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

Campos, André Luiz Siqueira; Albuquerque, Rodrigo Satamini Pires e; Silva, Edmilson Barbosa da; Fayad, Sami Gobbi; Acerbi, Lucas Delunardo; Almeida, Felipe Nunes de; Ooka, Nelson Hiroyuki Myiabe; Franco, José Sergio; Gameiro, Vinícius Schott

doi:10.1007/s00264-017-3625-9

Cited by 19 publications

(15 citation statements)

References 15 publications

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“…The effects of VS with Hylan G-F 20 and triamcinolone alone and in combination were also compared. In one study, this combination improved pain, mainly in the first week after infiltration (9), while in another study, the improvements in the functional scores lasted up to three months (27). Another study involving 47 patients showed that the same combination improves subjective pain and function (28).…”

Section: Discussionmentioning

confidence: 99%

Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

Maia

Cossich

Salles-Neto

et al. 2019

Clinics

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OBJECTIVES:This study aimed to evaluate the clinical outcomes of intra-articular infiltration with hyaluronic acid and dexamethasone alone and in combination in the treatment of knee osteoarthritis (OA).METHOD:This prospective randomized trial evaluated 44 patients undergoing treatment for OA. Patients were selected through clinical and radiological analysis using the American College of Rheumatology criteria. We included patients aged between 50 and 70 years who presented with K-L stage ≤2 knee OA and normal limb alignment. Patients with a previous history of knee injury (ligamentous, meniscal or traumatic), infection, patellofemoral OA or chondroprotective drug use in the previous year were excluded. Participants were randomized into 3 groups and underwent treatment with viscosupplementation (VS, n=16), viscosupplementation plus dexamethasone (VD, n=16) or dexamethasone (DX, n=12). All patients were evaluated before and 6 weeks, 3 months and 6 months after infiltration. Analysis included a physical examination, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire (total score and domain subscores) and an evaluation of knee extensor and flexor strength and proprioception using an isokinetic dynamometer.RESULTS:VS significantly improved the WOMAC total score and subscores for pain, stiffness and function for up to 6 months after infiltration. It also improved knee extensor and flexor strength during the same period. Proprioception was not affected by any of the treatments.CONCLUSIONS:VS alone improved pain, stiffness and function according to the WOMAC total score and subscores and improved knee extensor and flexor strength, but not proprioception, for up to six months after infiltration. These findings suggest that VS has a positive effect on quadriceps arthrogenic inhibition.

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Section: Discussionmentioning

confidence: 99%

Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

Maia

Cossich

Salles-Neto

et al. 2019

Clinics

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“…Particularly high patient satisfaction can be expected when using “complete joint space collapse” as indication for TKA surgery. In the case of incomplete joint space collapse, further conservative therapy [21, 24] or joint preserving knee surgery [25] might be considered an alternative to TKA.…”

Section: Discussionmentioning

confidence: 99%

Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Liebensteiner

Wurm

Gamper

et al. 2018

International Orthopaedics (SICOT)

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Aim of the study To determine if pre-operative radiologic minimal joint space width (mJSW) is related to the outcome of total knee arthroplasty (TKA) (primary hypothesis). Likewise, the aim was to test if pre-operative mJSW is related to prosthesis survival (secondary hypothesis). Methods A retrospective comparative analysis was performed. Group 1 was comprised of patients with pre-operative mJSW 0–1 mm. Group 2 were patients with pre-operative mJSW ≥ 2 mm. The clinical outcome was determined with the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) score pre-operatively and one year after TKA. Only patients with pre-operative weight-bearing radiographs and complete WOMAC score data were accepted. Results Available for analysis were 377 patients, of whom 188 were allocated to Group 1 (118 female, 70 male, age 70 ± 11 years) and 189 to Group 2 (118 female, 71 male, age 70 ± 13 years). Pre-operative WOMAC total and WOMAC subscores showed no significant differences between groups. Post-operatively, the WOMAC total was significantly better in Group 1 than in Group 2, 10 ± 22 and 19 ± 31, respectively ( p < 0.001, Power 97.5%). Similarly, the WOMAC subscores for pain, stiffness, and function were also significantly better in Group 1 than in Group 2. Five-year prosthesis survival was 94.2 and 91.6% in Groups 1 and 2, respectively ( p = 0.07, Power 71%). Discussion Patients with pre-operative complete joint space collapse (0 to 1 mm mJSW) achieve a significantly better WOMAC result from TKA than do those with a mJSW equal to or greater than 2 mm. From our findings, it is recommended that “complete joint space collapse” especially be used as an indication for TKA surgery. Conclusion Our study was underpowered to sufficiently show an effect of pre-operative mJSW on prosthesis survival. Electronic supplementary material The online version of this article (10.1007/s00264-018-4185-3) contains supplementary material, which is available to authorized users.

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“…A recent randomised clinical trial demonstrated improvement of pain and function in patients with severe OA of the knee. 28 Waddel et al 29 found that total knee arthroplasty was delayed by more than 7 years in 75% of 1863 knees with grade IV osteoarthritis (1342 patients) who had used viscosupplementation. The European Consensus 23 also states that viscosupplementation may be beneficial in cases of severe osteoarthritis of the knees.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding advanced stages of knee osteoarthritis, although the use of VS as an alternative to a knee prosthesis is not an ideal indication, it can bring benefits to those patients who cannot or do not wish to undergo total knee arthroplasty surgery. 23 , 28 …”

Section: Discussionmentioning

confidence: 99%

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

et al. 2019

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Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.

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

Abstract: 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.

Cited by 19 publications

References 15 publications

Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

Patient satisfaction after total knee arthroplasty is better in patients with pre-operative complete joint space collapse

Brazilian Consensus Statement on Viscosupplementation of the Knee (Cobravi)

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