors identified were age, preoperative anaemia, and long-term aspirin use. Significant abnormal sodium levels were found in123 patients (8.7%). However, only 36 patients (2.6%) required intervening treatment. Risk factors identified were age, preoperative abnormal sodium level, and long-term use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and corticosteroids. Similarly, abnormal potassium levels were evident in 53 patients (3.8%), and only 18 patients (1.3%) required intervening treatment. Risk factors identified were preoperative abnormal potassium level, and long-term use of angiotensin-converting enzyme inhibitors and diuretics. The incidence of AKI was 4.4% (61 patients). Risk factors identified were age, increased ASA grade, preoperative abnormal sodium, and creatinine level. Conclusion. Routine blood tests after primary TJR is unnecessary for most patients. Blood tests should only be performed on those with identifiable risk factors such as preoperative anaemia and electrolyte abnormalities, haematological conditions, long-term aspirin use, and electrolyte-altering medications. Cite this article: Bone Jt Open 2023;4(5):357–362

Background. Osteoarthritis (OA) pain treatment has limitations in terms of serious adverse effects and low efficacy. We aimed to evaluate efficacy and safety of naproxen sodium/codeine phosphate combination in these patients. Methods. In this prospective, randomised, double blind, placebo controlled clinical trial, 135 patients with osteoarthritis, who were 40–65 years; applied to our institution's orthopaedics outpatient clinic; had grade 1, 2, or 3 primary osteoarthritis diagnosed in last 1 year; and had Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score≥40, and Visual Analogue Scale score≥40, were enrolled. Subjects were randomised (1:1) to placebo (n= 67) or combination (n= 68) arms, in which 550 mg naproxen sodium/30mg codeine phosphate was given orally twice a day for 7 days. Rescue medicine was 500 mg paracetamol (max= 6 tablets/day). Demographic characteristics, medical history, adverse events, VAS and WOMAC scores were collected in study visits performed within 10 days. The study was approved by local institutional ethics committee and written informed consents were obtained from all participants. Results. Patients were evenly matched in both arms. The mean age was 52.3±6.6 years (89.7% female). WOMAC and VAS scores decreased significantly within each group (p<0.001 for all). For the study group (n=43) the mean (+ SD) and median (min-max) VAS Score was −29.8 (+21.0) and −30 (−70−0), respectively. In contrast, for the control group (n=36) the mean and median (min-max) VAS Score was −16.1 (+24.4) and −12.5 (−65−40), respectively. WOMAC score was decreased more in combination group (p= 0.044). Changes in VAS scores between visits were significantly different (more in combination receivers) between groups (p= 0.018). Ratio of patients requiring no rescue medicine was higher among combination receivers than controls (64.8% vs. 35.2%, respectively). Most common adverse events were constipation, dyspepsia, and somnolence; no fatality was encountered. Conclusions. Naproxen sodium/codeine phosphate combination is effective and safe in osteoarthritis patients. Level of Evidence. Level 1

Hyaluronic acid (HA) is responsible for the viscoelastic properties of synovial fluid and cartilage. Compared to healthy joints, synovial fluid in osteoarthritic joints contains HA of lower concentration and molecular weight. Hyaluronic acid hybrid complexes are composed by long and short HA chains linked by H bonds. These rheological characteristics and viscoelastic properties were produced by thermal patented process without chemical modification. Chondroitin sulfate (CS) is one of the essential components of the articular cartilage matrix and plays a key role in cartilage's mechanical and elastic properties. Biotechnological chondroitin (CB) is produced through fermentative/biotechnological processes and, unlike CS, is not sulfated. It has been shown that CB to play a more significant role in the phenotypic maintenance of chondrocytes than chondroitin sulfate and increases their viability and proliferation. A recent A Single-Arm, Open-Label, Pilot Study was conducted to evaluate the safety and efficacy of a single-dose intra-articular injection of Hybrid Hyaluronic acid and Sodium Chondroitin in the Treatment of Symptomatic Hip Osteoarthritis. A single injection of HS-SC was well tolerated and safe in the treatment of symptomatic hip OA. The treatment demonstrated a rapid significant improvement in pain (VAS) and function (Lequesne's Index) up to 6 months of follow-up

