Functional Outcome of Intra-Articular Hyaluronic Acid Injection in Osteoarthritis of Knee Joint
Pharmaceutical Science-Orthopaedics
DOI:
https://doi.org/10.22376/ijlpr.2023.13.5.P255-P272Keywords:
Osteoarthritis, Knee, Hyaluronic acid, Effects, Clinical study.Abstract
Osteoarthritis/Osteoarthrosis (OA) defines an idiopathic, slowly progressive disease of the diarthrodial (synovial)joints. Intra-articular - Hyaluronic acid has been proposed to have many therapeutic mechanisms of action in the OA knee,including shock absorption, joint lubrication, anti-inflammatory effects, chondroprotection, proteoglycan synthesis, and cartilagematrix alterations. Thirty-six patients were selected for the proposed study based on eligibility criteria, study period, andfeasibility. Patients with clinical symptoms of osteoarthritis were screened based on inclusion (grades 1 and 2) and exclusioncriteria (previous history of trauma). Patients with grade I or II Osteoarthritis based on Kellegren & Lawrence grading weretaken up for the study. After obtaining informed consent, a structured interview schedule was administered to obtaininformation on their background characteristics and clinical and functional outcome of Osteoarthritis using VAS (Visual AnalogueScale) and WOMAC (The Western Ontario and McMaster Universities Osteoarthritis Index) tools. Following this, theintervention was done. All the patients were given a single injection(6ml) of high molecular weight Hyaluronic acid. This studywas done to verify safety and feasibility. Our findings suggest that intra-articular hyaluronic acid is safe for use with kneeosteoarthritis. While local and minor adverse events related to hyaluronic acid injection occurred, all symptoms disappearedwithin 48 hours.
References
Rehan-Ul-Haq. Diseases of joints. In: Jain AK, editor. Turek's orthopedics principles and their applications. 7th ed. New Delhi: Wolters Kluver (India) Pvt Ltd.; 2016p. p. 421-38.
Mangone G, Orioli A, Pinna A, Pasquetti P. Infiltrative treatment with platelet-rich plasma (PRP) in gonarthrosis. Clin Cases Miner Bone Metab. 2014;11(1):67-72. doi: 10.11138/ccmbm/2014.11.1.067, PMID 25002882.
Hassan AS, El-Shafey AM, Ahmed HS, Hamed MS. Effectiveness of the intra-articular platelet-rich plasma injection in treating patients with primary knee osteoarthritis. Egypt Rheumatol. 2015;37(3):119-24. doi: 10.1016/j.ejr.2014.11.004.
Paterson KL, Nicholls M, Bennell KL, Bates D. Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study. BMC Musculoskelet Disord. 2016;17:67. doi: 10.1186/s12891-016-0920-3, PMID 26861957.
Kellgren JH, Lawrence JS. Radiological assessment of osteoarthrosis. Ann Rheum Dis. 1957;16(4):494-502. doi: 10.1136/ard.16.4.494, PMID 13498604.
WOMAC BN. A 20-year experimental review of a patient-centered self-reported health status questionnaire. Rheumatol. 2002;29:2473-6.
Rodriguez CS. Pain measurement in the elderly: a review. Pain Manag Nurs. 2001;2(2):38-46. doi: 10.1053/jpmn.2001.23746, PMID 11706769.
Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, et al. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):528-35. doi: 10.1007/s00167-010-1238-6, PMID 20740273.
Handl M, Amler E, Bräun K, Holzheu J, Trc T, Imhoff AB, et al. Positive effect of oral supplementation with glycosaminoglycans and antioxidants on the regeneration of osteochondral defects in the knee joint. Physiol Res. 2007;56(2):243-9. doi: 10.33549/physiolres.930917, PMID 16555950.
O'Reilly SC, Muir KR, Doherty M. Effectiveness of home exercise on pain and disability from osteoarthritis of the knee: a randomized controlled trial. Ann Rheum Dis. 1999;58(1):15-9. doi: 10.1136/ard.58.1.15, PMID 10343535.
Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;5(2):54-67. doi: 10.1186/ar623, PMID 12718745.
Goldring MB. The role of cytokines as inflammatory mediators in osteoarthritis: lessons from animal models. Connect Tissue Res. 1999;40(1):1-11. doi: 10.3109/03008209909005273, PMID 10770646.
Goldring MB. Osteoarthritis and cartilage: the role of cytokines. Curr Rheumatol Rep. 2000;2(6):459-65. doi: 10.1007/s11926-000-0021-y, PMID 11123098.
Studer R, Jaffurs D, Stefanovic-Kacie M, Robbins PD, Evans CH. Nitrie oxide in osteoarthritis, Osteoarthr. Cart. 1999;7:377-9.
