Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

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The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

10.21203/rs.2.14957/v3 ◽

2020 ◽

Author(s):

Bingjin Wang ◽

Wenbin Hua ◽

Wencan Ke ◽

Yukun Zhang ◽

Xianlin Zeng ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Allograft Bone ◽

Titanium Mesh ◽

Analog Scale ◽

Bony Fusion ◽

The Mean ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background: The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.Methods: We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.Results: All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up.Conclusions: Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

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The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

10.21203/rs.2.14957/v2 ◽

2020 ◽

Author(s):

Bingjin Wang ◽

Wenbin Hua ◽

Wencan Ke ◽

Yukun Zhang ◽

Xianlin Zeng ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Allograft Bone ◽

Titanium Mesh ◽

Analog Scale ◽

Bony Fusion ◽

The Mean ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis. Methods We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded. Results All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up. Conclusions Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

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The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

10.21203/rs.2.14957/v1 ◽

2019 ◽

Author(s):

Bingjin Wang ◽

Wenbin Hua ◽

Wencan Ke ◽

Yukun Zhang ◽

Xianlin Zeng ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Allograft Bone ◽

Titanium Mesh ◽

Analog Scale ◽

Bony Fusion ◽

The Mean ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.Methods We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.Results All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up.Conclusions Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

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Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study

Asian Spine Journal ◽

10.4184/asj.2017.11.4.618 ◽

2017 ◽

Vol 11 (4) ◽

pp. 618-626

Author(s):

Suryakant Singh ◽

Hitesh Dawar ◽

Kalidutta Das ◽

Bibhudendu Mohapatra ◽

Somya Prasad

Keyword(s):

Retrospective Study ◽

Posterior Approach ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Decompression ◽

Posterior Stabilization ◽

Bony Fusion ◽

Transpedicular Approach ◽

The Mean

<sec><title>Study Design</title>This is a retrospective study.</sec><sec><title>Purpose</title>To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.</sec><sec><title>Overview of Literature</title>Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.</sec><sec><title>Methods</title>The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.</sec><sec><title>Results</title>The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.</sec><sec><title>Conclusions</title>Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.</sec>

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Total subaxial reconstruction

Journal of Neurosurgery Spine ◽

10.3171/2010.4.spine09923 ◽

2010 ◽

Vol 13 (4) ◽

pp. 424-434 ◽

Cited By ~ 6

Author(s):

Vincent C. Traynelis

Keyword(s):

Cervical Spine ◽

Visual Analog Scale ◽

Anterior Decompression ◽

Analog Scale ◽

Excellent Outcome ◽

Arm Pain ◽

Subaxial Cervical Spine ◽

Pain Scores ◽

The Mean

Object Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the postoperative outcomes following surgery. Methods The author performed a review of data prospectively collected in 27 consecutive patients undergoing complete anterior decompression and reconstruction of the anterior cervical spine and followed by posterior instrumented arthrodesis with or without decompression. Results There were 16 men and 11 women whose mean age was 59 years (range 35–86 years). The minimum follow-up was 12 months and the mean follow-up period for all patients was 26 months. One patient underwent C2–7 surgery, and in all others the procedure crossed the cervicothoracic junction. Following surgery patients remained intubated for an average of 3.3 days (range 1–22 days). The mean hospital length of stay was 11 days (range 3–45 days). One patient died 6 weeks following an uneventful surgery. Pneumonia developed in 5 patients, 1 patient experienced a minor pulmonary embolism, and 2 patients had posterior wound infections. No patient was neurologically worse following surgery. A single patient presented with a C-8 radiculopathy 6 weeks after surgery. At final follow-up no patient complained of dysphagia when specifically questioned about this potential problem. In all patients solid fusions developed at each treated levels. Preoperatively the mean sagittal Cobb angle was 15.4° (kyphosis) and the postoperative mean angle was −10.9° (lordosis) representing a total average correction of over 25° (p < 0.0001). The mean preoperative Neck Disability Index was 27.6; this score decreased to 15.5 (p = 0.0008) postoperatively. The mean pre- and postoperative visual analog scale neck pain scores were 6.0 and 2.1, respectively (p = 0.0004), and mean visual analog scale arm pain scores decreased by 3.7 following surgery (p = 0.001). Based on Odom criteria, the author found that 8 patients had an excellent outcome and 14 patients a good outcome. There were 4 patients in whom the outcome was judged to be fair and the single death was recorded as a poor outcome. The mean preoperative Nurick score was 2.68. Postoperatively the group improved to an average score of 1.5; the difference between the 2 was statistically significant (p = 0.002). Conclusions Segmental anterior decompression and reconstruction of the entire subaxial cervical spine, combined with an instrumented posterolateral fusion, can be performed with acceptable morbidity and is of significant benefit in selected patients.