Introduction and Objective. Hyaluronic acid (HA) is an effective option for the treatment of osteoarthritis (OA) patients due to several properties such as normalization of the mechanical and rheological properties of the synovial fluid and amelioration of OA symptoms and joints function by promoting cartilage nutrition. Since OA progression is also significantly related to oxidative stress and reactive oxygen species (ROS), sodium succinate (SS) is envisioned as a promising compound for cartilage treatment by providing antioxidant defense able to normalize intracellular metabolism and tissue respiration via mitochondrial mechanism of action. The scope of this study was to investigate on an in vitro inflammatory model the efficacy of Diart. ®. product, a combination of HA and SS. Materials and Methods. Donor-matched chondrocytes and synoviocytes were obtained from KL 3–4 OA patients undergoing total knee replacement. At passage 4, inflammation was promoted with 1 ng/ml IL-1B for 48 hours in absence and presence of Diart. ®. at 1:3 dilution rate. Nitric oxide (NO) from cell culture supernatant was measured by Griess reaction. Mitochondrial and cytoplasmatic ROS evaluation was assessed by flow cytometry with MitoSox and dichlorodihydrofluorescein diacetate (DCFDA) assays. Gene expression of inflammation/oxidative stress-related transcripts (MMP1/MMP3/INOS/COX2) was evaluated by qRT-PCR using TBP as reference. Results. NO was detected only in inflamed chondrocytes and Diart® was able to abolish its levels. NO was not detected in synoviocytes in all conditions. IL-1B reduced both cytoplasmic (−66%) and mitochondrial (−68%) ROS in chondrocytes, with Diart® partially restoring (+40%) mitochondrial levels. In synoviocytes, IL-1B did not alter ROS, with Diart® modestly increasing (+27%) mitochondrial levels. Inflammation was able to increase transcript levels of all tested markers, with the exception of INOS in synoviocytes. In chondrocytes, Diart® significantly (p < 0.05) reduced COX2 (−75%) and MMP1 (−33%). In synoviocytes, Diart® significantly reduced COX2 (−77%) and MMP3 (−84%), with MMP1 53% decreased albeit without reaching statistical significance. Conclusions. Diart. ®. biochemical and physiologic properties in the tested in vitro model of inflammation on donor-matched chondrocytes and synoviocytes allowed reducing inflammation and oxidative stress-related markers, prompting the use of this combination as successful strategy to manage OA-related symptoms

Aims. The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. Methods. This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo). Results. Mean total blood loss (TBL) in groups A (605.0 ml (SD 235.9)), B (790.9 ml (SD 280.7)), and C (844.8 ml (SD 248.1)) were lower than in group D (1,064.9 ml (SD 318.3), p < 0.001). We also found that compared with group D, biomarker level of inflammation, transfusion rate, pain score, and hip range of motion at discharge in groups A, B, and C were significantly improved. There were no differences among the four groups in terms of intraoperative blood loss (IBL), intramuscular venous thrombosis (IMVT), and length of hospital stay (LOS). Conclusion. The combined application of CSS and TXA is more effective than TXA alone in reducing perioperative blood loss and transfusion rates, inflammatory response, and postoperative hip pain, results in better early hip flexion following THA, and did not increase the associated venous thromboembolism (VTE) events. Intravenous combined with topical injection of CSS was superior to intravenous or topical injection of CSS alone in reducing perioperative blood loss. Cite this article: Bone Joint Res 2021;10(6):354–362

