Download PDF
J Knee Surg 2016; 29(01): 063-067
DOI: 10.1055/s-0034-1394300
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Efficacy and Safety of a Biweekly Viscosupplementation Regimen for Knee Osteoarthritis

Marina Yiasemidou
1   Academic Surgical Unit, St. James University Hospital, Leeds, West Yorkshire, United Kingdom
,
Usama Munir
2   Department of Trauma and Orthopaedics, Whiston Hospital, Prescot, Merseyside, United Kingdom
,
Daniel Glassman
3   General Surgery Department, Pinderfields Hospital, Wakefield, West Yorkshire, United Kingdom
,
David Teanby
2   Department of Trauma and Orthopaedics, Whiston Hospital, Prescot, Merseyside, United Kingdom
› Author Affiliations
Further Information

Publication History

18 June 2014

01 September 2014

Publication Date:
22 October 2014 (online)

    Permissions and Reprints

Abstract

Osteoarthritis is the most common form of arthritis in the Western world, causing disabling symptoms in 10% of people older than 55 years. Hyaluronic acid injections can reduce osteoarthritic pain but require three to five doses administered weekly. This preliminary study aims to assess the efficacy of a more flexible viscosupplementation regimen. Patients were given three sodium hyaluronate isotonic solution injections (Ostenil; TRB Chemedica SA, Vouvry, Switzerland), biweekly. They were then asked to record their pain before and after administration of the injections, on a visual analog score. A total of 91 knees were injected. Analysis of the data showed that the viscosupplementation injections significantly reduced the baseline pain within the first 24 to 48 hours post first injection (before injection, 68.8mm; 2 days postinjection, 48.9 mm; p < 0.001); these effects were maintained up to 6 months. No adverse effects were reported. The proposed regimen appears safe and efficient in reducing osteoarthritic pain of the knee joint. A randomized controlled study is needed to confirm these results.

