A multi-centre, open label, long-term follow-up study to evaluate the benefits of a new viscoelastic hydrogel (Hymovis®) in the treatment of knee osteoarthritis.

OBJECTIVE: To evaluate the long-term efficacy and safety of Hymovis® in the symptomatic treatment of knee osteoarthritis (OA). PATIENTS AND METHODS: This is a prospective, multi-center, open label, phase III clinical study. Two intra-articular injections (3 mL) of Hymovis® (8 mg/mL HYADD® 4) were administered 1 week apart at the beginning of the study on day 0 and day 7 and after 6 months from baseline, on day 182 and 189. Follow-up assessment were conducted for 52 weeks. 50 subjects, > 40 years old, with knee OA, with clinical and radiological confirm, complain pain in the target knee were enrolled. The variables considered were: WOMAC questionnaire, Joint Space Width (JSW), OMERACT OARSI responder criteria, EQ-5D questionnaire, rescue medication consumption. RESULTS: After the injections of Hymovis®, pain perceived by the patient when walking on a flat surface (WOMAC A1 score) significantly improves at the end of the study respect to the baseline. WOMAC stiffness, physical function and total score significantly improve during the study since 3 months after treatment, and it is maintained up to the end of the study (p < 0.001). By the x-ray analysis of knee, a radiological progression of OA was observed in the 26% of patients at the end of the study, while 88% of patients result to be responder to the therapy classified as per OMERACT-OARSI criteria. The EQ-5D weighted index increased significantly, against baseline, at each study time point (p < 0.001). Investigator's and patient's global assessment of the disease measured by the VAS both show a marked improvement in patient's health conditions. CONCLUSIONS: Results from this study confirm that Hymovis® alleviate the knee pain since the first treatment cycle. The patients treated with two cycles of intra-articular injections of Hymovis® have a progressive pain reduction that is maintained up to one year after the treatment start with improve of all the scores considered in this study. Hymovis® is effective and safe in symptomatic treatment of painful knee OA.

Avulsion of the distal tendon of the biceps brachii: reattachment to the radial tuberosity via 1-incision technique.

Between 1995 and 1997 a total of 5 patients with injury of the distal tendon of the biceps brachii were treated by reattachment to the radial tuberosity using Henry anterior access to the elbow. The results obtained through a clinical and instrumental evaluation, and the answers to a questionnaire, were good or excellent. What was particular about our work was that we treated all of the patients by a single Henry anterior access and not a double Boyd and Anderson one, which is more commonly used. Our decision was based on the minor amount of surgical invasiveness, the simpler method of reinsertion of the tendon and the minor incidence of possible radio-ulnar synostoses. This surgical approach requires particular care with regard to possible injuries of the radial nerve, that, moreover, are easily avoidable if surgery is performed by experts, with accurate and limited preparation of the site of reattachment.

Two compression rods to treat unstable lesions of the pelvic ring.

The authors report 7 cases involving the surgical treatment of unstable pelvic ring fractures (Malgaigne type) using two compression bars, as described by Tile. The method was used only in cases where x-ray examination and CT scan revealed that the posterior branch of the fracture was located at the very medial aspect of the sacrum (fracture through the sacral foramina or even medial to the sacral foramina), and therefore could not be stabilized by using other devices.