Objectives: Nonsteroid antiinflamatory drugs have been widely used and recommended for ankle sprains despite the fact that they are also known to lead significant adverse effects especially to the gastrointestinal system. The aim of this study is to assess the efficacy of acetaminophen in comparison with diclofenac sodium. Patients and Methods: In this prospective, double blinded, parallel group study, one hundred patients suffering from first or second degree lateral ankle sprain within 48 hours of administration were comprised. Patients with bilateral injury, ipsilateral knee injury, trird degree sprain, previous sprain within 6 months and ankle pain less than 45 according to visuel analogue score (VAS) were excluded. In addition; history including gastrointestinal, renal or hepatic disease was the reason for exclusion. Prior to enrollment cases underwent physical examination. Patients rated pain on a 100 VAS, representing 0 no pain, 100 maximal pain. After enrollment patients were randomized (1:1); diclofenac sodium 150 mg/day or acetaminophen 1500 mg/day for 5 days. Patients tretaed by diclofenac sodium were called as group I and the others were group II. In addition; cases were prescribed other intervention modalities as RICE (rest, ice, compression, elevation) and crutches. Clinical assessments were carried out at baseline; on second, tenth days and sixth weeks (end of study). In each visit, VAS and adverse effects of medication were questioned. Results: The mean VAS of the GI and GII at the first visit were 81, 82.3 respectively. These scores decreased to 20.7, 9.9, 4.6 and 11.9, 6.3, 3 at the second, tenth days and last examination. Similar reductions in pain were observed at the last visit (p> 0.05) in both groups. However; cases treated by acetaminophen showed accelerated decrease in VAS at day 2 and 10 in comparison with GI (p< 0.05). Regarding the ankle ROM there was similar increase in both groups (38.9°, 36.9°) respectively. There was no significant difference between groups with regard to ankle ROM at the last control (p> 0.05). The incidence of gastrointestinal adverse effects of GI was much more than GII. However there was no significant difference (p> 0.05). Conclusion: It was concluded that diclofenac sodium and acetaminophen are effective and well tolarated short term treatment alternatives for acute ankle injuries

38 patients were taken from the arthroscopic washout waiting list and randomised after informed consent to receive either a course of sodium hyaluronate injections or an arthroscopic washout. Those patients who had previously had an arthroscopic washout, an intraarticular injection in the last 6 months, mechanical symptoms or hypersensitivity to avian proteins were excluded. The injections were given using an aseptic technique after first aspirating the knee to dryness. An injection was given each week for 5 weeks. The washouts were performed using 0. 9% saline and debridement was undertaken as necessary. The outcome measures used were a visual analogue pain score (VAS), Knee Society function score (FS) and Lequesne index (LI). 19 people were randomised into each group. The groups were similar in terms of age, sex and analgesics used. 2 patients in the arthroscopy group declined arthroscopy after randomisation as their symptoms had improved. There was no significant difference in the pre-intervention VAS or LI. The FS was worse in the arthroscopy group (p< 0. 01). After treatment, 2 patients in each group moved from the area and were lost to follow up. During the year, 5 patients from the sodium hyaluronate group underwent arthroscopy. 3 patients failed to improve and were listed for total knee replacement. The others had improved at 3 months. At 1 year, the VAS (NS), FS (p< 0. 02) and LI (p< 0. 04) were all better in the sodium hyaluronate group. Intra-articular sodium hyaluronate injections should be considered for use in selected patients with knee osteoarthritis without mechanical problems. Further study is required to confirm these findings and improve patient selection

Introduction: Staphylococcus aureus is a major cause of chronic infections and causes particular problems in relation to implanted prostheses. Biofilm formation on abiotic surfaces affords bacteria innate protection from opsonophagocytosis and antibiotic agents and complicates the eradication of infection from bone and implanted prostheses. Increased concentrations of sodium, the major extracellular cation, have previously been implicated in increased biofilm formation in Staphylococcus aureus. In this study we demonstrate that increased concentrations of potassium, the major intracellular cation, also causes a significant increase in biofilm formation. Furthermore we also show that halide stress also leads to a primary increase in penicillin resistance in Staphylococcus aureus. Finally we demonstrate that pbp4, a key gene in cell wall synthesis, is down-regulated under sodium and potassium stress. Methods: Staphylococcus aureus ATCC 9144 was cultured in broth supplemented with variable amounts of potassium chloride and sodium chloride. Biofilm formation was investigated in 96-well microtiter plates using a standard technique. Antibiotic resistance was investigated using graduated E-test strips. Gene transcription was assessed using RT-PCR. Results: There was a positive correlation between biofilm formation and increased concentrations of sodium and potassium. Biofilm formation was noted to be even greater under potassium stress than under sodium stress. Sodium stress also lead to a five-fold increase in penicillin resistance in naïve Staphylococcus aureus cells. A key gene involved in cell wall production (pbp4) was down-regulated under sodium (p = 0.03) and potassium (p = 0.03) stress. Discussion: Cellular injury or insult can lead to cell necrosis and lysis. The intracellular concentration of potassium is 30 times higher than that of the surrounding extracellular fluid. Hence, cell necrosis leads to markedly increased local concentrations of potassium. These experiments show that an increase in potassium concentration leads to an increase in biofilm formation. This suggests that biofilm formation and hence infection of implanted prostheses may be more likely in areas of major tissue trauma such as large resections and revisions. Furthermore, cellular stress leads to increased resistance to penicillin, a cell wall active antibiotic, in naïve cells which may nullify prophylaxis and complicate bacterial eradication in vivo. Finally we postulate a link between the experimental rise in penicillin resistance and the down-regulation of pbp4 demonstrated by RT-PCR under the same halide stresses

