Knee Viscosupplementation: Cost-Effectiveness Analysis between Stabilized Hyaluronic Acid in a Single Injection versus Five Injections of Standard Hyaluronic Acid

Given the wide difference in price per vial between various presentations of hyaluronic acid, this study seeks to compare the effectiveness and treatment cost of stabilized hyaluronic acid (NASHA) in a single injection with standard preparations of hyaluronic acid (HA) in five injections in osteoarthritis (OA) of the knee. Fifty-four patients with knee osteoarthritis (Kellgren–Lawrence Grade II and III) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score greater than 7, with a homogeneous distribution of age, sex, BMI, and duration of disease, were included in this study. Patients were randomized into two groups: Group I was treated with NASHA (Durolane®) and Group II with HA (Go-ON®). Patient’s evolution was followed up at the 1st, 2nd, 4th, 8th, 12th, and 26th week after treatment. A statistically significant improvement in WOMAC score was observed for patients treated with NASHA versus those who received HA at Week 26. In addition, the need for analgesia was significantly reduced at Week 26 in the NASHA-treated group. Finally, the economic analysis showed an increased cost of overall treatment with HA injections. Our data support the use of the NASHA class of products in the treatment of knee OA

Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in the Treatment of Osteoarthritic Knee Pain: A Randomized Clinical Trial in the Context of the Spanish National Health Care System

Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga’s Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades

Periprosthetic femoral fractures treated with intramedullary nail knee retrograde, and plate osteosynthesis: comparison of results in the medium to long term

INTRODUCTION: The femoral periprosthetic fracture of the knee is one of the most feared complications because of its repercussions. Incidence are more and more likely due to the increase of total implanted arthroplasty of the knee, due to the increasing lifespan among the general population. The objective of this study is to analyze some of the perioperative aspects of the treatment of these fractures, comparing the use of osteosynthesis with plates and the retrograde nailing in those patients with femoral periprosthetic knee fractures with a stable implant. MATERIAL AND METODS: The study retrospectively examines 18 cases treated consecutively in our hospital (3 men and 15 women, average age of 72.7 years) between the years of 2000 and 2009. All fractures were located in the distal femur and on a stable implant. Eight were treated through retrograde nailing (Group I) and ten with plates (Group II). The cases are analyzed through the tests of the University of Mann-Withney and the exact Fischer test, with significant values of p≤0.05, the variables of median hospital stay, necessity of transfusion indicated with values of hemoglobin less than 8 mg/ml, preoperative radiological alignment and postoperative alignment of the total knee prosthesis (TKR), measured following the anatomical tibiofemoral axis, time of consolidation and incidence of localized complications in both groups. RESULTS: We did not find any statistically significant differences between the two groups in any of the variables analyzed. Localized complications are more frequent in Group I (62.5 percent of patients) than in Group II (10 percent of patients). The need for transfusion is greater in Group II (40 percent) than in Group I (12.5 percent). CONCLUSIONS: The type of implant used in treatment of femoral periprosthetic knee fracture does not significantly influence perioperative factors. The treatment for this type of fractures should be individually chosen in relation to the type of fracture, characteristics of the patient and stability and prosthesis model of the primary knee.YesINTRODUCCIÓN: La fractura periprotésica femoral de rodilla constituye una de las complicaciones mas temidas por sus repercusiones. Su incidencia aumenta debido tanto al mayor número de artroplastias totales de rodilla (ATR) implantadas como al aumento de la esperanza de vida de la población. El objetivo del estudio es analizar algunos aspectos perioperatorios del tratamiento de estas fracturas comparando el uso de osteosíntesis con placas y el enclavado retrógrado en los pacientes con fracturas femorales periprotésicas de rodilla con implante estable. MATERIAL Y MÉTODOS: Se estudian retrospectivamente 18 casos tratados consecutivamente en nuestro hospital (3 hombres y 15 mujeres; edad media, 72.7 años) entre los años 2000 y 2009. Todas las fracturas asentaban en fémur distal y sobre implante estable. Fueron tratados mediante enclavado retrógrado 8 (Grupo I) y 10 con placas (Grupo II). Se analizan mediante el test de la U de Mann-Withney y el test exacto de Fisher, con valores significativos de p£0.05, las variables: estancia media hospitalaria, necesidad de transfusión indicada con cifras de hemoglobina menor a 8mg/ml, alineación radiológica preoperatoria y postoperatoria de la ATR, medida según el eje anatómico tibiofemoral, tiempo de consolidación e incidencia de complicaciones locales en ambos grupos. RESULTADOS: No hemos encontrado diferencias estadísticamente significativas entre ambos grupos para ninguna de las variables analizadas. Las complicaciones locales son más frecuentes en el Grupo I (75% pacientes) que en el Grupo II (50% pacientes). La necesidad de transfusión es mayor en el Grupo II (40%) que en el Grupo I (12.5%). CONClUSIONES: El tipo de implante utilizado en el tratamiento de las fracturas femorales periprotésicas no influye de forma significativa en los aspectos Perioperatorios. El tratamiento para este tipo de fracturas debe ser elegido de forma individualizada en función de tipo de fractura, características del paciente y estabilidad y modelo de prótesis de rodilla primaria