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Radiological and mid- to long-term patient-reported outcome after stabilization of traumatic thoraco-lumbar spinal fractures using an expandable vertebral body replacement implant

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04585-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Siegmund Lang ◽

Carsten Neumann ◽

Christina Schwaiger ◽

Andreas Voss ◽

Volker Alt ◽

...

Keyword(s):

Vertebral Body ◽

Spinal Fractures ◽

Patient Reported Outcome ◽

Bony Fusion ◽

Sf 36 ◽

Patient Reported ◽

The Mean ◽

Lumbar Spinal

Abstract Background For the treatment of unstable thoraco-lumbar burst fractures, a combined posterior and anterior stabilization instead of a posterior-only instrumentation is recommend in the current literature due to the instability of the anterior column. Data on restoring the bi-segmental kyphotic endplate angle (BKA) with expandable vertebral body replacements (VBR) and on the mid- to long-term patient-reported outcome measures (PROM) is sparse. Methods A retrospective cohort study of patients with traumatic thoraco-lumbar spinal fractures treated with an expandable VBR implant (Obelisc™, Ulrich Medical, Germany) between 2001 and 2015 was conducted. Patient and treatment characteristics were evaluated retrospectively. Radiological data acquisition was completed pre- and postoperatively, 6 months and at least 2 years after the VBR surgery. The BKA was measured and fusion-rates were assessed. The SF-36, EQ-5D and ODI questionnaires were evaluated prospectively. Results Ninety-six patients (25 female, 71 male; age: 46.1 ± 12.8 years) were included in the study. An AO Type A4 fracture was seen in 80/96 cases (83.3%). Seventy-three fractures (76.0%) were located at the lumbar spine. Intraoperative reduction of the BKA in n = 96 patients was 10.5 ± 9.4° (p < 0.01). A loss of correction of 1.0 ± 2.8° at the first follow-up (t1) and of 2.4 ± 4.0° at the second follow-up (t2) was measured (each p < 0.05). The bony fusion rate was 97.9%. The total revision rate was 4.2%. Fifty-one patients (53.1% of included patients; age: 48.9 ± 12.4 years) completed the PROM questionnaires after 106.4 ± 44.3 months and therefore were assigned to the respondent group. The mean ODI score was 28.2 ± 18.3%, the mean EQ-5D VAS reached 60.7 ± 4.1 points. Stratified SF-36 results (ISS < and ≥ 16) were lower compared to a reference population. Conclusion The treatment of traumatic thoraco-lumbar fractures with an expandable VBR implant lead to a high rate of bony fusion. A significant correction of the BKA could be achieved and no clinically relevant loss of reduction occurred during the follow-up. Even though health related quality of life did not reach the normative population values, overall satisfactory results were reported.

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EFFECTIVENESS OF SPIRULINA MOUTHWASH ON REDUCTION OF DENTAL PLAQUE AND GINGIVITIS: A CLINICAL STUDY

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i7.18415 ◽

2017 ◽

Vol 9 (7) ◽

pp. 136

Author(s):

Radhika Maniyar ◽

Umashankar G. K.

