Viscosupplementation in patients with severe osteoarthritis of the knee: six month follow-up of a randomized, double-blind clinical trial

Abstract

Purpose

To analyze the early outcomes of viscosupplementation in patients with severe knee osteoarthritis.

Method

A randomized, double-blind clinical trial of 143 knees divided into three groups: Group 1 – intra-articular injection of triamcinolone; Group 2 – hylan GF20; and Group 3 – triamcinolone + hylan GF20. Outcomes were evaluated using Lysholm and KSS scores before treatment and after one, three and six months.

Results

Within-group comparisons revealed improvements in Lysholm scores in all groups in the one month evaluation relative to pre-treatment levels (p < 0.01). This improvement was maintained in the third month after treatment (p > 0.05). Scores at six months were significantly lower than those observed in the previous follow-up assessments (p < 0.05), but still higher than pre-treatment levels (p < 0.05). KSS scores also improved after one month relative to pre-treatment levels (p < 0.01). This improvement was still present at three and six months after treatment in the corticosteroid group (p > 0.05). Patients treated with hylan GF20 showed lower scores in the last evaluation relative to month one (p < 0.05). No significant differences were observed between the treatment groups (p > 0.05).

Conclusions

Viscosupplementation increased functional scores in patients with severe osteoarthritis of the knee, especially within three months of injection. However, it was not superior to the use of triamcinolone.

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References

  1. 1.

    Scott WN (2012) Insall and Scott: surgery of the knee. Churchill Livingstone/Elsevier, London

    Google Scholar 

  2. 2.

    Windsor RE, Scuderi GR, Moran MC, Insall JN (1989) Mechanisms of failure of the femoral and tibial components in total knee arthroplasty. Clin Orthop Relat Res 248:15–19 discussion 19-20

  3. 3.

    Wang F, He X (2015) Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: a meta-analysis. Exp Ther Med 9:493–500. https://doi.org/10.3892/etm.2014.2131

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    de Campos GC, de Rezende MU, Pailo AF, Frucchi R, Pasqualim T, de Camargo OP (2013) Adding corticosteroid to viscosupplementation: three-month follow-up clinicaltrial. Rev Bras Ortop 48:322–329. https://doi.org/10.1016/j.rbo.2012.08.006

    Article  Google Scholar 

  5. 5.

    de Rezende MU, de Campos GC (2012) Viscosuplementation. Rev Bras Ortop 47:160–164

    Article  PubMed  Google Scholar 

  6. 6.

    de Campos GC, Rezende MU, Pailo AF, Frucchi R, Camargo OP (2013) Adding triamcinolone improves viscosupplementation: a randomized clinical trial. Clin Orthop Relat Res 471:613–620. https://doi.org/10.1007/s11999-012-2659-y

    Article  PubMed  Google Scholar 

  7. 7.

    Campbell KA, Erickson BJ, Saltzman BM, Mascarenhas R, Bach BR Jr, Cole BJ, Verma NN (2015) Is local Viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: a systematic review of overlapping meta-analyses. Arthroscopy 31(2036–45):e14. https://doi.org/10.1016/j.arthro.2015.03.030

    Google Scholar 

  8. 8.

    Ishijima M, Nakamura T, Shimizu K, Hayashi K, Kikuchi H, Soen S, Omori G, Yamashita T, Uchio Y, Chiba J, Ideno Y, Kubota M, Kurosawa H, Kaneko K, Research Group of Cartilage M (2014) Intra-articular hyaluronic acid injection versus oral non-steroidal anti-inflammatory drug for the treatment of knee osteoarthritis: a multi-center, randomized, open-label, non-inferiority trial. Arthritis Res Ther 16:R18. https://doi.org/10.1186/ar4446

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Ayhan E, Kesmezacar H, Akgun I (2014) Intraarticular injections (corticosteroid, hyaluronic acid, platelet rich plasma) for the knee osteoarthritis. World J Orthop 5:351–361. https://doi.org/10.5312/wjo.v5.i3.351

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Roque V, Agre M, Barroso J, Brito I (2013) Managing knee ostheoarthritis: efficacy of hyaluronic acid injections. Acta Reumatol Port 38:154–161

    CAS  PubMed  Google Scholar 

  11. 11.

    Petrella RJ (2005) Hyaluronic acid for the treatment of knee osteoarthritis: long-term outcomes from a naturalistic primary care experience. Am J Phys Med Rehabil 84:278–283 quiz 284, 293

    Article  PubMed  Google Scholar 

  12. 12.

    Weick JW, Bawa HS, Dirschl DR (2016) Hyaluronic acid injections for treatment of advanced osteoarthritis of the knee: utilization and cost in a national population sample. J Bone Joint Surg Am 98:1429–1435. https://doi.org/10.2106/JBJS.15.01358

    Article  PubMed  Google Scholar 

  13. 13.

    Waddell DD, Joseph B (2016) Delayed total knee replacement with Hylan G-F 20. J Knee Surg 29:159–168. https://doi.org/10.1055/s-0034-1395281

    PubMed  Google Scholar 

  14. 14.

    Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M (2008) The placebo effect and its determinants in osteoarthritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 67:1716–1723. https://doi.org/10.1136/ard.2008.092015

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Hepper CT, Halvorson JJ, Duncan ST, Gregory AJ, Dunn WR, Spindler KP (2009) The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg 17:638–646

    Article  PubMed  Google Scholar 

  16. 16.

    Tammachote N, Kanitnate S, Yakumpor T, Panichkul P (2016) Intra-articular, single-shot hylan G-F 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. J Bone Joint Surg Am 98:885–892. https://doi.org/10.2106/JBJS.15.00544

    Article  PubMed  Google Scholar 

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Correspondence to André Luiz Siqueira Campos.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Campos, A.L.S., e Albuquerque, R.S.P., da Silva, E.B. et al. Viscosupplementation in patients with severe osteoarthritis of the knee: six month follow-up of a randomized, double-blind clinical trial. International Orthopaedics (SICOT) 41, 2273–2280 (2017). https://doi.org/10.1007/s00264-017-3625-9

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Keywords

  • Knee
  • Osteoarthritis
  • Treatment
  • Viscosupplementation