Interview with Sanjiv Jari, Consultant Lower Limb & Orthopaedic Sports Medicine Surgeon at Manchester Sports Medicine Clinic
(Published in Orthopaedic Product News Issue 33 of April 2007)
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 Research Director, Mr Alex Flanagan (below, right), has been compiling a review of current thinking within progressive surgical practice, asking Consultant Orthopaedic Surgeons with experience of using Viscoseal® how it is benefiting patient outcomes.
This month he visited Hope Hospital (University of Manchester Teaching Hospital), in Salford, to speak with Mr Sanjiv Jari (below, left). Mr Jari is a Consultant Lower Limb & Orthopaedic Sports Medicine Surgeon, and a founding member of The Manchester Sports Medicine Clinic.
AF: How are your surgical lists typically split, in terms of elective and nonelective surgery?
SJ: I have 1 NHS trauma list a week and 2-3 elective NHS lists. Privately, I do between 2 and 3 lists a week. About 60% of my NHS elective cases are day cases, or over-night stays following ACL reconstructions and cartilage transplantations. In the private sector this rises to about 80%. The majority of the rest of my operations comprise total knee replacements, with those patients remaining in hospital approximately 3 days. 60% of my referrals in the NHS and around 75% in the private sector are sports related.
AF: What proportion of your surgery is done arthroscopically?
SJ: I would say between 60 and 70%.
AF: When did you first become aware of Viscoseal®?
SJ: Three or four years ago now. I'd been aware of the reported benefits associated with Hyaluronic Acid injections for degenerative and traumatic changes in knees for some time. The injections I use - Ostenil® - are manufactured by TRB Chemedica, and they introduced me and a number of my surgical colleagues to Viscoseal®.
AF: What were your first impressions of Viscoseal® when you introduced it into your post-operative treatment regime?
SJ: It's very quick and easy to use. I instil it following evacuation of irrigation fluid via a syringe attached to the outflow canula. I liked the concept of restoring a more physiologic environment to joints following arthroscopy, and my clinical experience has certainly borne out research that demonstrates improved pain and function scores following debridement and meniscectomy in patients receiving Viscoseal®.
AF: What about patients who undergo open knee surgery, do you consider Viscoseal® to be of any benefit in those cases?
SJ: Yes, I do. I use Viscoseal® following the majority of mini-open ACL reconstruction procedures, to good clinical effect. The only difference being I inject the Viscoseal using a needle following closure.
AF: Do you mix the Viscoseal® with local anaesthetic?
SJ: I always use a local anaesthetic around the superficial incisions made to accommodate arthroscopy anyway. In most instances, if there's a small amount of anaesthetic left I'll inject it into the capsule and then instil the Viscoseal®. There have been studies published that suggest local anaesthetic may be deleterious to hyaline cartilage, although I've had no clinical experience of this. If I've any concerns regarding the volume of fluid to be introduced into a joint following surgery, I use the Viscoseal® on its own.
AF: You're very involved in treating sports-related injury, how did that come about?
SJ: I spent a year in the USA on a Sports Medicine fellowship, and recognised the difference in care that "athletes" - not just elite ones - get in the United States compared with the United Kingdom. I saw no reason why this level of sports-specific care could not be adopted in the UK, and on my return to Britain I began putting together the Manchester Sports Medicine Clinic. The concept was to have a core of super-specialised surgeons with a passion for pushing the boundaries forward not only in surgery, but in rehabilitation, teaching, and research, and the ethos of the clinic directly reflects that concept. For further details visit www.thekneedoc.co.uk.
AF: Has the inclusion of Viscoseal® in the majority of your surgical procedures impacted on patient management in any way?
SJ: Average time to discharge on day cases has reduced, and this has impacted positively on throughput. Patients require less post-operative analgesics, and my rehabilitation colleagues report improved engagement and progress with physio regimes. Certainly in patients who wish to return quickly to work or to sporting activities I'd recommend using
AF: Have you had any adverse events or post-operative problems that you'd attribute to the use of Viscoseal®?
SJ: No. Viscoseal® is very well tolerated. I've had no adverse reports associated with it in all the time I've been using it.
Mr Sanjiv Jari
BSc(Hons), MB ChB, FRCS[Eng], FRCS[Tr & Orth], Ortho Sports Med Fellowship
He is an Honorary Clinical Lecturer in Orthopaedic & Trauma Surgery, and examiner for undergraduate medical students at The University of Manchester and the External Examiner in the Sports Rehabilitation Degree course at the University of Central Lancashire. All his published material, along with a host of knee related material can be accessed at www.thekneedoc.co.uk.