Viscosupplimentation for hip

[NJPAIN]

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I have a patient who wants a viscosupplimention injection in the hip. I am aware it's off label.
Anyone have experience with this? If so, what product(s). I would prefer a one shot product unless anyone has good experience otherwise. Since he will be paying OOP for this I can use anything.

 

[lobelsteve]

Try pharmacy benefit by writing a script.

 

[SSdoc33]

Ive done it. Orthovisc i think. Worked about as well as you would expect

 

[NJPAIN]

Try pharmacy benefit by writing a script.

Even for the hip?

Ive done it. Orthovisc i think. Worked about as well as you would expect

3 injections or just 1 and pray?

 

[SSdoc33]

3 injections or just 1 and pray?

we had a sample left over. i dont think there is any good data out there, but the hip is a MUCH bigger joint that the knee, and it can hold a lot more fluid. maybe the visco helps a bit. i wouldnt bet on it doing all that much. if it worked well, you can bet the producers of this stuff would put out the data about its efficacy. i was involved in some preliminary studies about hip OA and visco, and was planning on being a part of a trial, but it fizzled out ,and i never heard back from them.

 

[cowboydoc]

Monovisc or their covered 1 and done product. I still have nightmares about the pseudoseptic reactions we dealt with in training with Synvisc One. I've done hips N=5 fair results. If you could get it paid for thru the pharmacy, that would be slick!

 

[drusso]

I have a patient who wants a viscosupplimention injection in the hip. I am aware it's off label.
Anyone have experience with this? If so, what product(s). I would prefer a one shot product unless anyone has good experience otherwise. Since he will be paying OOP for this I can use anything.

Mix in PRP and do it for cash. It works better...

 

[NJPAIN]

Any experience with A2m and HA? I believe he is on Plavix +\- ASA.

If I use a one shot product this is going to cost above $1250 for my cost for just the supplies and drug.

 

[drusso]

Any experience with A2m and HA? I believe he is on Plavix +\- ASA.

If I use a one shot product this is going to cost above $1250 for my cost for just the supplies and drug.

I do A2M and HA too. In fact, for the femoral-acetabular joint, A2M is a great option. It's not really regenerative but anti-catabolic.

 

[oreosandsake]

Any experience with A2m and HA? I believe he is on Plavix +\- ASA.

If I use a one shot product this is going to cost above $1250 for my cost for just the supplies and drug.

HA cost $$$$ and is not covered by insurance.

PRP not covered by insurance and money goes to Dr. NJ

HA vs PRP studies - PRCT at least 6-7 of them for the knees. 3 or 4 for hip.

PRP >>> HA for knees, > for hips

visco studies never panned out well for hips that's why they never got the approval. otherwise, no reason not to. such a big market

 

[bedrock]

HA cost $$$$ and is not covered by insurance.

PRP not covered by insurance and money goes to Dr. NJ

HA vs PRP studies - PRCT at least 6-7 of them for the knees. 3 or 4 for hip.

PRP >>> HA for knees, > for hips

visco studies never panned out well for hips that's why they never got the approval. otherwise, no reason not to. such a big market

Agree. Silly to use visco for hip. I’d go straight to PRP

 

[deleted185747]

Mix in PRP and do it for cash. It works better...

I saw a study that supports PRP + visco work better than either alone

 

[oreosandsake]

I saw a study that supports PRP + visco work better than either alone

there are great studies that support this. clinical as well as basic science.

but need to re-evaluate the math

if

PRP > HA

PRP + HA > PRP or HA alone

is PRP x 2 better than PRP + HA?

for the same/similar cost

also... it's not just injecting the joint

 

[jesspt]

For those of you who use PRP, is there any interest in using BFR prior to obtaining the blood to increase platelet yield?

Blood Flow Restriction Training Using the Delfi System Is Associated With a Cellular Systemic Response

To determine the effects of blood flow restriction (BFR) exercise on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and…

www.sciencedirect.com

 

[oreosandsake]

For those of you who use PRP, is there any interest in using BFR prior to obtaining the blood to increase platelet yield?

Blood Flow Restriction Training Using the Delfi System Is Associated With a Cellular Systemic Response

To determine the effects of blood flow restriction (BFR) exercise on CD34+ cells, platelets, white blood cells, neutrophils, lymphocytes, lactate, and…

www.sciencedirect.com

there was a study that showed even a short bit of exercise prior to blood draw changed the cytokine profile and the numbers as well.

 

[oreosandsake]

there was a study that showed even a short bit of exercise prior to blood draw changed the cytokine profile and I believe the numbers as well... so is it the BFR? is this study funded by the delfi system?

There was a significant increase in platelet counts immediately after the exercise session (T0) for both the EXP (232,400/μL vs 266,600/μL; PRE range, 169,000-364,000/μL; T0 range, 153,000-439,000/μL; P < .002) and CON (235,900/μL vs 247,500/μL; PRE range, 133,000-428,000/μL; T0 range, 152,000-458,000/μL; P < .002) testing sessions. The average increase was higher after the EXP session versus the CON session

(mean difference [MD], 8,000/μL).


i'm not sure how clinically relevant this is.

 

[jesspt]

There was a significant increase in platelet counts immediately after the exercise session (T0) for both the EXP (232,400/μL vs 266,600/μL; PRE range, 169,000-364,000/μL; T0 range, 153,000-439,000/μL; P < .002) and CON (235,900/μL vs 247,500/μL; PRE range, 133,000-428,000/μL; T0 range, 152,000-458,000/μL; P < .002) testing sessions. The average increase was higher after the EXP session versus the CON session

(mean difference [MD], 8,000/μL).


i'm not sure how clinically relevant this is.

There's a lot of research happening with BFR at the moment. Hopefully there will be something that compares BRF PRP vs PRP.

 

[jesspt]

There was a significant increase in platelet counts immediately after the exercise session (T0) for both the EXP (232,400/μL vs 266,600/μL; PRE range, 169,000-364,000/μL; T0 range, 153,000-439,000/μL; P < .002) and CON (235,900/μL vs 247,500/μL; PRE range, 133,000-428,000/μL; T0 range, 152,000-458,000/μL; P < .002) testing sessions. The average increase was higher after the EXP session versus the CON session

(mean difference [MD], 8,000/μL).


i'm not sure how clinically relevant this is.

Sorry - didn't see your Delphi question.Yes, they used the Delphi tourniquet system. Not sure if Delphi funded it.

 

[lobelsteve]

There's a lot of research happening with BFR at the moment. Hopefully there will be something that compares BRF PRP vs PRP.

A lot of literature is usually a lot of background noise of poorly designed and performed studies.