Aim: To evaluate the long term effect of Distal transfer of the greater trochanter in Perthes’ disease.

Patients and methods: Twelve patients (thirteen hip joints, 10 males and 2 females) who suffered from Perthes’ Disease were treated by distal transfer of the greater trochanter (DTT). The operation was performed because of progressive shortening of the articulo-trochanteric distance accompanied by signs of insufficiency of the hip abductors. Total or near total femoral head involvement was found in all the patients except for one of them. Follow up period was 28 years (21–35). Mean age at diagnosis of Perthes’ was 7 years (4–11). Patient were studied in 1992 and reviewed again 13 years later, using the Harris hip score, short form 36 (SF36), physical examination and A-P X-rays.

Results: Not one of the patients underwent a total hip arthroplasty. Mean Harris hip score is 80 (range 54–100, 4 patients under 70 score). Mean SF36 score was 71 (range 30–94) and was correlated to the Harris score. Three of the patients were working in a physically demanding profession. The rest were office workers. Two of them chose non strenuous type of work due to the hip condition. Limb length discrepancy was 1.7 cm short on the operated side (range 0–3) and correlated with Trendelenburg sign (4 patients with positive sign). Femoral head sphericity according to Stulberg classification was good in 5 patients (grades 1–2), fair in 3 patients (grade 3) and poor in 4 patients (grade 4–5). Head sphericity was not correlated to age at diagnosis, Harris score, SF36 score or level of hip pain.

Conclusions: Long term outcome are surprisingly good in those patients, considering the degree of head involvement, advanced age at diagnosis and severity of disease which necessitated high degree of varus osteotomy and hence trochanter transfer.

Objective: To evaluate viscosupplementation by intraarticular injection of Orthovisc® Vs. Synvisc® (Molecular Weight 1.55 and 6 Million Daltons, respectively) in the treatment of knee osteoarthritis in clinical practice in Israel.

Methods: We performed a prospective evaluation of all patients treated with either Orthovisc® or Synvisc® by the senior author during a 2 year period. All patients suitable for hyaluronic acid injections were included in the study. Patients bought either product at their own expense and preference.

A total of 1566 injections were performed involving 522 knees. Patients were divided into two groups; one consisting of 277 patients who purchased Orthovisc® and a second consisting of 245 patients who purchased Synvisc®.

A Visual Analog Scale (VAS) assessed pain. The senior author performed all injections and sterile injection protocol was strictly adhered to.

Knees were injected at weekly intervals for 3 weeks. Patients were assessed at baseline, 1, 2, 3 & 4 weeks and 3, 6 & 12 months following initial visit.

Results: Both products were found to be of clinical benefit and have an acceptable safety profile. No difference in VAS values was found between the two groups. The calculated Power of Study for detection of a one-pain unit difference was 99.9% (α=0.05). This power was maintained through the first three visits and later declined.

Conclusion Our findings question the impact of hyaluronic acid molecular weight in alleviating osteoarthritic knee pain.

Purpose: Glucosamine-based massage cream has been developed by an Israeli company (Manon Pharmaceuticals). Prior literature indicates that a single study performed about 30 years ago has demonstrated a certain efficacy of a glucosamine containing topical formulation for the treatment of gonarthrosis.

Materials and Methods: Eighty patients suffering from grade 2–3 degenerative changes of the knee were randomized and received either a menthol based cream or a glucos-amine-containing formulation. The study was approved by the institutional Helsinki committee. Patients were evaluated pre treatment using the VAS pain measure as well as the KSS score. Standardized radiographs were evaluated as described by Ahlbeck to evaluate the stage of articular cartilage degeneration. Exclusion criteria were grade 1 and 4, inflammatory arthritis and Charcot arthropathy. Patients employed the massage cream on a tid basis for a minimum of one month. Patients were followed for a minimum of 6 months. Medication usage was evaluated during follow-up.

Results: Improvement was noted in 32 of 40 patients (defined as VAS improvement by 20 percent or more) of the experimental group and in 12 of 40 patients of the control group. KSS scores improved in 21 of 40 patients of the experimental group by 5 points or more at the 6 months time-point. Only 5 patients in the control group demonstrated similar improvement.

Conclusions: Some improvement is noted in symptoms by the use of topically applied glucosamine- containing massage cream in knee arthrosis. However many questions remain un-answered. What is the mechanism of action of topically applied glucosemamine? Does it penetrate skin and capsule to reach the cartilage and synovium? What is the role of the placebo effect in the treatment of joint symptoms in osteoarthritis, a disease typified by an undulating clinical course.