Knee Replacement Surgery May Now Be Delayed

By: Admin – – Monday, July 04, 2005

A meeting involving 70 doctors and consultants took place last Thursday 30th June at the Crown Plaza Hotel, Dublin Airport to discuss the treatment of osteoarthritis, a condition that up to 400,000 people in Ireland suffer from each year. This meeting hosted by Premier Medical and chaired by Dr. Douglas Veale, Consultant Rheumatologist, St. Vincent’s University Hospital was an informative symposium on recent changes in treatment of osteoarthritis and sport injuries of the knee and introduced Synovial Fluid Replacement Therapy.

Guest speaker Dr. Robert J Petrella, MA, MD, CCFP, FACSM, PhD
researcher from Canada gave insights into the use of Synovial Fluid Replacement Therapy using Hyaluronan and showed results of research, its different applications and the benefits of the treatment.
‘Hyaluronan is a safe and proven, effective therapy in all grades of Osteoarthritis and in all patients there are no contraindications. It offers an alternative when options are becoming limited for treatment. It is the only therapy that can treat pain and function and does so for up to six months or more with a single series. Applications are expanding to patients with all types of OA as well as those predisposed or in a pre-osteoarthritic state. Specifically sport injuries can lead to OA but more immediately can impair performance. Hyaluronan may offer a novel preventative and therapeutic option in sport medicine’, stated Dr. J Petrella.
Dr. Robert J. Petrella is Medical Director at the Canadian Centre for Activity and Aging. His areas of research include investigation into Hyaluronan for the treatment of Osteoarthritis. He has investigated the use of Hyaluronan in many different patient groups and has presented his research at EULAR for the past number of years. He has a particular interest in Sport Medicine and some of his more recent work presented by him at EULAR includes the use of Hyaluronan in soft tissue injury such as ankle sprain.

This information was welcomed by the Irish doctors as being a positive addition to current practices especially in light of recent limitations regarding the prescription of anti-inflammatory drugs.

Background Information
This therapy, involving a series of injections into the knee joint, is regarded as revolutionary in that pain relief can last up to six months as well as preventing further loss of cartilage in some cases. Patient’s reliance on other pain relieving medications is significantly reduced. It is a valuable tool for GPs whose patients find themselves on long waiting lists to see an orthopaedic surgeon and can delay necessity for knee replacement surgery in suitable cases. It also improves function in patients with OA of the knee thus increasing their mobility and allowing them exercise. This therapy is now on the Medical Card Scheme.

This therapy can also be effectively used in the treatment of sport injuries to the knee providing athletes and sports persons with pain relief reducing the need for anti-inflammatory drugs.

The therapy, known also as Viscosupplementation using Hyaluronan, came into clinical use in Japan and Italy in 1987 in Canada in 1992 and in Europe in 1995 has been approved in the United States since 1997. Synovial Fluid Replacement Therapy is a prescription-only product and is now available on the GMS (General Medical Scheme) in Ireland since the first of February 2005.

Waiting lists for Orthopaedic and Rheumatology services in Ireland can be months even years long and this causes further difficulty for patients in extreme pain. Currently, the standard treatment for these patients is weight loss and physiotherapy. If this approach is not successful, analgesics, as well as anti-inflammatory drugs may be used as well as steroid injections but the effects of which may only last up to six weeks.

Applications in Sport Medicine
Another development more recently is the use of Hyaluronan in the area of Sport-medicine. Many patients have been treated successfully to date and this therapy and its applications to sport medicine are currently attracting a lot of interest from specialist’s world-wide. Rudolf Zioloko, a sports-medicine specialist from Cologne, discussed sports-related injuries at the EULAR (European League against Rheumaticism) symposium in Berlin 10th June 2004 as another area of application for hyaluronan injections.” In this case it is important to treat the patient while they are still in the chondropathy (cartilage disease) stage” he said, “otherwise cartilage defects no longer spontaneously heal and the subchondral bone eventually also becomes involved”. However as he explained, hyaluronan injections can prevent further loss of cartilage.

This is good news for team doctors, sports persons, GPs and physiotherapists where early symptoms of wear and tear osteoarthritis are apparent. Considering the results of a survey of over 260 top GAA players conducted by Dr. Doug Veale Consultant Rheumatologist at St.Vincent’s Hospital with the help of team doctors last year during the championship season where results showed that 65% of players were suffering pain and stiffness compared to rates of around 10% in the general population.

Patients and members of the public who require further information on Synovial fluid replacement therapy are advised to talk to their Doctor or Pharmacist.


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Thursday, March 22, 2018
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