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Injections May Boost Knee Surgery Success
Date:1/28/2010

Patients with torn meniscus plus arthritis recover better when given sodium hyaluronate, study finds

THURSDAY, Jan. 28 (HealthDay News) -- For people with arthritis, injections of a nonsteroidal anti-inflammatory fluid can improve recovery from arthroscopic knee surgery to repair damaged cartilage, researchers say.

The fluid, sodium hyaluronate, known by the brand names Hyalgan, Euflexxa, Ostenil and Synject, is made from rooster combs. Studies have shown that hyaluronic acid products can reduce arthritis pain and improve functioning for patients who do not respond to standard anti-inflammatory medications.

"They [patients] had better pain relief and better functional mobility when we combined surgery with the injections," said study leader Dr. Geoffrey Westrich, an associate professor of orthopedic surgery at the Weil Medical College of Cornell University in New York City and co-director of Joint Replacement Research at the Hospital for Special Surgery.

Almost 16 million Americans between 25 and 74 have osteoarthritis, according to background information in the study. And many have torn or debilitated knee cartilage (meniscus), requiring surgery. The meniscus pad functions like a shock absorber between the femur (thigh bone) and tibia (shin bone). When it decays, bone friction can cause extreme pain and loss of functioning.

The presence of arthritis in patients with meniscus tears impedes knee surgery outcomes, and the study authors wanted to know if combining injections with surgery would improve results.

Their findings were published recently in the American Journal of Orthopedics.

In the study, 46 patients over the age of 40 were divided into two groups. One group received three injections of Hyalgan, one immediately following surgery, the others two and three weeks after the procedure. The other group had surgery but no injections. Factors that could affect the outcome, such as age and weight, were controlled.

Six months after surgery, 53 percent of the control group had significant pain on motion, but only 5 percent of the study group did. Those injected with Hyalgan also had significantly more flexibility.

Westrich said he believes that these results will help surgeons who discover during surgery that the patient has some arthritis, which doesn't always show on X-rays or MRIs ahead of time.

"The important point is that surgeons, when they encounter arthritis during surgery, they should consider injecting the knee with Hyalgan," said Westrich. Further studies are needed to determine whether the improvements are long-lasting, he added.

Dr. Joseph Guettler, an orthopedic surgeon at William Beaumont Hospital in Royal Oak, Mich., thinks the study is promising. He treats many patients with the study participants' symptoms and has used both arthroscopy and hyaluronate injections, but not together.

"As an orthopedic surgeon, there is consideration [based on this study] for making it automatic [injections]," said Guettler. "My one hesitation is that when you scope a knee, you're running saline through it, cleaning it out, and I do have a hesitation about injecting a foreign substance during surgery." This would slightly increase the risk of infection, he said. He usually uses the fluid during recuperation, if he thinks the patient needs it.

Dr. Howard Luks, chief of sports medicine and arthroscopy at Westchester Medical Center and New York Medical College in Valhalla, N.Y., found the study results limited by the short time that pain was alleviated. Eventually, patients with severe arthritis will need knee replacement surgery, he said, noting that it's best to have the one procedure instead of two, thereby limiting risk of infection and recuperation time.

"Knee replacement is the definitive treatment for this. It's a bigger procedure with longer recovery, but it will address both entities (meniscus deterioration and arthritis), said Luks.

Luks uses hyaluronate to treat pain, but if knee replacement is in a patient's foreseeable future, he is not likely to recommend surgery for meniscus repair. Luks emphasized, however, that patients who may want to buy time before knee replacement surgery need to have all the information available to make a decision that suits their needs and lifestyle.

More information

Find out more about arthritis of the knee at the American Academy of Orthopaedic Surgeons.



SOURCES: Geoffrey Westrich, M.D., associate professor, orthopedic surgery, Weil Medical College of Cornell University, New York City, and co-director, joint replacement research, Hospital for Special Surgery, New York City; Joseph Guettler, M.D., orthopedic surgeon, William Beaumont Hospital, Royal Oak, Mich.; Howard Luks, M.D., chief, sports medicine and arthroscopy, Westchester Medical Center and New York Medical College, Valhalla, N.Y.; December 2009 American Journal of Orthopedics


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