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Synvisc (Hylan GF-20)
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Synvisc (Hylan GF-20) - December 16, 2005 5:00:00 AM
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ehanso
Posts: 356
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From: Minnesota
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Does anyone have a comment on the effectiveness of Synvisc for medial knee OA? I have been without a medial meniscus for years. I recently aggravated it and have been told this is the next logical step. Thanks for you thoughts. Ed
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Re: Synvisc (Hylan GF-20) - December 16, 2005 5:18:00 AM
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Shill
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From: Madison WI USA
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Ive seen the series ( I think its a total of 3 injections) buy people some time, from a day or two, up to maybe, if I recall correctly, one year. Im sure their website paints a more glowing picture. Steve
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Steve Hill PT
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Re: Synvisc (Hylan GF-20) - December 16, 2005 6:35:00 AM
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Jon Newman
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There are a few references in [URL=http://www.rehabedge.com/cgi-bin/ultimatebb.cgi?/ubb/get_topic/f/34/t/000035.html]this short thread[/URL]
I haven't done a search on it since. The fellow I mention in that thread continues to get synvisc injections.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Synvisc (Hylan GF-20) - December 16, 2005 6:53:00 AM
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Jon Newman
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[URL=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15846754&query_hl=1]Here's something new[/URL] from the folks at Cochrane
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Synvisc (Hylan GF-20) - December 16, 2005 7:49:00 AM
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ehanso
Posts: 356
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From: Minnesota
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Thanks for the feedback. I agree the website paints a glowing picture. It sounds like I will be trying to delay the inevitable.
Another thought. Any feedback on hemi arthroplasty of the knee replacing only the medial component?
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Re: Synvisc (Hylan GF-20) - December 16, 2005 9:56:00 AM
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SJBird55
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The surgeons that I was employed with tended to use the synvisc to prolong when the total knee arthroplasty or hemi-arthroplasty would occur. Their rationale was that the younger the person receiving a TKA then the greater the risk of needing a revision down the road. The impressiont that I got was that revisions weren't easy to perform combined with maybe less than desireable outcomes. Of course, at some point in time the quality of life issue needs to be considered versus age because there are people younger than the desireable age that do need a TKA.
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Re: Synvisc (Hylan GF-20) - December 16, 2005 11:16:00 AM
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jma
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haven't heard of many getting it where I work. Agree with SJBIRD.
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Re: Synvisc (Hylan GF-20) - December 16, 2005 1:09:00 PM
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connie.pt
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From: Michigan
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From what I've seen from those who have had the injection, those who have more degeneration generally have less symptom releif from the shots.
If I had to make the choice between TKA and hemiarthroplasty, I would definitely take the TKA. When they put in the components for a hemi- there is no certainty in which those components are put in with anatomic precision. If they are only a degree or two off, that is going to put unusual forces on the other areas of the joint, and those areas will degenerate more quickly.
I'd look up what the research says about hemis and TKAs.
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Re: Synvisc (Hylan GF-20) - December 17, 2005 1:48:00 AM
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Shill
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From: Madison WI USA
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If you only have one compartment that is truly severely degenerative, talk to a surgeon who has done a bunch of UKA's. Im not sure that there is less precision with the UKA surgeries. Bottom line is that if the UKA doesnt turn out so well, by the time you have a TKA, the higher flex knees may be improved. I have only seen one UKA postoperatively, and she did fairly well.
Good Luck.
Have you considered an unloader? We recently had a visit from the JAS (joint active systems) company rep. They have an unloader with only one strut, which seems to make far more sense than the double strut braces that so few people use correctly.
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Steve Hill PT
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Re: Synvisc (Hylan GF-20) - December 17, 2005 2:08:00 AM
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Jon Newman
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From: Amherst, WI
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I've not bothered to look anything up on this lately but my personal experience is that UKA are done for temporary relief of OA, with the expectation of having a full TKA in the future if you live long enough. It would seem that the less you can get away with without compromising your overall health the better. For some, they may hurt so much that they stopped moving about and injections don't help and thus start a spiral of debility early. A UKA seems like a reasonable step if they are young and failed all other measures. That said, we had a flurry of them come through our hospital a year ago or so and I've not seen one since. I've not asked why that is. The people I did see did so well they didn't need PT post acute care.
