A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee

Kirchner, M.; Marshall, Dennis C.

doi:10.1016/j.joca.2005.09.003

Cited by 107 publications

(101 citation statements)

References 22 publications

(23 reference statements)

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“…Despite its widespread use, the magnitude of the clinical effect of VS remains controversial and appears different according to the VS formulations, which differ widely in molecular weight, origin (animal or bacterial), and residence time in the joint [4,20,25,27,29]. The advantage of cross-linkage seems mainly to increase the stability and residence time of the VS in the joint.…”

Section: Introductionmentioning

confidence: 99%

“…The advantage of cross-linkage seems mainly to increase the stability and residence time of the VS in the joint. However, other studies suggest the noncross-linked VS effect is comparable with that of the cross-linked system [27,43], and to date, no definitive conclusion has been reached regarding any advantage of cross-linkage on the clinical benefit [2,27,29,33,52,59]. Therefore, techniques aimed at investigating variations of HA (concentration and molecular weight) and rheologic changes attributable to VS are needed to better understand its mechanisms of action and to determine possible differences between different HA commercial formulations.…”

Section: Introductionmentioning

confidence: 99%

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Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study

Mathieu

Conrozier

Vignon

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Viscosupplementation is a symptomatic treatment of osteoarthritis (OA) intended to restore rheologic homeostasis of the synovial fluid by injecting hyaluronic acid intraarticularly. Despite the long history of this therapy, little is known about its mechanisms of action and differences between commercial preparations. We investigated the rheologic behavior of OA synovial fluid with time, when stored at 4°C, before and after the addition of two hyaluronic acid commercial preparations (linear and cross-linked). Thirteen OA synovial fluids were stored at 4°C and assayed using steric exclusion chromatography, which allows hyaluronic acid to be separated from the remaining pool of proteins and its molecular weight and concentration to be determined without any pretreatment and calibration. The synovial fluid rheology also was studied in vitro, before and after addition of two viscosupplements, over 6 weeks. The non-Newtonian behavior of synovial fluid throughout followup appears to be the result of loose interactions between proteins and hyaluronic acid. When mixed with the linear hyaluronic acid, synovial fluid becomes less non-Newtonian whereas the non-Newtonian behavior was reinforced when mixed with the cross-linked hyaluronic acid. The rheology was nearly unchanged for all synovial fluids over 6 weeks. Our preliminary trial shows it is possible to study synovial fluid, stored at 4°C, over a long time and suggests the enzymatic degradation of hyaluronic acid is negligible under these experimental conditions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study

Mathieu

Conrozier

Vignon

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…Although evidence on its effectiveness is still accruing from randomised controlled clinical trials (RCTs) (Aggarwal and Sempowski, 2004;Atamaz et al, 2006;Kirchner and Marshall, 2006;Kotevoglu et al, 2006;Lee et al, 2006;Lo et al, 2003;Paker et al, 2006;Petrella and Petrella, 2006), the updated Cochrane systematic review of 76 RCTs published up to January 2006 found benefi cial effects on pain, function and patient global assessment, most notably fi ve to 13 weeks after the period of injections (Bellamy et al, 2006). These provide cautious support for the use of intra-articular HA, although several areas of uncertainty remain.…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes from a physiotherapist‐led intra‐articular hyaluronic acid injection clinic

Birchall

Ismail

Peat

2008

Musculoskeletal Care

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“…The majority of adverse events were transient pain, stiffness, swelling, or joint effusion in the treated knee that resolved within a few days without sequelae. The study performed by Kirchner and Marshall 26 showed a higher incidence of postinjection effusion in the cross-linking hyaluronic acid group, which provides a safety advantage for biological hyaluronic acid. These data suggest that biological hyaluronic acid has an improved benefit-risk profile compared with cross-linking hyaluronic acid.…”

Section: Safetymentioning

confidence: 93%

Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20

Migliore¹

2010

ORR

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Background: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease. Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc ® ) in the management of joint pain in knee osteoarthritis. Methods: Three databases were searched, ie, Medline (1970Medline ( -2010, the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references. Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy. Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.

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A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee

Abstract: The effectiveness of Bio-HA was not inferior to that of CL-HA. The significantly higher incidence of post-injection effusion in the CL-HA group provides a safety advantage for Bio-HA. These data suggest that Bio-HA has an improved benefit-risk profile compared with CL-HA.

Cited by 107 publications

References 22 publications

Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study

Rheologic Behavior of Osteoarthritic Synovial Fluid after Addition of Hyaluronic Acid: A Pilot Study

Clinical outcomes from a physiotherapist‐led intra‐articular hyaluronic acid injection clinic

Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20

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