Introduction: Rivaroxaban is a novel, oral, direct Factor Xa inhibitor for the prevention of venous thromboembolism (VTE) after total hip and knee arthroplasty (THA, TKA). The pivotal RECORD trials showed that 35 days’ rivaroxaban significantly reduced total VTE following THA versus both 35-day and 14-day enoxaparin regimens. Following TKA, 14 days’ rivaroxaban significantly reduced total and symptomatic VTE versus 14 days enoxaparin. Major bleeding was similar for rivaroxaban and enoxaparin. An economic model was developed based on these results to assess the cost-effectiveness of rivaroxaban relative to enoxaparin in Sweden.

Methods: The incidence of clinical events and resulting consequences on resource use and quality of life were modelled for rivaroxaban and enoxaparin over 5 years. VTE incidence during the prophylaxis period was based upon RECORD2 (THA) and RECORD3 (TKA) and extrapolated out to 90 days following surgery based on published epidemiological data. These trials were used because they best reflect the treatment length currently applied in clinical practice in Sweden. Recurrent VTE and post-thrombotic syndrome (PTS) beyond 90 days were modelled from published clinical data. Literature indicates that 10% of enoxaparin patients require visits from a district nurse following hospital discharge to administer subcutaneous (sc) enoxaparin, a cost not incurred with oral rivaroxaban. The cost associated with clinical events (major bleed, VTE and PTS) and home care visit was derived from published Swedish sources and expressed in Swedish kroner (SEK). Rivaroxaban and enoxaparin costs were included.

Results: In THA, 35 days’ rivaroxaban produced an additional cost (SEK 119 [€12.59] per patient) versus 14 days enoxaparin. However, rivaroxaban resulted in a gain of quality-adjusted life years (QALYs) and in fewer symptomatic events per patient relative to enoxaparin. This means an extra cost with rivaroxaban of SEK 29,378 (€3,109) per QALY gained and SEK 3,929 (€416) per symptomatic event avoided. Because the cost for treating a VTE range from SEK 12,000 to 30,000, it is less costly to avoid such an event by using rivaroxaban than treating it once it occurs. In TKA, 14 days’ rivaroxaban produced savings of SEK 873 (€92) per patient versus 14 days’ enoxaparin, as well as an improvement in QALYs and a reduction in symptomatic VTE events. Consequently, rivaroxaban was both more effective and less costly. Extensive sensitivity analyses showed that these results persist in a clear majority of situations.

Conclusion: The economic analysis showed that by reducing VTE, and providing an oral alternative to sc enoxaparin, oral rivaroxaban has the potential to significantly improve health outcomes in Sweden at a slightly higher (in THA) or lower (in TKA) cost than existing VTE prophylaxis.

Aims: To evaluate the long-term results of arthroscopic meniscal repair of any longitudinal meniscal tear in red-red or red-white zone. Methods: 60 patients 30.5 years old average (range 15 to 50) underwent arthroscopic meniscal repair (Ç inside-out È technique, Jacobs-Staue-bli method, 1988) and were followed up 30.1 months on average. 34 patients (50%) had an additional ACL rapture, which was repaired at the same operation. Postoperatively, all patients followed a particular program of rehabilitation using a controlled motion knee brace: immediate weight-bearing with the brace locked in 10¡, motion without weight-bearing from 10 to 90 degrees of ßexion for the þrst six weeks and then weight-bearing in motion was allowed. Results: Patients were re-examined and average Lysholm score was 95, while recurrence occurred in 5 patients (7.3%) and 3 of them submitted to meniscectomy. The rest of the patients returned to their former activities in a six-month period, including those who underwent an ACL reconstruction. Conclusions: Arthroscopic meniscal repair has excellent functional results and should always be applied on any longitudinal meniscal tear in red-red or red-white zone. Additional ACL ruptures should be treated at the same time.

The arthroscopic meniscal repair is being applied nowadays successfully in any longitudinal tear of the medial or the lateral meniscus wliicli is located in zones II and 111 (in consistency with the zones of menisci vascularity according to Miller, Wagner, Hamer).

The material of this study includes 68 consecutive cases of patients who underwent arthroseopic meniscal repair. Thirty four of them (50%) were in conjunction with anterior cruciate ligament tear, which was treated at the same time. The patients age ranged from 15 to 50 (average 30.5 years). The length of follow up averaged 30.1 months. In all cases ilic “inside out” technique was performed according to Jacobs – Staenbli method. Postoperatively, all the patients followed a particular program of rehabihtation with the aid of a controlled motion knee brace, immediate weight-bearing with the brace locked in 10°, and motion without weight – bearing from 10 to 90 degrees of flexion for the first six weeks. Weight – bearing in motion was followed after the sixth week.

The reexamination of the patients and the evaluation of the results was subjective and was performed according to the Lyshota score (average 95%). Recurrence occurred in 5 paiicms within 6 months, 3 of whom were submitted to menisccctomy. The rest of the patients returned to their former activities in a six month period.

The arthroscopic meniscal repair provides excellent results and should always be applied when there is an indication, because the salvage of the meniscus contributes -among others- to the prevention of degenerative articular cartilage disease (osteoarthrosis).