The purpose is to observe the clinical effects of sodium hyaluronate injection plus herbal fumigation in the treatment of knee osteoarthritis. 58 patients(73knees)were treated by sodium hyaluronate injection plus herbal fumigation with a treatment course of five weeks and after a fellow-up of 6–36 months, the average fellow-up time was 12.1 months, the curative effect showed that 39 patients was excellent (52knees), 11 patients was fine (15knees), 4 patients was midst (5knees), 1 patient was bad (1knees), and the total fineness rate was 91.78%. Sodium hyaluronate injection plus herbal fumigation in the treatment of early metaphase of knee osteoarthritis, which had a better curative effect, less adverse reaction, and worth to extend clinical application

Background: Osteoarthritis (OA) may affect large and small joints and is common final pathway of large array of conditions. OA of the large joints includes mainly hip, knee, shoulder and ankle. The treatment of OA of the ankle is limited and the surgical treatment is usually salvage procedure as fusion. Therefore there is a need for an efficient conservative treatment of the ankle OA. Aims: The objective of this clinical trial was to evaluate the symptomatic efficacy of intraarticular preparation containing Sodium Hyaluronate, in the treatment of OA of the ankle. Methods: The study was conducted on patients who visited our out-patients clinic under the direct supervision of the principle investigator. The male or female patient aged between 30 and 80 suffering from osteoarthritis of the ankle joint of radiographic severity II or III or IV according to Kellgren and Lawrance, suffering from one or more of the following conditions of the ankle joint: swelling, tenderness or pressure, and/or pain on motion or at rest, who have clinical history of ankle pain for over 6 months. Intraarticular injections of 25 mg Sodium-hyaluronate in 5 following weeks were administrated to 16 patients, 31–79 years old (average 43 years) suffering from pain in the ankle, 9 months to 27 years. 12 patients after operation, 4 with no trauma history. Follow-up visits were performed 1,2,3,4,7 months post treatment and included clinical evaluation and score scale. Results: Global assessment showed in 13 out of 16 patients improvement in the motion range (20%) and significantly reduction of the OA symptoms according to the score: 2–3 points improvement on each scale and according to the osteoarthritis ankle hindfoot score scale (100 points total): up to 20 points improvement. Seven months after the treatment, no decrease in the treatment efficacy has been shown. Global assessment of 2 patients did not show any significant improvement after the treatment. One patient dropped off the study due to other operation. Conclusions: Symptomatic relief of OA of the ankle can be achieved by admission of intraarticular preparation containing Sodium Hyaluronate