Keywords

knee osteoarthritis - viscosupplementation - pain control
 

  • References

  • 1 Pathological features of osteoarthritis. Available at: http://www.wheelessonline.com/ortho/pathological_features_of_osteoarthritis
    PubMed
  • 2 Navarro-Sarabia F, Coronel P, Collantes E , et al; AMELIA study group. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Ann Rheum Dis 2011; 70 (11) 1957-1962
    CrossrefPubMedGoogle Scholar
  • 3 Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. JAMA 2003; 290 (18) 2443-2454
    CrossrefPubMedGoogle Scholar
  • 4 Jordan KM, Arden NK, Doherty M , et al; Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12) 1145-1155
    CrossrefPubMedGoogle Scholar
  • 5 McArthur BA, Dy CJ, Fabricant PD, Valle AG. Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee. Patient Prefer Adherence 2012; 6: 905-910
    PubMedGoogle Scholar
  • 6 Dieppe P, Basler H-D, Chard J , et al. Knee replacement surgery for osteoarthritis: effectiveness, practice variations, indications and possible determinants of utilization. Rheumatology (Oxford) 1999; 38 (1) 73-83
    CrossrefPubMedGoogle Scholar
  • 7 Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am 2005; 87 (7) 1487-1497
    CrossrefPubMedGoogle Scholar
  • 8 Wylde V, Dieppe P, Hewlett S, Learmonth ID. Total knee replacement: is it really an effective procedure for all?. Knee 2007; 14 (6) 417-423
    CrossrefPubMedGoogle Scholar
  • 9 Carr AJ, Robertsson O, Graves S , et al. Knee replacement. Lancet 2012; 379 (9823) 1331-1340
    CrossrefPubMedGoogle Scholar
  • 10 British Orthopaedic Association; British Association for Surgery of the Knee. Knee Replacement A Guide to Good Practice. London: British Orthopaedic Association; 1999
    Google Scholar
  • 11 Della Valle C, Rosenberg A, Indications for total knee replacement. In: Callaghan J, Rosenberg A, Rubash H, Simonian P, Wickiewicz T. , eds. The Adult Knee. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2003: 1047-1057
    Google Scholar
  • 12 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; 2 (2) CD005321
    PubMedGoogle Scholar
  • 13 Goldberg VM, Goldberg L. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. J Pain Res 2010; 3: 51-56
    PubMedGoogle Scholar
  • 14 Strauss EJ, Hart JA, Miller MD, Altman RD, Rosen JE. Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions. Am J Sports Med 2009; 37 (8) 1636-1644
    CrossrefPubMedGoogle Scholar
  • 15 Brockmeier SF, Shaffer BS. Viscosupplementation therapy for osteoarthritis. Sports Med Arthrosc 2006; 14 (3) 155-162
    CrossrefPubMedGoogle Scholar
  • 16 Altman RD, Rosen JE, Bloch DA, Hatoum HT, Korner P. A double-blind, randomized, saline-controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis of the knee, with an open-label safety extension (the FLEXX trial). Semin Arthritis Rheum 2009; 39 (1) 1-9
    CrossrefPubMedGoogle Scholar
  • 17 Watterson JR, Esdaile JM. Viscosupplementation: therapeutic mechanisms and clinical potential in osteoarthritis of the knee. J Am Acad Orthop Surg 2000; 8 (5) 277-284
    PubMedGoogle Scholar
  • 18 Goldberg VM, Buckwalter JA. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage 2005; 13 (3) 216-224
    CrossrefPubMedGoogle Scholar
  • 19 Henderson EB, Smith EC, Pegley F, Blake DR. Intra-articular injections of 750.  kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy. Ann Rheum Dis 1994; 53 (8) 529-534
    CrossrefPubMedGoogle Scholar
  • 20 Jones AC, Pattrick M, Doherty S, Doherty M. Intra-articular hyaluronic acid compared to intra-articular triamcinolone hexacetonide in inflammatory knee osteoarthritis. Osteoarthritis Cartilage 1995; 3 (4) 269-273
    CrossrefPubMedGoogle Scholar
  • 21 Lohmander LS, Dalén N, Englund G , et al; Hyaluronan Multicentre Trial Group. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial. Ann Rheum Dis 1996; 55 (7) 424-431
    CrossrefPubMedGoogle Scholar
  • 22 Huskisson EC, Donnelly S. Hyaluronan Multicentre Trial Group. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology (Oxford) 1999; 38 (7) 602-607
    CrossrefPubMedGoogle Scholar
  • 23 Day R, Brooks P, Conaghan PG, Petersen M. Multicenter Trial Group. A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticular hyaluronan in osteoarthritis of the knee. J Rheumatol 2004; 31 (4) 775-782
    PubMedGoogle Scholar
  • 24 WMA Declaration of Helsinki—Ethical Principles for Medical Research Involving Human Subjects. Available at: http://www.wma.net
    PubMedGoogle Scholar
  • 25 Ahlbäck S. Osteoarthrosis of the knee. A radiographic investigation. Acta Radiol Diagn (Stockh) 1968; 277: 7-72
    PubMedGoogle Scholar
  • 26 Palmieri B, Rottigni V, Iannitti T. Preliminary study of highly cross-linked hyaluronic acid-based combination therapy for management of knee osteoarthritis-related pain. Drug Des Devel Ther 2013; 7: 7-12
    PubMedGoogle Scholar
  • 27 Tikiz C, Unlü Z, Sener A, Efe M, Tüzün C. Comparison of the efficacy of lower and higher molecular weight viscosupplementation in the treatment of hip osteoarthritis. Clin Rheumatol 2005; 24 (3) 244-250
    CrossrefPubMedGoogle Scholar
  • 28 Balazs EA, Leshchiner A. Biomatrix, Inc., assignee. Hylan preparation and method of recovery thereof from animal tissues. US Patent 5, 099, 013; March 24, 1992
    PubMedGoogle Scholar
  • 29 Wobig M, Bach G, Beks P , et al. The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee: a comparison of hylan G-F 20 and a lower-molecular-weight hyaluronan. Clin Ther 1999; 21 (9) 1549-1562
    CrossrefPubMedGoogle Scholar
  • 30 Bayramoğlu M, Karataş M, Çetin N, Akman N, Sözay S, Dilek A. Comparison of two different viscosupplements in knee osteoarthritis: a pilot study. Clin Rheumatol 2003; 22 (2) 118-122
    CrossrefPubMedGoogle Scholar
  • 31 Karlsson J, Sjögren LS, Lohmander LS. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology (Oxford) 2002; 41 (11) 1240-1248
    CrossrefPubMedGoogle Scholar
  • 32 Frizziero L, Govoni E, Bacchini P. Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: clinical and morphological study. Clin Exp Rheumatol 1998; 16 (4) 441-449
    PubMedGoogle Scholar
  • 33 Altman RD, Moskowitz R. Hyalgan Study Group. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. J Rheumatol 1998; 25 (11) 2203-2212
    PubMedGoogle Scholar
  • 34 Tasciotaoglu F, Oner C. Efficacy of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Clin Rheumatol 2003; 22 (2) 112-117
    CrossrefPubMedGoogle Scholar
  • 35 Neustadt DH. Long-term efficacy and safety of intra-articular sodium hyaluronate (Hyalgan) in patients with osteoarthritis of the knee. Clin Exp Rheumatol 2003; 21 (3) 307-311
    PubMedGoogle Scholar
  • 36 Maheu E, Ayral X, Dougados M. A hyaluronan preparation (500-730 kDa) in the treatment of osteoarthritis: a review of clinical trials with Hyalgan. Int J Clin Pract 2002; 56 (10) 804-813
    PubMedGoogle Scholar
  • 37 Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 1998; 20 (3) 410-423
    CrossrefPubMedGoogle Scholar
  • 38 Brandt KD, Block JA, Michalski JP, Moreland LW, Caldwell JR, Lavin PT. ORTHOVISC Study Group. Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. Clin Orthop Relat Res 2001; (385) 130-143
    PubMedGoogle Scholar
  • 39 Leopold SS, Redd BB, Warme WJ, Wehrle PA, Pettis PD, Shott S. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee. A prospective, randomized trial. J Bone Joint Surg Am 2003; 85-A (7) 1197-1203
    PubMedGoogle Scholar
  • 40 Reichenbach S, Blank S, Rutjes AW , et al. Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis. Arthritis Rheum 2007; 57 (8) 1410-1418
    CrossrefPubMedGoogle Scholar
  • 41 Huang TL, Chang CC, Lee CH, Chen SC, Lai CH, Tsai CL. Intra-articular injections of sodium hyaluronate (Hyalgan®) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the Asian population. BMC Musculoskelet Disord 2011; 12: 221
    CrossrefPubMedGoogle Scholar