Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study.

OBJECTIVE: To evaluate the feasibility, safety, and symptomatic efficacy of intra-articular Hylan G-F 20 in patients with shoulder osteoarthritis and an intact rotator cuff. METHODS: Open-label, prospective, multicenter study in patients with pain scores on a visual analog scale (VAS) between 40/100 and 90/100. An intra-articular injection of 2 ml of Hylan G-F 20 was given under fluoroscopic guidance. A second injection was given after 1, 2, or 3 months in the event of inadequate pain relief. The primary evaluation criterion was the VAS pain score 3 months after the first injection. Follow-up was 6 months. RESULTS: Of 39 included patients, 33 received a first injection and, among these, 16 received a second injection; 29 patients completed the study. No serious or severe treatment-related adverse events were recorded. There were 10 mild or moderate adverse events in eight patients. The mean VAS pain score decreased from 61.2 mm at baseline to 37.1 mm after 3 months (P<0.001), and the decrease was larger in the subgroup that required a single injection. CONCLUSION: This prospective study shows that treatment with one or two intra-articular injections of Hylan GF 20 in patients who have shoulder osteoarthritis and an intact cuff is feasible, safe, and probably effective. Viscosupplementation using Hylan G-F 20 may constitute a helpful treatment option in patients who have shoulder osteoarthritis with an intact rotator cuff.

Ulnohumeral arthroplasty: results in primary degenerative arthritis of the elbow.

Our results with the ulnohumeral arthroplasty are presented. Seventeen patients were evaluated at an average followup greater than 36 months (range, 24-50 months). The average age of the patients was 52 years (range, 40-74 years). At final followup, 15 patients had complete pain relief at end ranges of motion whereas two patients had moderate pain after prolonged activity. Extension and flexion were improved by a mean of 12 degrees and 20 degrees, respectively, with a mean range of motion 14 degrees to 118 degrees. Postoperative radiographs showed a correctly placed drill hole with complete osteophyte resection. There were no neurologic or other complications and good stability of the elbow was observed in all patients. We think ulnohumeral arthroplasty is a good procedure for active patients with primary degenerative joint disease of the elbow.

Extracorporeal shock wave therapy for plantar fasciitis: randomised controlled multicentre trial.

OBJECTIVE: To determine the effectiveness of extracorporeal shock wave therapy compared with placebo in the treatment of chronic plantar fasciitis. DESIGN: Randomised, blinded, multicentre trial with parallel group design. SETTING: Nine hospitals and one outpatient clinic in Germany. PARTICIPANTS: 272 patients with chronic plantar fasciitis recalcitrant to conservative therapy for at least six months: 135 patients were allocated extracorporeal shock wave therapy and 137 were allocated placebo. MAIN OUTCOME MEASURES: Primary end point was the success rate 12 weeks after intervention based on the Roles and Maudsley score. Secondary end points encompassed subjective pain ratings and walking ability up to a year after the last intervention. RESULTS: The primary end point could be assessed in 94% (n=256) of patients. The success rate 12 weeks after intervention was 34% (n=43) in the extracorporeal shock wave therapy group and 30% (n=39) in the placebo group (95% confidence interval - 8.0% to 15.1%). No difference was found in the secondary end points. Few side effects were reported. CONCLUSIONS: Extracorporeal shock wave therapy is ineffective in the treatment of chronic plantar fasciitis.

Evaluating and treating the stiff elbow.

The evaluation and treatment of the stiff elbow are described, as well as the lateral, medial, anterior, and posterior approaches for release of elbow contractures. The results after surgical release in 48 patients that failed nonoperative treatment for elbow contractures in our institution are reported. A literature review is provided.