Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison

Abstract

Introduction:Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative disease characterized by deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence, joint positive for TMJ noise with jaw movement or function, crepitus detected on palpation on opening, closing, right/left lateral, or protrusive movement. Hyaluronic acid (HA) is a polysaccharide of the family of glycosaminoglycans. HA has been shown to improve and restore normal lubrication in joint, provide nutrition to the avascular articulating disc, and stabilize the joint.Materials and Methods:Twenty patients with OA of TMJ with age limit between 18 and 60 years of age were enrolled in this study. Patients were randomly divided into two groups, in which one group received arthrocentesis only, and another group received arthrocentesis plus intra-articular injection of sodium HA (0.5 ml) in superior joint space in a cycle of 5 weekly arthrocentesis (one per week). Patients were followed at regular interval of 1st day, 5th day, 7th day, 4 weeks, 6 weeks, and 12 weeks. Assessment of clinical outcome was done in terms of reduction in pain (visual analog scale score), maximum mouth opening (MMO) in millimeters, painful/pain-free lateral or protrusive jaw movement, and clicking/crepitus in joint.Results:Significant reduction in pain was observed in both the groups. MMO, lateral and protrusive movements improved significantly in both groups; however, arthrocentesis with sodium HA was superior to arthrocentesis alone.Conclusion:Combination of arthrocentesis with HA injection showed much better outcome than arthrocentesis alone.

Evaluation of the therapeutic potentials of adipose Derived stem cells in comparison to hyaluronic acid in temporomandibular joint osteoarthritis A multi assessment study

“…Although this study didn't use arthrocentesis but it casts a shadow on the minimal potential of hyaluronic acid in treatment of TMJ/OA. Likewise, Gurung, et al [29] in 2017 obtained similar results where the mild reparative ability of hyaluronic acid on the osteoarthritic degeneration was manifested using CBCT .Similar results were attained by Sun, et al [49] where the hyaluronate injection in the osteoarthritic joints improved the clinical symptoms but it failed to quit the progression of joint degeneration.…”

“…Gurung et al [29] , in 2017 conducted a study comparing the effect of arthrocentesis alone and coupled with for 3 -5 consecutive weeks in contrast to our single technique. Yet, Hegab, et al [33] in 2015 reported the short term effectiveness of HA on symptoms associated with TMJ/OA inspite of repeating the technique for three consecutive weeks.…”

Short-Term Effects of Intra-Articular Hyaluronic Acid Administration in Patients with Temporomandibular Joint Disorders

“…However, that study did not distinguish between muscle and joint pain, in a typically synthetic approach that dominates the research on the effectiveness of TMD treatment with joint rinsing and viscosupplementation. The study by Gurung et al [25] on the effectiveness of intra-articular HA injections as an additional procedure performed after rinsing the joint cavity is no exception. In the studied group of 10 patients, the pain intensity expressed on the VAS scale decreased from 5.9 to 1.3, i.e., by 78%, compared to a 56% pain reduction following joint rinsing only.…”

“…The possibility of combining joint rinsing with HA viscosupplementation should also be considered. In a unique study by Gurung et al [25], the highest efficacy in improving chewing function by using this combination of therapies was demonstrated. The amplitude of mandibular opening in the group of patients treated with a combination of joint rinsing and viscosupplementation was 13% higher than in the control group treated with joint rinsing alone.…”

Therapeutic effects of arthrocentesis in treatment of temporomandibular joint disorders

“…Treatment with arthrocentesis is very effective and the results are comparable to arthroscopy or arthrotomy. The success of arthrocentesis is indicated in 70-80 % of cases, which is comparable to arthroscopy (more than an 80 % success rate) (9,11,15,25,27).…”