The treatment of OA of the ankle is similar to any other large joint and includes conservative and surgical treatment. The surgical treatment is fusion or replacement but conservative treatment is limited and include mainly ankle supports and physiotherapy. Hyaluronic acid was discovered by Meyer and Palmer in 1934 and recently is widely used in the treatment of knee osteoarthritis. We evaluated the efficacy of intra-articular preparation containing Sodium Hyaluronate, in the treatment of OA of the ankle. A group of 16 patients suffering from ankle osteoarthritis were selected for the study. The mean age was 43 years (range 31–79 years) and the duration of pain from nine months to 27 years. Twelve patients had ankle fractures and four had no trauma history. The clinical presentation included at least one or more of the following conditions of the ankle joint: pain in motion or at rest, swelling and tenderness for over than nine months. The radiographic severity of the ankle osteoarthritis was grade II, III or IV according to Kellgren and Lawrence. Intra-articular injections of 25 mg Sodium-hyaluronate (Adant) were administered on five consecutive weeks. Follow-up visits were perfumed one, two, three, four and seven months post treatment and included clinical evaluation and score scale. Global assessment showed, in 13 out of 16 patients, improvement in the range of motion by 20%. Significant reduction of the OA symptoms according to the score: two to three points improvement on each scale. According to the osteoarthrithis ankle score scale: up to 20 points. Improvement continued for seven months follow-up after the treatment; no decrease in the treatment efficacy has been shown. Global assessment of two patients did not show any significant improvement after the treatment. One patient dropped off the study due to other operation. Symptomatic relief of OA of the ankle can be achieved by injection of intraarticular preparation containing Sodium Hyaluronate

Aims. MicroRNA-183 (miR-183) is known to play important roles in osteoarthritis (OA) pain. The aims of this study were to explore the specific functions of miR-183 in OA pain and to investigate the underlying mechanisms. Methods. Clinical samples were collected from patients with OA, and a mouse model of OA pain was constructed by surgically induced destabilization of the medial meniscus (DMM). Reverse transcription quantitative polymerase chain reaction was employed to measure the expression of miR-183, transforming growth factor α (TGFα), C-C motif chemokine ligand 2 (CCL2), proinflammatory cytokines (interleukin (IL)-6, IL-1β, and tumour necrosis factor-α (TNF-α)), and pain-related factors (transient receptor potential vanilloid subtype-1 (TRPV1), voltage-gated sodium 1.3, 1.7, and 1.8 (Nav1.3, Nav1.7, and Nav1.8)). Expression of miR-183 in the dorsal root ganglia (DRG) of mice was evaluated by in situ hybridization. TGFα, CCL2, and C-C chemokine receptor type 2 (CCR2) levels were examined by immunoblot analysis and interaction between miR-183 and TGFα, determined by luciferase reporter assay. The extent of pain in mice was measured using a behavioural assay, and OA severity assessed by Safranin O and Fast Green staining. Immunofluorescent staining was conducted to examine the infiltration of macrophages in mouse DRG. Results. miR-183 was downregulated in tissue samples from patients and mice with OA. In DMM mice, overexpression of miR-183 inhibited the expression of proinflammatory cytokines (IL-6, IL-1β, TNF-α) and pain-related factors (TRPV1, Nav1.3, Nav1.7, Nav1.8) in DRG. OA pain was relieved by miR-183-mediated inhibition of macrophage infiltration, and dual luciferase reporter assay demonstrated that miR-183 directly targeted TGFα. Conclusion. Our data demonstrate that miR-183 can ameliorate OA pain by inhibiting the TGFα-CCL2/CCR2 signalling axis, providing an excellent therapeutic target for OA treatment. Cite this article: Bone Joint Res 2021;10(8):548–557

The aim of this study was to evaluate the effect of a single per operative injection of sodium hyaluronate (HA, Viscoseal. ¯. ) into the knee following arthroscopy. This was a prospective, randomised controlled study. Knee arthroscopy patients were randomised into two groups: one receiving bupivicaine and the other sodium hyaluronate. Pre and post operative VAS scores for pain and Western Ontario and MacMaster Universities (WOMAC) scores for knee function were obtained. Forty eight patients of a single surgeon were randomised into two groups of 24. Both groups were similar as regards to age, sex, etc. Three patients withdrew from the study after randomisation. There was significant drop in pain scores for the Viscoseal¯ group compared to Bupivicaine group particularly between three-six weeks period (p< 0.05) and a significant improvement in WOMAC scores in the study group compared to control at 3 and 6 weeks (p=0.01). Viscosupplementation after arthroscopic knee surgery offers significantly improved function and pain relief over the medium term period (three-six weeks)