Kosinska MK, Ludwig TE, Liebisch G, Zhang R, Siebert HC, Wilhelm J, et al. Articular joint lubricants during osteoarthritis and rheumatoid arthritis display altered levels and molecular species. PLOS ONE. 2015;10(5):e0125192. doi: 10.1371/journal.pone.0125192, PMID 25933137.
Band PA, Heeter J, Wisniewski HG, Liublinska V, Pattanayak CW, Karia RJ, et al. Hyaluronan molecular weight distribution is associated with the risk of knee osteoarthritis progression. Osteoarthritis Cartilage. 2015;23(1):70-6. doi: 10.1016/j.joca.2014.09.017, PMID 25266961.
Elmorsy S, Funakoshi T, Sasazawa F, Todoh M, Tadano S, Iwasaki N. Chondroprotective effects of high-molecular-weight cross-linked hyaluronic acid in a rabbit knee osteoarthritis model. Osteoarthritis Cartilage. 2014;22(1):121-7. doi: 10.1016/j.joca.2013.10.005, PMID 24185110.
Stitik TP, Levy JA. Viscosupplementation (biosupplementation) for osteoarthritis. Am J Phys Med Rehabil. 2006;85(11); Suppl:S32-50. doi: 10.1097/01.phm.0000245677.20294.c2, PMID 17079978.
Medicine UW. Orthopedics and Sports Medicine [Internet]. Seattle: University of Washington, Osteoarthritis. University of Washington. Available from: http://www.orthop.washington.edu/?q=patient-care/articles/arthritis/osteoarthritis.html [cited 31/7/2023].
Aigner T, Schmitz N. Osteoarthritis and related disorders. Pathogenesis and pathology of osteoarthritis. P. 1741-59. Available from: https://www.med.unc.edu/tarc/events/event-files/Hichberg%20text.%20OA%20path..pdf [cited 31/7/2023].
Vincent KR, Conrad BP, Fregly BJ, Vincent HK. The pathophysiology of osteoarthritis: A mechanical perspective on the knee joint. PM R. 2012;4(5);Suppl:S3-9. doi: 10.1016/j.pmrj.2012.01.020, PMID 22632700.
Treppo S, Koepp H, Quan EC, Cole AA, Kuettner KE, Grodzinsky AJ. Comparison of biomechanical and biochemical properties of cartilage from human knee and ankle pairs. J Orthop Res. 2000;18(5):739-48. doi: 10.1002/jor.1100180510, PMID 11117295.
Allen KD, Golightly YM. Y. State of the evidence. Curr Opin Rheumatol. 2015;27(3):276-83. doi: 10.1097/BOR.0000000000000161, PMID 25775186.
Litwic A, Edwards MH, Dennison EM, Cooper C. Epidemiology and burden of osteoarthritis. Br Med Bull. 2013;105(1):185-99. doi: 10.1093/bmb/lds038, PMID 23337796.
Singh AK, Kalaivani M, Krishnan A, Aggarwal PK, Gupta SK. Prevalence of Osteoarthritis of Knee Among Elderly Persons in Urban Slums Using American College of Rheumatology (ACR) Criteria. J Clin Diagn Res. 2014;8(9):JC09-11. doi: 10.7860/JCDR/2014/7763.4868. PMID 25386465.
Pal CP. Study to find the prevalence of knee osteoarthritis in the Indian population and factors associated with it. Indian Orthopedics Association Conference.2013. Agra.
Mahajan A, Verma S, Tandon V. Osteoarthritis. J Assoc Physicians India. 2005;53:634-41. PMID 16190135.
Murphy L, Helmick CG. The impact of osteoarthritis in the United States: a population-health perspective. Am J Nurs. 2012;112(3);Suppl 1:S13-9. doi: 10.1097/01.NAJ.0000412646.80054.21. PMID 22373741.
Radha MS et al. Serum enzyme of matrix metalloproteinase-3 in patients with knee osteoarthritis. Int J Recent Sci Res. Jun 2015;6(6):4457-60.
Farr J, Miller LE, Block JE. Quality of life in patients with knee osteoarthritis: A commentary on nonsurgical and surgical treatments. TOORTHJ. 2013;7(1):619-23. doi: 10.2174/1874325001307010619.
Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321. doi: 10.1186/s12891-015-0775-z, PMID 26503103.
Bucci J, Chen X, LaValley M, Nevitt M, Torner J, Lewis CE, Felson DT. Progression of knee osteoarthritis with use of intraarticular glucocorticoids versus hyaluronic acid. Arthritis & Rheumatology. 2022 Feb;74(2):223-6.
