Sanjiv Jari
Manchester Sports Medicine Clinic
Q: How are your surgical lists typically split, in terms of elective and non-elective surgery?
A: 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.
Q: What proportion of your surgery is done arthroscopically?
A: I would say between 60 and 70%
Q: When did you first become aware of Viscoseal?
A: 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.
Q: What were your first impressions of Viscoseal when you introduced it into your post-operative treatment regime?
A: 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.
Q: What about patients who undergo open knee surgery, do you consider Viscoseal to be of any benefit in those cases?
A: 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.
Q: Do you mix the Viscoseal with local anaesthetic?
A: 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.
Q: You’re very involved in treating sports-related injury, how did that come about?
A: 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 <a href=”http://www.thekneedoc.co.uk” target=”newindow”>www.thekneedoc.co.uk</a>.
Q: Has the inclusion of Viscoseal in the majority of your surgical procedures impacted on patient management in any way?
A: 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 Viscoseal post-op.
Q: Have you had any adverse events or post-operative problems that you’d attribute to the use of Viscoseal?
A: No. Viscoseal is very well tolerated. I’ve had no adverse reports associated with it in all the time I’ve been using it.