Aim: To determine effect of single post-operative injection of Sodium Hyaluronate (Viscoseal) on the pain and joint function, following arthroscopic knee surgery. Method: Study design: A randomized, prospective, controlled, double blinded trial after ethical approval. Study procedure: Consenting patients (age group 18–60 years) undergoing arthroscopic knee surgery were randomized to either study group or control group, after the completion of their operation. Control group had 10 mls of 0.5% Bupivacaine injected in the joint after the procedure, while study group had 10 mls of Viscoseal (Sodium Hyaluronate preparation devoid of animal protein) injected in the joint. Patients were given questionnaires to assess their pain and function at various times (Preoperatively; 2 hour following surgery; Day 1, Day 7, 3 week and 6 week following surgery). Primary efficacy parameters used were Pain visual analogue scores at rest, on movement and on weight bearing. Secondary efficacy parameters used included WOMAC questionnaire, SF-12 general health questionnaire and use of rescue medication. Patients were evaluated clinically at 6 weeks by a blinded physiotherapist. Results: 48 patients (Average age-41 years, 20 female, 28 male) undergoing knee arthroscopy were randomized (24 patients each). The hyaluronate group exhibited markedly lesser degrees of immediate post-operative pain and swelling; reduced need for analgesics, and a significantly larger drop in WOMAC scores than the bupivacaine group (p< 0.05). SF-12 scores and delayed pain VAS score improved by a comparable amount. In particular, those undergoing partial meniscectomy exhibited greater benefits with hyaluronate. No complications were recorded in either of the groups. Conclusion: Sodium hyaluronate (Viscoseal) injections could be safely used following arthroscopic knee surgery, to facilitate patient’s recovery

Introduction. According to proposal of Noble, the femoral bone marrow cavity form of patients who underwent Total Hip Arthroplasty (THA) can be classified under 3 categories; those are Stovepipe, Normal and Champagne-fluted. We developed typical sodium chloride femoral model was created by 3D prototyping technique. The purpose was to identify the relationship of pressure zone of the surrounding areas between femoral bone marrow cavity form and hip stem. Materials and Method. As opponent clarified stem design concept Zweymüller type model was used. According to CT data with the patients who underwent THA, the sodium chloride femoral model was custom-made and selected as the representative model based on Noble's 3 categories. Eight models of each category were used to performed mechanical test. Result. In mechanics test, the result of comparison between the contact pressure zones of zone 1–7, significant differences of contact pressure zones were identified between the Stovepipe group and Normal group in zone 3, 4 and 5. In zone 3 and 5, such significant differences were also identified between Champagne-fluted group and Normal group. In Stovepipe group, a significant difference of the contact pressure zone was observed at the proximal and distal. In Champagne-fluted group and the Normal group, a significant difference was observed in the contact pressure in distal femur (3, 4, 5 Zone) and (Zone1, 2, 6, 7) proximal femur. Discussion. Although in most studies Sawbone® is used for femoral models, the focus of this research is of those who possess a characteristic femur with marrow cavity form. Therefore, sodium chloride bone model was used instead. In comparison in terms of applicability between sodium chloride bone model and regular model, the failure of all 24 joints of sodium chloride bone model were unconfirmed in mechanics test. Moreover, the possibility that its performance in mechanics test is equivalent to Sawbone®is considered. The design concept for Zweymüller type achieves the ability to load distribute within a wide range of cortical bone across the middle position to distal femur. It's determined by the concept that a wide range of contact pressure was admitted at middle position and distal femur in the Champagne-fluted group and the Normal group. On the other hand, the contact pressure zone of Stovepipe was not able to meet the expected level at distal femur. The method of this research is control its stress condition within the stem design. By this point, it is considered possible that the stability of various stem design was able to be forecasted and the assessment of stableness was positive. Conclusion. On the basis of Noble's categories, 3 types of bone models were created by 3D prototyping technique, and pressure distribution measurement were performed. The result from the pressure distribution indicated that even in Zweymüller stem had anxiety of securing force in Champagne-fluted type and Stovepipe type canal. We believe the method of in vivo study can develop to assess the stability of implant preoperatively