Keyword(s):

Visual Analog Scale ◽

Dental Plaque ◽

Rank Test ◽

Analog Scale ◽

Mean Values ◽

Significant Difference ◽

Intervention Protocol ◽

The Mean ◽

The Individual

Objective: The present study evaluated the effectiveness of Spirulina mouthwash on the reduction of dental plaque and gingivitis.Methods: A single-blind clinical trial was conducted among thirty patient’s aged 18-40 y visiting dental college and hospital in Bangalore city. Mouthwash was prepared using 0.5% Spirulina. Intervention protocol consisted of instructing the patients to rinse with 10 ml of mouthwash for 1 minute twice daily for 7 d. Plaque index and Gingival index were used to assess the variables at the baseline and after the intervention. The perception of the individual subjects with regard to the use of mouthwash was assessed using 10 cm long visual analog scale (VAS). Statistical analysis was carried out using Wilcoxon signed rank test for mean pre and post plaque and gingival scores respectively. Descriptive statistics was performed for VAS questionnaireResults: The results showed a highly significant difference (p<0.001) between the mean plaque scores at the baseline (2.16±0.34) and at the follow up (1.27±0.46). The mean gingival scores at the baseline (1.86±0.38) and at the follow-up (1.05±0.43) also showed a highly significant difference (p<0.001). Regarding the Visual Analog Scale, the mean values of 5 or greater than suggested the responses to be favourable as the values were reflectedConclusion: The study showed that Spirulina mouthwash resulted in significant reduction in dental plaque and gingivitis. Also, the mouthwash was convenient to use without any adverse effects. Hence, the use of herbal mouth rinses such as Spirulina should be supported.

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Coverage of Painful Peripheral Nerve Neuromas with Vascularized Soft Tissue: Method and Results

Operative Neurosurgery ◽

10.1227/01.neu.0000156881.10388.d8 ◽

2005 ◽

Vol 56 (suppl_4) ◽

pp. ONS-369-ONS-378 ◽

Cited By ~ 17

Author(s):

Kartik G. Krishnan ◽

Thomas Pinzer ◽

Gabriele Schackert

Keyword(s):

Spinal Cord ◽

Soft Tissue ◽

Peripheral Nerve ◽

Visual Analog Scale ◽

Soft Tissue Coverage ◽

Spinal Cord Stimulator ◽

Analog Scale ◽

Before And After ◽

The Mean

Abstract OBJECTIVE: Our goals are to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in seven patients, and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients, and medications before and after surgery is presented. METHODS: Seven male patients (mean age, 45.1 yr) with posttraumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity, and who had unsuccessfully undergone several treatment procedures, were selected for the surgery described here. The operation included resection of the stump neuroma (four patients) or neurolysis of the neuroma-in-continuity (three patients) and coverage of the nerve with a vascularized fascial, fasciocutaneous, or perforator flap (three pedicled regional flaps and four free flaps). A modified quadruple visual analog scale was used to quantify pain before and after surgical treatment. The mean follow-up was 16.6 months. RESULTS: The mean values of the quadruple visual analog scale (pain now/typically/at its best/at its worst) before surgery were 6.5/6.5/4.7/7.9. These values changed to 0.3/0.4/0/0.9 at a mean follow-up of 16.6 months after surgery. Five patients returned to their original profession, one receives a pension, and one began a less demanding job after undergoing surgery. Six of the seven patients received opioids before surgery (one had a spinal cord stimulator). After surgery, all patients stopped taking regular pain killers and the spinal cord stimulator was deactivated in one; two patients still take nonsteroidal anti-inflammatory drugs occasionally, but not on a regular basis. CONCLUSION: Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective and attractive, but also complex, method of treatment. This option may be considered and reserved for patients who have already undergone several pain treatment modalities without success.

