The Disease-Modifying Effects of Hyaluronan in the Osteoarthritic Disease State.

Hyaluronic acid (HA) has been a treatment modality for patients with knee osteoarthritis (OA) for many years now. Since HA was first introduced for the treatment of painful knee OA, much has been elucidated regarding both the etiology of this disease and the mechanisms by which HA may mitigate joint pain and tissue destruction. The objectives of this article are to (1) describe the etiology and pathophysiology of OA including both what is known about the genetics and biochemistry, (2) describe the role of HA on disease progression, (3) detail the antinociceptive and anti-inflammatory actions of HA in OA, and (4) present evidence of disease-modifying effects of HA in the preservation and restoration of the extracellular matrix. These data support that HA is not only just a simple device used for viscosupplementation but also a biologically active molecule that can affect the physiology of articular cartilage.

Immobilization for scaphoid fracture: forearm rotation in long arm thumb-spica versus Munster thumb-spica casts.

A Munster thumb-spica cast may play a role in the conservative treatment of non-displaced scaphoid fractures by allowing some elbow motion during the long immobilization period.

Athletic activity after total joint replacement.

Total hip and knee replacement surgery is a successful treatment for the arthritic hip and knee ensuring proven pain relief and return of function. Younger, more active patients who have greater expectations and higher demands are receiving hip and knee replacements. With current surgical techniques and implant designs, athletic participation should be limited to low impact, low demand, and low duration activity. Future advancesin bearing surfaces may allow for higher demand activities.