Altman R, Bedi A, Manjoo A, Niazi F, Shaw P, Mease P. Anti-inflammatory effects of intra-articular hyaluronic acid: A systematic review. Cartilage. 2019;10(1):43-52. doi: 10.1177/1947603517749919. PMID 29429372.
Prill R, Królikowska A, de Girolamo L, Becker R, Karlsson J. Checklists, risk of bias tools, and reporting guidelines for research in orthopedics, sports medicine, and rehabilitation. Knee Surgery, Sports Traumatology, Arthroscopy. 2023 May 5:1-5.
Goyal DD, Garg DRS. Role of platelet-rich plasma in osteoarthritis knee. Int J Orthop Sci. 2017;3(3e):280-2. doi: 10.22271/ortho.2017.v3.i3e.51.
Chavda S, Rabbani SA, Wadhwa T. Role and effectiveness of intra-articular injection of hyaluronic acid in the treatment of knee osteoarthritis: A systematic review. Cureus. 2022 Apr 26;14(4).
Patil PS. Risk factors of Osteoarthritis Knee – a Cross-sectional study. IOSR-JDMS;2(5):8-10. doi: 10.9790/0853-0250810.
Lawrence RC, Helmick CG, Arnett FC, Deyo RA, Felson DT, Giannini EH et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum. 1998 May;41(5):778-99. doi: 10.1002/1529-0131(199805)41:5<778:AID-ART4>3.0.CO;2-V. PMID 9588729.
Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic Acid Versus Platelet-Rich Plasma: a Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. Am J Sports Med. 2017;45(2):339-46. doi: 10.1177/0363546516665809, PMID 28146403.
Iqbal MN, Haidri FR, Motiani B, Mannan A. Frequency of factors associated with knee osteoarthritis. J Pak Med Assoc. 2011 Aug;61(8):786-9. PMID 22356003.
Sharma MK, Swami H, Bhatia V, Verma A, Bhatia S, Kaur G. An epidemiological study of correlates of osteoarthritis in the geriatric population of UT Chandigarh. Indian J Community Med. 2007;32(1):77. doi: 10.4103/0970-0218.53414.
Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR et al. Guidelines for the medical management of osteoarthritis. Part II. Osteoarthritis of the knee. American College of Rheumatology. Arthritis Rheum. 1995 Nov;38(11):1541-6. doi: 10.1002/art.1780381104, PMID 7488273.
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):775-82. PMID 15088306.
Huskisson EC, Donnelly S. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatol (Oxf Engl). 1999;38(7):602-7. doi: 10.1093/rheumatology/38.7.602, PMID 10461471.
Henrotin Y, Raman R, Richette P, Bard H, Jerosch J, Conrozier T, et al. Consensus statement on viscosupplementation with hyaluronic acid for the management of osteoarthritis. Semin Arthritis Rheum. 2015;45(2):140-9. doi: 10.1016/j.semarthrit.2015.04.011, PMID 26094903.
He W-W, Kuang MJ, Zhao J, Sun L, Lu B, Wang Y, et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg. 2017;39:95-103. doi: 10.1016/j.ijsu.2017.01.087, PMID 28137554.
Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum. 2018 Oct;48(2):168-75. doi: 10.1016/j.semarthrit.2018.01.009. PMID 29496227.
Wang F, He X. Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis. Exp Ther Med. 2015 Feb;9(2):493-500. doi: 10.3892/etm.2014.2131. PMID 25574222, PMCID PMC4280939.
Cooper C, Snow S, McAlindon TE, Kellingray S, Stuart B, Coggon D, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000 May;43(5):995-1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1. PMID 10817551.
Wen DY. Intra-articular hyaluronic acid injections for knee osteoarthritis. I am Fam Physician. 2000 Aug 1;62(3):565-70, 572. PMID 10950213.
Disla E, Infante R, Fahmy A, Karten I, Cuppari GG. Recurrent acute calcium pyrophosphate dihydrate arthritis following intraarticular hyaluronate injection. Arthritis Rheum. 1999;42(6):1302-3. doi: 10.1002/1529-0131(199906)42:6<1302::AID-ANR33>3.0.CO;2-4, PMID 10366130.
Maheu E. Hyaluronan in knee osteoarthritis: a review of the clinical trials with Hyalgan. Eur J Rheumatol Inflam. 1995;15:17-24.
Cole BJ, Karas V, Hussey K, Merkow DB, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. The American journal of sports medicine. 2017 Feb;45(2):339-46.
Published
How to Cite
Issue
Section
Copyright (c) 2023 Dr Parthiv Shah, Dr Umang R Sachapara, Dr Nitin S. Patil
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.