DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172884

Role of viscosupplementation in the management of primary osteoarthritis knee

Venu Gosikonda, Vamshidhar Reddy, Ramu Chokkarapu

Abstract


Background: Viscosupplementation is frequently used as a therapeutic strategy to manage patients with early osteo-arthritis of knees. A case series was followed up for a period of one year to study the clinical efficacy of intra-articular hyaluronic acid injections in different Kellegren Lawrence grades of osteoarthritis knee.

Methods: 76 patients with primary osteoarthritis of knee not responding to analgesics, Quadriceps strengthening exercises, superficial and deep heat modalities were recruited after meeting inclusion criteria. They were followed up till the end of one year at an interval of every four months. Seventy patients completed the study and were analyzed for pain, stiffness and physical function using WOMAC osteoarthritis index. WOMAC scores were documented at initial consultation and follow up visits at the end of fourth, eighth and twelfth month.

Results: Patients with Grade 1 and 2 osteoarthritis knee showed improvement in pain, stiffness and physical function following viscosupplementation lasting for one year. Those with Grade 3 osteoarthritis knee initially revealed good pain relief, enhanced function clinically till the second follow up. After that majority of the patients with Grade 3 osteoarthritis demanded for another session of viscosupplementation and expressed worsening of their knee symptoms. In Grade 4 osteoarthritis knee viscosupplementation found to be clinically and statistically ineffective. Adverse reactions following intra-articular hyaluronic acid injections included pain in five patients, pain and swelling in three patients, and injection site erythema in one patient.

Conclusions: Viscosupplementation is a good therapeutic strategy in management of Grade 1-2 osteoarthritis knee. Intra-articular hyaluronic acid injections in Grade 3 osteoarthritis knee helps in delaying surgical intervention. It is in effective in Grade 4 osteoarthritis knee.


Keywords


Viscosupplementation, Osteoarthritis knee, WOMAC scores

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References


Rastogi S, Sharma VK, Chandra R, Sivaraman ST. Open Label Multicentre Trial on Safety and Efficacy of Intraarticular Hyaluronic acid in the Treatment of Osteoarthritis of the Knee – A prospective study. J Indian Acad Clin Med. 2005;6(3):232-5.

Hunter DJ, Neogi T, Hochberg MC. Quality of Osteoarthritis Management and the Need for Reform in the US. Arthritis Care Res. 2011;63(1):31-8.

Vista ES, Lau CS. What about supplements for osteoarthritis? A critical and evidenced-based review. Int J Rheumatic Diseases. 2011;14:152–8.

Feeley BT, Gallo RA, Sherman S, Williams RJ. Management of Osteoarthritis of the knee in active young patient. J Am Acad Orthopaedic Surgeons. 2010;18(7):406-16.

Rydell NW, Balazs EA. Effect of intra-articular injection of hyaluronic acid on the clinical symptoms of osteoarthritis and on granulation tissue formation. Clin Orthop. 1971;80:25-32.

Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomizedcontrolled trials. J Bone Joint Surg Am. 2004;86(3):538-45.

Aggarwal A, Sempowski IP. Hyaluronic acid injections for knee osteoarthritis, Systematic review of the literature. Can Fam Physician. 2004;50:249-56.

Toh EM, Prasad PS, Teanby D. Correlating the efficacy of kneeviscosupplementation with osteoarthritic changes on roentgenlogical examination. Knee. 2002;9(4):321-30.

Lohmander LS, Dalen N, Englund G, Hämäläinen M, Jensen EM, Karlsson K, et al. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, doubleblind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. Ann Rheum Dis. 1996;55(7):424-31.

Kemper F, Gebhardt U, Meng T, Murray C. Tolerability and short-termeffectiveness of hylan G-F 20 in 4253 patients with osteoarthritis of the kneein clinical practice. Curr Med Res Opin. 2005;21(8):1261-9.

Migliore A, Tormenta S, Massafra U, Bizzi E, Iannessi F, Alimonti A, et al. Intra-articular administration ofhylan G-F 20 in patients with symptomatic hip osteoarthritis: tolerability andeffectiveness in a large cohort study in clinical practice. Curr Med Res Opin. 2008;24:1309-16.

Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Müllner M. Intraarticular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005;172:1039-43.

Lundsgaard C, Dufour N, Fallentin N, Winkel P, Gluud C. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versusphysiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial. Scand J Rheumatol. 2008;37:142–50.

Jevsevar DS. Treatment of osteoarthritis of the Knee Evidence based guidelines. 2nd ed. J Am Acad Orthop Surg. 2013;21(9):571-6.