Susanne Fuchs

Intraarticular Hyaluronic Acid versus Glucocorticoid Injections for Nonradicular Pain in the Lumbar Spine

PURPOSE To investigate the efficacy and safety of intraarticular sodium hyaluronate (SH) compared with intraarticular glucocorticoids (triamcinolone acetonide; TA) in the treatment of chronic nonradicular lumbar pain. MATERIALS AND METHODS Sixty patients were included in this randomized, controlled, blind-observer clinical study and randomly assigned to two groups to receive 10 mg SH or 10 mg TA per facet joint. The facet joints on both sides at levels S1-L5, L5-L4, and L4-L3 were treated once per week under computed tomographic guidance. The study visits were timed to permit assessment of the immediate effect as well as possible carryover effects at 3 and 6 months after completion of treatment. Changes in pain were assessed with a visual analog scale (VAS) and changes in function and quality of life were assessed by the Roland Morris Questionnaire (RMQ), the Oswestry Disability Questionnaire (ODQ), the Low Back Outcome Score (LBOS), and the Short Form 36 (SF-36) questionnaire. RESULTS Patients reported lasting pain relief, better function, and improved quality of life with both treatments. Mann-Whitney analyses of the patient questionnaires (RMQ, ODQ, and LBOS) very consistently showed that SH is not inferior to TA. In addition, the efficacy of SH was largely comparable with that of TA on the VAS and SF-36. No adverse effects were reported after administration of the test products. The intraarticular treatment of facet joints (levels S1-L5, L5-L4, and L4-L3) with SH in patients with chronic nonradicular pain in the lumbar spine resulted in a marked reduction in pain with improved function and better quality of life, which was at least equal to the effect of a course of TA injections. SH-treated patients showed greater benefits in the long term. CONCLUSION Intraarticular SH is a very promising new option for the treatment of patients with chronic nonradicular lumbar symptoms.

Clinical and functional comparison of uni- and bicondylar sledge prostheses

The aim of the present study was the evaluation of differences in clinical results, proprioceptive performance and gait in patients with unicondylar and bicondylar sledge prostheses of the knee. In a retrospective study, 17 patients with unicondylar sledge prostheses were compared with 15 patients with bicondylar sledge prostheses. Clinical examination was rated using HSS, Knee Society, and patellar scores and a visual analogue scale for pain. Proprioceptive performance was examined using sway measurements during single leg stance on a force platform. In addition, the patients underwent 3-D gait analysis including measurements of ground reaction forces and surface electromyographic (EMG) investigation of the lower extremity. Comparing both patient groups in clinical scores, gait, EMG and proprioception, no significant differences were found. Implantation of bicondylar sledge prostheses retaining both cruciate ligaments achieves functional results as good as unicompartmental arthroplasty. The presented results might encourage future research on new models of total joint replacement with preservation of both cruciate ligaments.

Clinical and functional results after the rehabilitation period in minimally-invasive unicondylar knee arthroplasty patients

The objective of the present study was to analyze the clinical and functional outcome after minimally-invasive implantation of a Repicci-type unicompartmental sledge prosthesis . In 29 patients with primary unicompartmental knee osteoarthritis, 29 replacements of the medial compartment and four of the lateral compartment were performed using the minimally-invasive technique with the metal-backed and the all-polyethylene versions of the Repicci sledge prosthesis. Electromyography (EMG) of standardized locations was measured with the MyoSystem 2000 and analyzed with Myoresearch software. Gait analysis was performed with a six-camera motion analysis system and force platforms. Established clinical and quality of life (SF-36) scores were used to compare patients with 11 healthy age-matched individuals. The Repicci sledge prosthesis led postoperatively to functional results that were in the range of healthy joints, and superior to sledge prostheses of a different design. Gait and balance parameters were comparable to the control group, whilst electromyographically lower amplitudes were found in the patients than the controls and in the operated legs as compared to the non-operated legs. Many parameters of quality of life and activity were comparable to age-matched healthy individuals, and quality of life was superior to total knee replacement. When implanted using a minimally-invasive technique and with suitable patient selection, the Repicci sledge led to functional results comparable to those of healthy joints and gait parameters comparable to those of healthy individuals. The level of evidence is Level III, retrospective cohort study.