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[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Synvisc (Hylan GF-20) - December 17, 2005 4:28:00 PM
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bp2317
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From: Columbus, GA
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the physicians in our office use the synvisc injections frequently. i would say that i have seen an even mix of patients that received the 3 injections that were quickly d/c from my services and haven't had the need to return, as well as now post op TKA patients that also went through the series but eventually had to have the knee replaced. from what patients have told me (those that eventually had a TKA) the injections gave them a lot of relief.
i have only seen one patient use the above mentioned unloader brace, but she eventually had a TKA. my father-in-law has the brace and says its what helps enable him to continue to golf and do gardening/yardwork. just my $.02
bp ><>
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Brian Phillips, PT
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Re: Synvisc (Hylan GF-20) - December 18, 2005 5:03:00 AM
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ehanso
Posts: 356
Joined: September 14, 2004
From: Minnesota
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Again, Thanks for all your input. I do have a Bledsoe Aligner that I have been wearing when I know I am going to be on unven ground (like hunting or mowing the river bank). I did start to wear it full time after I irritated my knee this time around. PMH includes injury in HS football, then again in college playing hockey. At that time they just scooped the entire meniscus out. So i have been medial meniscusless since then. I did it in recently bowling. The force on the medial knee when releasing of the ball sent it over the edge. Of course this is never supposed to happen to us only our patients. LOL Past cortisone injections have helped during flare ups (a total of 5 over 35 years). This time it did not respond so I am greatful to the advise and thoughts from colleagues who have seen a variety of these through the years.
Thanks again and I will keep you posted as things progress.
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Re: Synvisc (Hylan GF-20) - December 19, 2005 12:16:00 AM
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Sebastian Asselbergs
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The hemi arthroplasty is used a lot here. Seems to do well. One of the "newer" TKA models - made of titanium, has removable parts - making it easier to go in after 12-18 years, and replace the surfaces without the need of removing the whole arthroplasty. This leaves the cortex at the same thickness and is likely to cause very few additional issues. Please note that I just heard this from a local orthopod at Saturday night's Christmas party - I have NO names of products (I had a few drinks... he may not even have mentioned them..), articles or any other info. It just sounded reasonable with today's developments....
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Re: Synvisc (Hylan GF-20) - December 19, 2005 5:05:00 AM
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JLS_PT_OCS
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Is anyone in your area doing meniscus transplants?
Depending on your age, it may be too early to start with the TKA, as it eats up a lot of bone (or rather they remove a lot) to put it in. Given your lifestyle and requirements, you may need more than one, once it's done, and we all know each one leaves less bone to put in the next one.
Just a thought...
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Synvisc (Hylan GF-20) - December 19, 2005 7:23:00 AM
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ehanso
Posts: 356
Joined: September 14, 2004
From: Minnesota
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Jason, Thanks for the suggestion. I have looked into it and most say you need to have only a small lesion in the articular cartilage. A few years ago, I know there was some research being done, I think, at the University of Arizona Tempe. I have been able to find minimal info online. Most research is on dogs. Does anyone else know of more info on the meniscal transplants? Again, Thanks for the information.
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Re: Synvisc (Hylan GF-20) - January 27, 2006 3:05:00 AM
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ehanso
Posts: 356
Joined: September 14, 2004
From: Minnesota
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Update, I had my 3rd synvisc injection yesterday. I have been using a Bledsoe aligner brace to unload the medial compartment daily for 5 weeks. I can now go up and down stairs even without the brace with minimal to no discomfort. The aching is completely gone. I plan on wearing the aligner consistently for another month before I try doing activities on uneven ground. The orthropedist feels I will get about 6 months relief. Obviously I am hoping for at least 6 years. lol
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