Dispositivo para la fijación del injerto en mosaicoplastia de tracción

Número de publicación: 2 541 867Número de solicitud: 201301204La invención describe un dispositivo (1) para el taladrado y fijación del injerto (100) osteocondral en la técnica quirúrgica de mosaicoplastia de tracción, comprendiendo el dispositivo (1): un primer cuerpo (2) que tiene un primer orificio (3) cilíndrico pasante para recibir un injerto (100); Y un segundo cuerpo (4) contiguo al primer cuerpo (2) y que tiene un segundo orificio (5) cilíndrico pasante para recibir una broca (25) o una varilla (27), donde el primer orificio (3) tiene un diámetro mayor que el segundo orificio (5), y donde el primer orificio (3) y el segundo orificio (5) son coaxiales entre sí.Universidad de GranadaUniversidad de MálagaServicio Andaluz de Salu

Guía de tutorización de especialistas en formación en ciencias de la salud

YesGuía de Tutorización cuya finalidad es apoyar a las tutoras y los tutores a orientar a las y los especialistas en formación en el desarrollo de sus competencias necesarias para satisfacer las necesidades de salud de la ciudadanía

The autologous chondrocyte implantation in the public health system of Andalusia. Results after 6 years of care circuits

Artículo publicadoObjective: To asses the results of Autologous Chondrocyte Implantation (ACI) whith periosteal patch and To propagate the care circuits existing about in Andalusia. Material and Methods: From its of ficial licence in 2005, the tissue bank and the Virgen de la Victoria Hospital from Málaga, performed the ACI in the Andalusian public health system. 16 patients has been operated between 2006-2013, whith medium follow-up 47,6 months (6 months-6 years), from public hos- pitals throughout Andalucia, managed by hospital admission source and destination. Physiologically younger patients were selected ( 2cm2 symptomatics chondral lesions, in stables and well aligned knees. ACI was used as res- cue procedure after microfracture ́s failure except osteochondritis dissecans. To assess the results the Concinnati score and the Short Form 36 (SF-36) score were used. A descriptive analysis was performed and non-parametric tests were used to establish correlations and compare results. Results: In 15 patients with more than one year of follow-up: 14 men(87.5%) and 2women (14.5%), medium age 28.2 years old (min 17 max 43), the lesion was located into de femoral condyle, mostly in the internal one (81,2%) with medium size 2,7cm2(2-4,2). We founded significant improvement (p<0,001), both daily activities ( 89,3% preop. limitatión - 9% postop), as in the sports (90,2% preop limitatión - 38% postop) and the exploration of the knee (67,7% hpatological findings preop- 13,3%postop). The SF-36 score improved in all categories, over all in mental health (p> 0,01). The patient satisfaction was high or very high in 12 of the 15 patients ( 80%), and low in 3 patients. Conclusions: ACI improve quality of life and knee function in femoral condyle chondral lesions. The case ́s selection and the collaboration with Tissue Bank, allows us to create care circuits for treatment of patients from other provinces in the Public Sanitary Health System in Andalucia. It is necessary to increase the experience with this type of therapy, consolidating multicenter workgroups that provide strength to the conclusions.YesObjetivo: Evaluar los resultados del Implante de Condrocitos Autólogos (ICA) con parche de periostio y difundir los circuitos asistenciales existentes al respecto en Andalucía. Material y método: Desde su autorización oficial en 2005, el Banco de Tejidos y el Hospital Virgen dla Victoria de Málaga, llevan a cabo los ICA del sistema sanitario público andaluz. Se han operado 16 pacientes entre 2006-2013 con seguimiento medio 47,6 meses (6 meses-6 años), de hospitales públicos de toda Andalucía, gestionados por los servicios de admisión de los hospitales origen y destino. Se seleccionaron pacientes fisiológicamente jóvenes (2cm 2, en rodillas estables y sin desalineación. El ICA fue utilizado como procedimiento de rescate de fracaso de microfracturas, salvo en osteocondritis disecante. Para valorar los resultados se utilizaron la escala de Cincinnati y la Short Form 36 (SF-36). Se realizó un análisis descriptivo y test no paramétricos para buscar correlaciones y comparar resultados. Resultados: En los 15 pacientes con más de un año de seguimiento: 14 hombres (87,5%) y 2 mujeres (14,5%), de edad media 28,2 años (min 17 max 43), la lesión asentó en los cóndilos femorales, más en el interno (81,2%) y tamaño 2,7cm 2 (2-4,2). Encontramos mejoría significativa (p<0,001), tanto en actividades de la vida diaria (89,3% limitación preoperatoria -preop- y 9% postoperatoria -postop-), como en las deportivas (90,2% preop - 38% postop) y en la exploración de la rodilla (67,7% hallazgos patológicos preop y 13,3% postop). La escala de calidad de vida SF-36 mejoró en todas las dimensiones sobre todo la salud mental (p> 0,01). El grado de satisfacción de los pacientes fue alto o muy alto en 12 de los 15 casos (80%) y bajo en los 3 restantes. Conclusiones: El ICA mejora la calidad de vida y la funcionalidad de la rodilla con lesiones condrales en cóndilo femoral. La selección de casos y la colaboración con el Banco de Tejidos, permite crear circuitos asistenciales para tratar pacientes de otras provincias del Sistema Sanitario Público de Andalucía. Es necesario ampliar la experiencia en este tipo de terapia, consolidando grupos de trabajo multicén- tricos que aporten solidez a las conclusiones