What can you do for patients while they wait for surgery?

Doctor and Patient  

The current NHS waiting lists for joint replacements leave many patients - and their clinicians - struggling to find effective ways to alleviate pain and improve quality of life, and this can impact adversely on general health. Several studies have shown that viscosupplementation can actually help delay the need for orthopaedic surgery, and even allow some patients to indefinitely postpone arthroplasty. Here are some for your consideration:
 
1 Gigliucci, G., Iolascon, G., Moretti, B., Tarantino, U., Gallelli, L., Paoletta, M., Picarelli, G., & Migliore, A. (2020). The evidence of surgery delay after viscosupplementation is increasing. Beyond Rheumatology, 2(3), 79–82. 
https://doi.org/10.4081/br.2020.38
 
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2 Johnston J, Brown K, Muir J, Sloniewsky MJ. Long-Term Outcomes of Single versus Multiple Courses of Viscosupplementation for Osteoarthritic Knee Pain: Real-World, Multi-Practice Experience Over a Six-Year Period. J Pain Res. 2021 Aug 10;14:2413-2421. 
doi: 10.2147/JPR.S312418. PMID: 34408486; PMCID: PMC8364370. 
https://pubmed.ncbi.nlm.nih.gov/34408486/
 
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3 TITLE: Hyaluronic Acid Injections Are Associated with Delay of Total Knee Replacement Surgery in Patients with Knee Osteoarthritis: Evidence from a Large U.S. Health Claims Database
LEAD AUTHOR: Altman
PUBLICATION: PLoS One
DATE: 2015
SUMMARY: Retrospective evaluation of an American patient database between 2007-2013. 182,022 patients identified with KOA who received TKR. Of this population 131,673 (72.3%) patients received noIAHA versus 50,349 (27.7%) who received at least one course of IAHA. Of those receiving IAHA, 36,861(73.2%) received 1 course, 8893 (17.7%) received 2 courses, 2,783 (5.5%) received 3 courses, 1052 (2.1%) received 4 courses and 760 (1.5%) received 5 courses or more. Patients who received no HA had a meantime-to-TKR of 0.7 years, one course of HA was 1.4 years (p<0.0001), ≥5 courses delayed TKR by 3.6 years(p<0.0001). HA injection in patients with KOA is associated with a dose-dependent increase in time-to-TKR.
https://pubmed.ncbi.nlm.nih.gov/26694145/
 
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4 TITLE: Do Intra-Articular Hyaluronic Acid Injections Delay Total Knee Replacement in Patients with Osteoarthritis – A Cox Model Analysis
LEAD AUTHOR: Delbarre
PUBLICATION: PLoS One
DATE: 2017
SUMMARY: Retrospective evaluation of a French patient database between 2006-2013. 14,782 patientsidentified aged ≥50 years treated for KOA. Of this population 1,662 patients received TKR (11.2%). 5,306patients (36%) had IACS injections only whilst 9,476 patients (64%) had at least one IAHA injection. Approximately 7.5 years after diagnosis, patients who received HA had an additional time-to-TKR of 217(±10) days on average compared to patients who did not receive HA (p<0.0001). In the year prior to TKR, the means for total direct medical costs were similar between the 2 treatment groups (€744 for HA vs €805for control, p=0.104); IA injections accounted for <10% of the total costs.
https://pubmed.ncbi.nlm.nih.gov/29155833/
 
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5 TITLE: Delay to TKA and Costs Associated with Knee Osteoarthritis Care Using Intra-Articular Hyaluronic Acid: Analysis of an Administrative Database
LEAD AUTHOR: Concoff
PUBLICATION: Clinical Medicine Insights:Arthritis and Musculoskeletal Disorders
DATE: 2021
SUMMARY: Retrospective evaluation of an American patient database between2010-2015. Median time to TKR was 1.3years (IQR 1.57) in the IAHA group and0.38 years (IQR 0.95) in the no IAHAgroup (P < .0001). Patients treated with multiple courses of IA-HA demonstrated an incremental increase in delay to TKAwith more courses of IA-HA, suggesting that the risk of TKA over the study time period is reduced with additional IA-HA courses. The hazard ratio for the need of TKA was 0.85 (95% CI 0.84-0.86) for a single course and 0.27 (95% CI 0.25-0.28)for ⩾5 courses, both compared to the non IA-HA group.
 
Delay to TKA and Costs Associated with Knee OA - Concoff - Graph

https://pubmed.ncbi.nlm.nih.gov/33814937/
 
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6 TITLE: Why We Should Definitely Include Intra-Articular Hyaluronic Acid as a Therapeutic Option in the Management of Knee Osteoarthritis: Results of an Extensive Critical Literature Review
LEAD AUTHOR: Maheu
PUBLICATION: Semin. Arthritis Rheum.
DATE: 2019
SUMMARY: Meta-analysis of 137 studies including 33,243 patients to determine the comparative effectiveness of pharmacologic interventions for KOA on the main outcomes of pain and function. Most efficacious treatment was IAHA with an ES of 0.63 (95% CrI: 0.39–0.88), while the least effective treatment was paracetamol (ES = 0.18; 95% CrI: 0.04–0.33).
 
Why we should definitely include IA-HA - Maheu - Table

https://pubmed.ncbi.nlm.nih.gov/30072113/

Do Ostenil injections need a prescription?

OSTENIL® injections are licensed and registered as a Class III medical device, not a prescription only medicine (POM). They may be administered by a doctor, or any other accredited clinician – such as Extended Scope Physiotherapists – who are suitably qualified to deliver intra-articular injections. The recommendation for treatment with, and the administration of Ostenil injections does not require a prescribing license.