Osteoarthritis of the trapezometacarpal joint is a common form of arthritis. At present, there is a significant void between conservative and operative managements. Viscosupplementation is occasionally considered as an in-between therapy. We aimed to compare the therapeutic benefit of a single intra-articular injection of Sodium Hyaluronate (SH; Ostenil®mini) to a single intra-articular injection of Methylprednisolone Acetate (MA; Depomedrone) in the management of rhizarthrosis (TMOA; Trapezometacarpal Osteoarthritis). A retrospective review was performed over a 12 month period. We reviewed 25 patients who had received a single injection of viscosupplementation (SH) performed with fluoroscopic guidance and had been followed up at 12 weeks. These patients were compared with 21 patients who had received a single steroid injection (MA) and had been followed up at 12 weeks. Of the SH group, 52% (n = 13) reported some benefit from the injection. The MA group reported an 86% (n=18) benefit from the injection. We found that a single injection of viscosupplementation (SH) is effective in relieving pain and improving function in about half of patients with rhizarthrosis (TMOA). The efficacy of a single steroid injection (MA), however, was superior with a far greater proportion of patients reporting analgesic and functional benefits

Aim: To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Hylan G-F-20 and Sodium Hyaluro-nate in patients with osteoarthritis (OA) of the knee. Methods: In this independent study, 382 consecutive patients with OA of the knee were prospectively randomized into two groups to receive Hylan G-F-20 -Syn-visc (n=196) or Sodium Hyaluronate -Hyalgan (n=186) and reviewed by blinded independent assessors at pre injection, 6 weeks, 3, 6, 12 months. Knee pain, patient satisfaction was measured on a VAS. Functional outcome was assessed using WOMAC, UCLA, Tegner, Oxford knee score and EuroQol- 5D scores. Mean follow up was 14 months. Results: Patients in both groups predominantly had grade III OA. Knee pain on VAS improved from 6.7 to 3.2 by 6 weeks (p=0.02) and was sustained until 12 months (3.7, p=0.04) with Synvisc. In the Hyal-gan group, pain improved from 6.6 to 5.7 at 6 weeks (p> 0.05) and to 4.1 at 3 months (p=0.04) but was sustained only until 6 months (5.9, p> 0.05). Improvements in the WOMAC pain and physical activity subscales were significantly superior in the Synvisc group at 3 months (p=0.02), 6 months (p=0.01) and 12 months (p=0.02). General patient satisfaction was better in the Synvisc group at all times although statistically significant at 3 months (p=0.01) and 6 months (p=0.02). There was local increase in knee pain in one patient who received Synvisc, which settled by 4 weeks. Total treatment cost was 23% more in the Hyalgan group due to the two additional visits. Conclusion: Although both treatments offered significant pain reduction, it was achieved earlier and sustained for a longer period in patients with Synvisc with early increase in activity levels. However, a local reaction of pseudo sepsis was observed with Synvisc in one patient. The total treatment cost, both for the patient and the hospital are higher with Hyalgan. From this study, it appears that the clinical effectiveness and general patient satisfaction are better amongst patients who received Synvisc

Background: Postoperative thromboses are among the most feared complications in orthopedic surgery, possibly causing life-threatening conditions in otherwise highly successful procedures such as total joint replacement. Body weight is an important risk factor for thromboses and is being used in algorithms to determine dosages in prophylaxis. However, weight patterns among orthopedic populations have changed considerably since the introduction of these algorithms, essentially shifting towards obesity. This study asks whether present-day obese patients are essential under-dosed and would benefit from higher than usual dosages of bemiparin sodium in the prophylaxis of postoperative thrombosis. Patients and Methods: To ensure sufficient power a sample of 750 patients, allocated into two cohorts receiving either 3,500 IU or 5,00o IU bemiparin sodium were followed postoperatively for 6 weeks and blindly assessed for clinically symptomatic thrombotic events. Differences in rates of thrombotic events were modeled using mulitvariate Poisson regression including potential confounders severity of immobilisation, gender, exact weight, and age as covariates. A p-value of 5% was considered significant. Results: Information on 723 patients for a total of 66.8 person-years was analysed per intention-to-treat. The adjusted incidence rate ratio was 0.35 (95%CI: 0.03 to 2.91). Thus there was not evidence for a difference in rates between groups. There was, however, a borderline significant association between rates and body weight, suggesting a potential benefit of higher dosages in even heavier patients. There were no complications due to higher dosages of bemiparin sodium. Conclusion: We did not see a significant reduction of incidence rates of thromboses with higher dosages of bemiparin in this population. However, there was some evidence that higher dosages might prove beneficial as populations further gain weight

