Introduction

Viscosupplementation is used widely to provide symptomatic relief to patients with knee OA. This study aimed to compare the efficacy and safety of the standard (3×2ml) and single (1×6ml) dosing regimens of hylan G-F 20

Introduction

Viscosupplementation is used widely to provide symptomatic relief to patients with knee OA. This study aimed to compare the efficacy and safety of the standard (3×2ml) and single (1×6ml) dosing regimens of hylan G-F 20.

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.

Introduction: Obtaining adequate images can be difficult in ring fixator patients during outpatient follow-up. Following a recent publication, we introduced the spirit level technique as an effective method to ensure better quality images for interpretation, reduce unnecessary x-ray exposure, and improve clinic efficiency.

Method: A comparison was made of radiograph quality, patient inconvenience and x-ray exposure between standard X-ray techniques and those with a frame mounted spirit-level in all patients attending the senior author’s outpatient clinic for routine follow up following Ilizarov and Taylor-Spatial frames.

Prospective data was collected using a paper proforma in frame clinic. Information was gathered on all patients sent for plain radiographs. Radiographers collected data regarding time taken in the X-ray Department and total number of radiographs taken to gain the images required. The senior author recorded if these images were satisfactory and if returned to the department for further imaging. The radiation dose was retrieved from the Radiology computer.

The control group consisted of patients from clinics prior to implementation of the spirit-level device. Following a period of familiarization, data was collected from the study group using the spirit-level.

Results: (Table deleted)

Conclusion: The implementation of a simple frame mounted spirit-level as a guide for the radiographers in the outpatient clinic improves x ray quality, to assess healing, and significantly reduces the number of suboptimal images. The data does not support a significant impact on patient inconvenience.

Digital x-ray systems are now widely used in hospitals in the UK. Most systems have facilities to take measurements from the images that, we are lead to believe, can be used in accurate pre-operative planning. The aim of this study was to assess whether or not pre-operative planning can reliably predict the size of the implant required when using a hemiarthroplasty to treat an intracapsular hip fracture.

A magnification factor was calculated for pre-operative pelvic x-rays using typical beam to plate distance and plate to hip distance. The pre-operative digital radiographs of 188 consecutive patients who underwent a hip hemiarthroplasty were examined. The femoral head diameters of both the fractured and non-fractured sides were measured. The size of the implanted prosthesis was also recorded from the patients’ operation notes. The x-ray measurements were multiplied by the magnification factor and compared with the known size of the prosthesis. The calculated magnification factor was 128%. Attempts at estimating implant size from measurements of the fractured and non-fractured sides underestimated the size of the prosthesis by 3.0mm (CI 6.5 to −0.5) and 3.1mm (CI 6.8 to −0.6) respectively.

Many hospitals do not stock the full range of hemiarthroplasty implants on the shelf. Sizes at the extremes of the range may need to be specially ordered. It is important that the correct size prosthesis be inserted; an oversized prosthesis can increase the risk of dislocation and an undersized prosthesis will result in point loading and acetabular erosion. Our study shows that pre-operative planning consistently underestimates the size of the implant. However, the accuracy of these estimations is not sufficiently reliable, being +/− 3.5mm, to be able to accurately predict the size of the prosthesis required. Reasons for the under estimation are likely to be due to the fact that the measurement taken from the images does not account for the articular cartilage covering the femoral head. One of the factors leading to inaccuracy in the estimation is variation in patient anatomy and habitus, which affects hip to plate distance and thus the magnification factor. Also, the distance of the beam to plate will vary according to the radiographer’s positioning of the x-ray source.

In order to accurately pre-operatively plan the size of the prosthesis one would need to standardise the beam to hip distance. radio-opaque markers would need to be positioned at the level of the hip in order to accurately calculate the magnification factor. Without these modifications, we do not feel that hip prosthesis size can be accurately predicted from pre-operative images.

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.