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).

Solitary plasmacytomas in the appendicular skeleton are rare monoclonal expansions of plasmacytoid cells. They are two main hazards; local destruction of bone with resultant loss of function and possible fracture, and progression to Myeloma.

Between February 1988 and July 2005 seven patients (4 male, 3 female) were treated for solitary plasmacytoma with surgical resection and endoprosthetic reconstruction. The median age was 46.7 (35-75). The site was: distal humerus (2), proximal humerus (2) proximal femur (2) proximal tibia (1). Three patients had sustained a pathological fracture. Five patients had received pre-operative radiotherapy and three received post-operative radiotherapy. Mean follow-up is 8.6 years. Two cases became infected at 2 and 5 years post-operatively and have had revisions of their endoprosthesis. Both remain functional at 18 and 15 years. No patient has suffered a local recurrence. Two patients have progressed to multiple Myeloma but no patients have died. Literature review shows that the progression of solitary bone plasmacytoma to Myeloma is around 53% despite radiotherapy, in an average period of 2-4 years. With resection and endoprosthetic reconstruction, the progression in this series has been 28% despite an average follow up of 8.6 years.

Although the numbers are small, due to the rarity of the condition, surgical resection and endoprosthetic reconstruction reduces disease progression than radiotherapy alone. This produces far superior results compared to the intramedullary nailing of the long bones for this condition. Endoprosthetic reconstruction after resection should be given consideration in cases of solitary plasmacytoma of the appendicular skeleton when there is extensive bone destruction present. The optimal timing of local radiotherapy to be combined with surgery is still to be established.