Introduction and Aims: This randomised, double-blind, placebo-controlled study evaluated the safety and effectiveness of dermal iontophoretic administration of Dexamethasone Sodium Phosphate 0.4% Injection, USP versus placebo in patients with medial and lateral elbow epicondylitis. Method: 199 patients with elbow epicondylitis received 40 mA-min of either active or placebo treatment on six occasions. Treatments were spaced one to three days apart and were completed within 15 days. Efficacy variables included patient and investigator global evaluation of improvement, patient and investigator pain evaluation, patient evaluation of symptoms, investigator disease severity assessment and investigator evaluation of tenderness. Baseline scores were compared with scores two days and one month after the sixth treatment. Results: Dexamethasone produced a 23 mm improvement in patient visual analog scale ratings compared with 14 mm for placebo (p=0.012) at two days and 24 mm compared with 19 mm (p=0.249) at one month. More dexamethasone patients than placebo patients had a score of moderate or better on the investigator global improvement score (52% vs 33%, p=0.013) at two days. This was not significant at one month (54% vs 49%, p=0.650). Investigator pain scores and tenderness scores favoured dexamethasone over placebo (p=0.019 and p< 0.001, respectively) at two days. Patients completing six treatments in ≤10 days appeared to show better efficacy than patients completing treatments over a longer period of time. Conclusion: Iontophoresis treatment was well tolerated by the majority of the patients and was effective in reducing symptoms of epicondylitis at short-term follow-up

Aim. To compare the clinical effectiveness, functional outcome and patient satisfaction following intra articular injection with Synvisc. ¯. and Hyalgan. ¯. in patients with osteoarthritis (OA) of the knee. Methods. 348 consecutive patients were randomised into two groups to receive either Hylan G-F 20 -Synvisc (n= 181) or Sodium Hyaluronate -Hyalgan (n=167). All patients were prospectively reviewed by independent assessors blinded for the treatment. Knee pain on a VAS were recorded. The functional outcome was assessed using Tegner, UCLA, Oxford knee score and EuroQol-5D scores. VAS was used to quantify patient satisfaction. Mean follow-up was 12 months. Results. Mean age 66.7 yrs. Patients predominantly had grade III OA. Knee pain improved from 6.7 to 3.2 by 6 weeks (p=0.02) and was sustained until 12 months (3.7, p=0.04) with Synvisc. In the Hyalgan group, pain improved from 6.6 to 5.7 at 6 weeks (p>0.05) and to 4.1 at 3 months (p=0.04) but was sustained only until 6 months (5.9, p>0.05). Similarly, the Tegner, UCLA and Oxford knee scores were significantly better in the Synvisc group at 6 weeks (p=0.02) and 6 months (p=0.03) and 12 months (p=0.04). EQ-5D description scores were higher in the Synvisc group at 6 months (p=0.03) and 1 year (p=0.04). There was local increase in knee pain in one patient (Synvisc), which settled by 4 weeks. Patient compliance was 99.2% in the Synvisc group as compared to 92.2% in the Hyalgan. Treatment cost was 23% more in the Hyalgan group. Conclusion. Although both treatments offered significant pain reduction, it was earlier and sustained for a longer period in patients with Synvisc. Patients treated with Synvisc have demonstrated an early increase in activity levels. Local reaction of pseudo sepsis was observed with Synvisc in one patient. Total treatment cost, both for patient and hospital, is higher with Hyalgan