Published in Orthopaedic Product News - March 2007)
Manchester Sports Medicine Clinic
Viscoseal® is a unique product designed to reduce pain and swelling following arthroscopic joint surgery. Developed and manufactured by TRB Chemedica, and marketed exclusively in the UK by TRB Chemedica (UK ) Ltd, this novel, non-animal, Sodium Hyaluronate formulation is being used by an ever increasing number of Orthopaedic surgeons, and has enjoyed substantial year on year growth since its introduction to the UK in 2003.
TRBC UK Clinical Trials Manager, Mr Alex Flanagan, has been compiling a review of current thinking within progressive surgical practice, asking Consultant Orthopaedic Surgeons with experience of using Viscoseal how it is benefitting patient outcomes.
This month he visited The Manchester Sports Medicine Clinic - at The Bridgewater Hospital, Manchester - to speak with one of its founding surgeons, Mr Lennard Funk.
Alex Flanagan: How much of your surgery is done arthroscopically?
Lennard Funk (left): More than 80% of my surgery is done arthroscopically. Basically all my elective surgery is arthroscopic, other than shoulder replacements.
AF: How did you first become aware of Viscoseal?
LF: I was always concerned about bursal adhesions following arthroscopic Subacromial decompressions and also aware of the literature on the damage large amounts of irrigation fluids caused to cartilage. Therefore,both the theoretical and research benefits of Vicoseal appealed to me. I was also pleasantly surprised by the improved pain relief with Viscoseal use and have continued to use it for this purpose as well.
AF: What were your first impressions of Viscoseal when you introduced it into your post-operative treatment regime?
LF: I initially noticed no benefit, however my anaesthetist and the ward staff did notice improved pain relief and earlier discharge when we used Viscoseal in addition to intra-articular Marcain. This encouraged me to set up a randomised trial.
AF: Were your favourable clinical impressions of Viscoseal born out by the subsequent research you undertook?
LF: Yes, there were significant differences in pain and analgesia requirements between the patients who received Viscoseal and those that did not. I was pleasantly surprised when I presented our data at the OARSI Conference in 2004 that almost identical data was presented for the knee. We are now expanding our study to a larger cohort.
AF: Has the inclusion of Viscoseal in the majority of your surgical procedures impacted on patient management in any way?
LF: The average time to discharge has reduced with Viscoseal when used in addition to an intra-articular local anaesthetic. We have also found that there is less rebound pain with Viscoseal in patients who have an interscalene block for their surgery. There has been less need for additional oral analgesia in the first few days after surgery and we found that the outcome scores (Constant scores) were slightly higher at three weeks post-op in patients who had Viscoseal. Personally, I would insist on having Viscoseal instilled for my arthroscopic surgery.
AF: Does the inclusion of Vicoseal at the end of surgery add significantly to the time each operation takes?
LF: No, it takes a couple of seconds.
AF: How do you instil the Vicoseal?
LF: Usually via a syringe attached to the trochar bridge. It can also be injected following closure.
AF: Have you had any adverse events or post-operative problems that you'd attibute to the use of Vicoseal?
LF: None at all. It appears to be very well tolerated.
Prof Lennard Funk
BSc. MSc. FRCS(Tr&Orth). FFSEM(UK)
Mr Lennard Funk is a Consultant Shoulder & Upper Limb Surgeon at Wrightington Hospital in Lancashire, and Honorary Lecturer at The University of Manchester. All his published articles, along with a wealth of shoulder related information can be found at www.shoulderdoc.co.uk.