Abstract
Background
In the present study, patients with symptomatic knee osteoarthritis (OA) were treated with single intra-articular injection of a high molecular weight, non-cross-linked hyaluronic acid (HA), highly concentrated (2%) and associated with sorbitol (4%). The aims of this study were to (1) evaluate clinical outcome after 6 months, (2) evaluate clinical outcomes after 12 months and (3) evaluate clinical outcomes according to OA grade. Hypothesis of the study was that a single intra-articular injection of this HA associated with sorbitol leads to a significant clinical improvement within 6 months in patients with early or moderate knee OA.
Materials and methods
A total of 77 patients were enrolled in this prospective multicentric study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score was recorded at baseline and at months 1, 3, 6 and 12 following the intra-articular injection. Moreover, a stratified analysis of all WOMAC items following the OA grade was performed for both groups of patients, one with low (grade I–II according to Kellgren–Lawrence classification) and another with moderate OA grade (grade III according to Kellgren–Lawrence) and the differences between groups were evaluated.
Results
Seventy-three patients completed the 12 months follow-up. Pain, stiffness, functional limitation and total scores were significantly reduced at 1, 3 and 6 months (p < 0.05), but not at 12 months. Stratified analysis of all subscores according to OA grade showed that pain, functional limitation and total score decreased at 1, 3, 6 and 12 months (p < 0.05) in both groups. Stiffness was the only item that decreased significantly at 1, 3 and 6 months but not at 12 months in both groups. All subscore values were significantly lower in the group of patients with low OA grade compared to the one with moderate OA grade. No adverse events were reported.
Conclusion
At 6 months after a single intra-articular injection of a high molecular weight, non-cross-linked HA associated with sorbitol, WOMAC scores decreased significantly. Clinical benefits were observed both in patients with low and in those with moderate OA grade, with better results in the first group.
Similar content being viewed by others
References
Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 58(1):15–25
Madden CC, Putukian M, McCarty EC, Young CC (2010) Netter's sports medicine. In: Mayo clin proc., vol 85. Saunders, Philadelphia, p 69
Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE (2015) Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med 162:46–54
Cyphert JM, Trempus CS, Garantziotis S (2015) Size matters: molecular weight specificity of hyaluronan effects in cell biology. J Cell Biol 2015:1–8
Jevsevar D, Donnelly P, Brown G, Cummins D (2015) Viscosupplementation for osteoarthritis of the knee: a systematic review of the evidence. J Bone Joint Surg Am 97:2047–2060
Johal J, Devji T, Schemitsch EH, Bhandari M (2016) Viscosupplementation in knee osteoarthritis: evidence revisited. JBJS Rev 4(4):e11–e111
Kellgren JH, Lawrence JS (1952) Rheumatism in miners. II. X-ray study. Br J Ind Med 9:197–207
Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. https://europepmc-org.ezproxy.unibo.it/abstract/med/3068365
Bannuru RR, Natov NS, Dasi UR et al (2011) Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis–meta-analysis. Osteoarthr Cartil 19(6):611–619
Rutjes AW, Jüni P, da Costa BR et al (2012) Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med 157(3):180–191
Dıracoglu D, Tuncay TB, Sahbaz T et al (2016) Single versus multiple dose hyaluronic acid: comparison of the results. J Back Musculoskelet Rehabil 29(4):881–886
Sun SF, Hsu CW, Lin HS et al (2017) Comparison of single intra-articular injection of novel hyaluronan (HYA-JOINT Plus) with synvisc-one for knee osteoarthritis: a randomized, controlled, double-blind trial of efficacy and safety. J Bone Joint Surg Am 99(6):462–471
Manias E, Claydon-Platt K, McColl GJ et al (2007) Managing complex medication regimens: perspectives of consumers with osteoarthritis and healthcare professionals. Ann Pharmac 41(5):764–771
Posnett J, Dixit S, Oppenheimer B et al (2015) Patient preference and willingness to pay for knee osteoarthritis treatments. Patient Prefer Adherence 9:733–744
Zhang W, Moskowitz RW, Nuki G (2008) OARSI recommendations for the management of hip and knee osteoarthritis, part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest regarding the publication of this paper.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cucurnia, I., Pudda, A., Madonna, V. et al. Patient-reported outcomes of intra-articular hyaluronic acid for osteoarthritis of the knee: a prospective and multicentric case series. Musculoskelet Surg 106, 303–310 (2022). https://doi.org/10.1007/s12306-021-00698-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-021-00698-8