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Long-Term Outcomes of Total Ankle arthroplasty with mobile bearing in 124 ankles, Over eight years of follow-up

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00258 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0025

Author(s):

Yeokgu Hwang ◽

Kwang Hwan Park ◽

Seung Hwan Han ◽

Jin Woo Lee

Keyword(s):

Visual Analog Scale ◽

Revision Rate ◽

Total Ankle Arthroplasty ◽

Long Term Outcomes ◽

Analog Scale ◽

Ankle Arthroplasty ◽

Patient Reported ◽

The Mean

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is increasingly recommended for patients with end-stage ankle osteoarthritis. However, there were few studies which had investigated long-term clinical outcomes with mobile baering system. We analyzed the patient reported results of 124 arthroplasties performed with one type of three-component total ankle prosthesis. This prospective cohort study analyzed long-term outcomes of total ankle arthroplasty with use of the Hintegra prosthesis at one center. Methods: Consecutive patients who received the hintegra prosthesis between September 2004 and December 2009 were enrolled at one large, university hospitals. Patients were annually evaluated clinically, and the patients reported survey with visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and revision rate. Kaplan-Meier survival result showed survival outcomes of TAA in long-term follow-up. Results: One hundred and twenty-four ankles underwent arthroplasty with the Hintegra prosthesis. The mean age of patient at operation time was 64.2 years old (range, 47 to 84 years old). The mean duration of follow-up for all living patients without revision (Eighty-six ankles) was 10.0 ± 1.3 years. The mean change from baseline to final follow-up was -6.7 ± 4.3 points for Visual analog scale, and 26.1 ± 10.3 points for the AOFAS score. . Seven (5.6%) of the ankles required metal component revision at a mean of 2.9 ± 1.8 years (range, 0.5 to 5.8 years). Ten (8%) of the prostheses underwent polyethylene bearing exchange, mostly due to asymmetric wear, at a mean of 2.8 ± 1.8 years (range, 0.1 to 9.1 years). Conclusion: Long term outcomes were good after ankle arthroplasty with the Hintegra prosthesis performed by experienced surgeons, and long-term outcomes demonstrated. The revision rate was substantially higher among the first fifty ankles than among subsequent ankles. Further study to elucidate possible reasons for osteolysis and subjective pain after TAA is warranted.

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The Use of Intra-articular Hylan G-F 20 in the Treatment of Symptomatic Osteoarthritis of the Shoulder

The American Journal of Sports Medicine ◽

10.1177/0363546507300256 ◽

2007 ◽

Vol 35 (6) ◽

pp. 979-985 ◽

Cited By ~ 54

Author(s):

Eric Silverstein ◽

Robin Leger ◽

Kevin P. Shea

Keyword(s):

Visual Analog Scale ◽

Case Series ◽

Visual Analog Scale Score ◽

Analog Scale ◽

Level Of Evidence ◽

Simple Shoulder Test ◽

Ucla Score ◽

Glenohumeral Osteoarthritis ◽

The Mean

Background While hylan G-F 20 is an approved therapy for the treatment of knee osteoarthritis, there are few reports of its use in shoulder osteoarthritis. Hypothesis Hylan G-F 20 can reduce pain and improve function in patients with glenohumeral osteoarthritis. Study Design Case series; Level of evidence, 4. Methods Thirty consecutive patients with idiopathic glenohumeral osteoarthritis who failed to respond to standard conservative measures were enrolled. Patients received 3 weekly intra-articular hylan G-F 20 injections in their affected shoulder and completed a visual analog scale for pain, the UCLA score, and the Simple Shoulder Test at baseline and at 1, 3, and 6 months after the third injection. Results Of the 30 patients, 3 withdrew during the washout period before treatment; the remaining patients (17 men and 10 women) had an average age of 62 years. The mean baseline visual analog scale score was 54, UCLA score was 15.7, and Simple Shoulder Test score was 5.7 (of 12 possible “yes” responses). At the 6-month follow-up, hylan G-F 20 significantly improved visual analog scale (mean 30, P < .001), UCLA (mean 24, P < .001), and Simple Shoulder Test (7.6 “yes” responses, P < .001) scores. More patients slept comfortably after treatment (56%) versus before treatment (15%). Nine patients had a visual analog scale improvement >40 points after 6 months. No device-related adverse events were observed. Conclusion Hylan G-F 20 may have a beneficial therapeutic effect on some symptomatic patients with glenohumeral osteoarthritis.

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