The effects of ultrasound-guided corticosteroid injection compared to oxygen–ozone (O2–O3) injection in patients with knee osteoarthritis: a randomized controlled trial

Abstract

Osteoarthritis (OA) is a chronic multifactorial disease characterized by progressive joint degeneration. The purpose of this study was to compare the effects of ultrasound-guided corticosteroid injection with oxygen-ozone injection in patients with knee OA. This double-blind randomized clinical trial was performed on 62 patients with knee OA. The patients were randomly divided into two groups. In the first group 40 mg triamcinolone (1 cc) and in the second group 10 cc (15 μg/ml) oxygen-ozone (O-O) were injected into the knee joint under ultrasound guidance. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis (WOMAC), knee flexion range of motion (ROM), effusion in ultrasound images of the suprapatellar recess, and visual analog scale (VAS), which were evaluated before injection, 1 week, 1 month, and 3 months after the treatment. Sixty-two patients (10 men and 52 women) were enrolled with mean age of 57.9 years. VAS improved in both groups (steroid P value = 0.001, oxygen-ozone P value > 0.001). The improvements seen in VAS and WOMAC scores 3 months after treatment were in favor of the oxygen-ozone group when compared to the steroid group (P = 0.041 vs P = 0.19). There was no significant difference between the two groups in ROM and joint effusion seen under ultrasound (ROM p = 0.880, effusion p = 0.362). However, in the oxygen-ozone-receiving group, joint effusion was decreased significantly (p < 0.001). Both steroid and oxygen-ozone injections are effective in patients with knee osteoarthritis. Our study showed that the effects of oxygen-ozone injection last longer than those of steroid injection to the knee joint.

Oxygen–Ozone Therapy for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

“…Flow diagrams depicting the patient selection process were reported only in 4 papers. 13,14,19,20 Finally, we found that 3 trials were prospectively registered in a public clinical trial registry, 13,14,16 one was registered retrospectively, 19 whereas the others did not mention any registration, which should be mandatory according to the Consolidated Standards of Reporting Trials 2010 guidelines.…”

“…A detailed description of each study has been provided in Table 1. 8,[13][14][15][16][17][18][19][20][21][22] Study Design and Quality All studies were, as per inclusion criteria, RCTs. The study designs were highly variable: patients in the control groups received different injection or treatment, such as HA in 3 studies; corticosteroids in 4 studies; and placebo, hypertonic dextrose, radiofrequency, or celecoxib þ glucosamine in the remaining 4 studies.…”

“…In regards to the random sequence generation process, it was not specified in 3 papers, whereas it was based on odd/even number in the study of Chansoria et al 21 The method of allocation concealment was described in nearly none of the studies included, except for 2. 13,14 Four papers reported outcomes incompletely. [15][16][17][18] Regarding sample size calculation, in all the included trials the power analysis methods were not fully clarified.…”

“…All papers except one 15 performed a radiographic assessment before treatment and classified patients according to Kellgren-Lawrence (K-L) grading system. Five papers included patients with radiographic K-L grades II-III, 13,16,17,19,20 4 papers included patients with radiographic K-L grades I-II, 8,18,21,22 whereas Babaei-Ghazani et al 14…”

El paradigma del ozono en el tratamiento del dolor

“…A nivel articular, y especialmente en la gonalgia por artrosis de rodilla, también se han publicado artículos que consolidan el uso del ozono mostrando su eficacia versus placebo, plasma rico en plaquetas, ácido hialurónico y corticoides (15)(16)(17)(18); asimismo, una revisión sistemática remarca esa eficacia en el metanálisis obtenido (19). En este número de la Revista de la Sociedad Española del Dolor se presenta un interesante e innovador artículo de Fernández-Cuadros ME y cols., sobre la repercusión del tratamiento con ozono en la gonartrosis, no solo sobre parámetros clínicos de eficacia, sino también, y por primera vez en la literatura científica, sobre indicadores bioquímicos y radiológicos.…”