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: Rehospitalisation following surgery is widely regarded as an important outcome measure. In this study we identified causes of readmission following surgery, in proximal hip fracture patients.

Method: A total of 267 patients underwent surgery for proximal hip fractures in one year (2001–2002) at our institution. Notes of these patients were reviewed to look for readmissions within three months.

Results: A total of 43 (16.1%) patients died during initial hospital admission episode. Of the remaining 224 patients, 46 (20.5%) patients had an emergency unplanned readmission back to the hospital, within 3 months of discharge. 9 admissions (19.5% of readmissions, 4.01% of discharged patients) were due to operative site complications. 8 patients (17.3% of readmissions, 3.5% of discharged patients) were referred back for suspected thromboembolic events. 29 admissions (63.04% of readmissions, 12.9% of discharged patients) were due to other medical problems. Of these 18 medical problems could be attributed to preceding hip fracture. 15 patients died during this 2nd admission episode. 10 of these patients could have their ‘cause of death’ attributable to previous hip fracture, though this was not mentioned in their death certificates. A total of 8 patients had died in community in the 3 months following discharge giving a total mortality of 24.7% (66/267 patients) within 3 months.

Conclusions: Hip fracture is underreported as a cause of prolonged morbidity and mortality. A high percentage of these patients were readmitted adding to resource crunch. An understanding of the causes of readmission would help to decrease this workload.

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.

Volar wrist ganglion has a different mode of origin and higher complication rate after excision compared to its dorsal counterpart. This study, which is part of the Trent region ganglion audit, was carried out to prospectively evaluate the natural history and treatment outcome for volar wrist ganglia.

Patients were invited to join the study between 1993 and 1995 following initial consultation with either an orthopaedic or plastic surgeon. Questionnaires were sent within the first year, at two years and finally at five to six years. The final review included a Patient Evaluation Measure (PEM) questionnaire.

Of the 234 patients initially consulted, 186 joined the study, 155 of these responded, 122 at final review and 109 at year two. There were 98 females and 57 males. Three patient groups were identified:

Group I: natural history (no intervention) (N=38)

Group II: aspiration/injection (39)

Group III: excision group (78)

In conclusion, over half of volar wrist ganglia disappear without any intervention between 2 to 5 years. About 45% recur whether aspirated or excised. There is a 18% complication rate with excision, but neither aspiration/injection nor leaving them alone with reassurance was associated with any complications. Irrespective of the treatment, about 80% of patients are satisfied at five years, slightly more than at two years.

This information may form a basis for patient information before deciding treatment. It could also help general practitioners advise patients before hospital referral.