DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20221122

Study of clinical outcome of single intra-articular injection of artificial hyaluronic acid preparation in patients with grade III and grade IV knee osteoarthritis

Sumedh Choudhary, Santosh Ghoti

Abstract


Background: Knee osteoarthritis (OA) is problematic in elderlies. Intra-articular injection of hyaluronic acid (HA) has been used with good results in patients with early OA, but evidence to recommend their use in late stages is insufficient. The aim of the study was to analyse whether intra-articular injections of hyaluronic acid preparation can provide relief in patients with grade III and grade IV knee OA.

Methods: This observational study was conducted over 2 years amongst patients with late knee arthritis. On standing radiographs, patients were categorized- group 1 with stage III and group 2 with stage IV knee OA. Standardized technique was employed in all participants for single shot intra-articular hylan-GF-20 injection. Clinical outcomes were evaluated at 3, 6 and 12 months.

Results: Group 1 patients showed significant improvement in Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores at 3, 6 and 12 months (p<0.05). In group 2, improvement was noted in WOMAC score for pain and function at 3 months (p<0.05). There was no significant improvement in functional and total WOMAC score at 6 and 12 months (p>0.05). Results for the new OA research society international (OARSI) responder criteria measures for proposition D reflected that, 94.87% and 25% patients were responder and 5.13% and 75% of patients were non-responder in group 1 (grade III) and group 2 (grade IV) respectively at the end of 6 months.

Conclusions: In patients with grade III and grade IV knee OA, a single intra-articular injection of HA preparation (Hylan GF-20) showed pain relief for medium and short duration respectively. TKA remains the mainstay of management.

 


Keywords


Osteoarthritis, Intra-articular, Hyaluronic, Hylan GF-20, Outcome

Full Text:

PDF

References


RGI. Sample Registration System Statistical Report 2011, 2013. Available at: https://censusindia. gov.in/Vital_Statistics/SRS/Sample_Registration_System.aspx. Accessed on 12 November 2021.

Silman AJ, Hochberg MC. Epidemiology of the Rheumatic Diseases. 2nd ed. Oxford: Oxford University Press. 2001;42-6.

Pal CP, Singh P, Chaturvedi S, Pruthi KK, Vij A, Epidemiology of knee osteoarthritis in India and related factors. Indian J Orthop. 2016;50:518-22.

Haq I, Murphy E, Dacre J. Osteoarthritis. Postgrad Med J. 2003;79:377-83.

Yang ZY, Chen W, Li CX, Wang J, Shao DC, Hou ZY, et al. Medial compartment decompression by fibular osteotomy to treat medial compartment knee osteoarthritis: a pilot study. Orthopedics. 2015;38(12):e1110-4.

Balazs EA, Denlinger JL. Visco-supplementation: a new concept in the treatment of osteoarthritis. The J Rheumatol. 1993;39:3-9.

Ng HY, Lee KA, Shen YF. Articular cartilage: structure, composition, injuries and repair. JSM Bone Joint Dis. 2017;1(2):1010.

Farrokhi S, Voycheck CA, Tashman S, Fitzgerald GK. A biomechanical perspective on physical therapy management of knee osteoarthritis. J Orthop Sports Physical Therapy. 2013;43(9):600-19.

Lespasio MJ, Piuzzi NS, Husni ME, Muschler GF, Guarino AJ, Mont MA. Knee osteoarthritis: a primer. Permanente J. 2017;21.

Wu CW, Morrell MR, Heinze E, Concoff AL, Wollaston SJ, Arnold EL, et al. Validation of American College of Rheumatology classification criteria for knee osteoarthritis using arthroscopically defined cartilage damage scores. Semin Arthritis Rheumatism. 2005;35(3):197-201.

Menkes CJ. Radiographic criteria for classification of osteoarthritis. J Rheumatol. 1991;27:13-5.

Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: international knee documentation committee (IKDC) subjective knee evaluation form, knee injury and osteoarthritis outcome score (KOOS), knee injury and osteoarthritis outcome score physical function short form (KOOS‐PS), knee outcome survey activities of daily living scale (KOS‐ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res. 2011;63(11):208-28.

Hawker GA, Davis AM, French MR, Cibere J, Jordan JM, March L, et al. Development and preliminary psychometric testing of a new OA pain measure–an OARSI/OMERACT initiative. Osteoarthritis and Cartilage. 2008;16(4):409-14.

Wen DY. Intra-articular hyaluronic acid injections for knee osteoarthritis. Am Fam Physician. 2000;62(3):565.

Boutefnouchet T, Puranik G, Holmes E, Bell KM. Hylan GF-20 visco-supplementation in the treatment of symptomatic osteoarthritis of the knee: clinical effect survivorship at 5 years. Knee Surg Relat Res. 2017;29(2):129.

Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee: a meta-analysis of randomized controlled trials. JBJS. 2004;86(3):538-45.

Bellamy N, Campbell J, Welch V, Gee TL, Bourne R, Wells GA. Visco-supplementation for the treatment of osteoarthritis of the knee. Cochrane database of systematic reviews. 2006;2.

Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-articular, single-shot hylan GF-20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. J Bone Joint Surg Am. 2016;98:885-92.

Chevalier X, Jerosch J, Goupille P, van Dijk N, Luyten FP, Scott DL, Bailleul F, Pavelka K. Single, intra-articular treatment with 6 ml hylan GF 20 in patients with symptomatic primary osteoarthritis of the knee: a randomized, multi-centre, double-blind, placebo-controlled trial. Ann Rheumat Dis. 2010;69(01):113-9.