Comparison of the effects of intraarticular hyaluronic acid and antiinflammatory drug treatments on the surgical intervention rates in patients with gonarthrosis

The aim of this study was to compare the frequencies of surgical interventions between patients receiving intraarticular hyaluronic acid (IAHA) injection and those receiving only oral antiinflammatory drug treatment at the end of a 1-year follow-up period. Materials and methods: A total of 705 patients diagnosed with knee osteoarthritis (OA) between 2007 and 2009 were included in this study. Their records were investigated retrospectively. We divided 218 of the patients into 3 groups according to the Kellgren–Lawrence criteria, and they received sodium hyaluronate once a week for 3 weeks. Another 487 patients with gonarthrosis served as group 2 and were treated with nonsteroidal oral antiinflammatory drugs and exercises. The surgical rates between the IAHA groups and the control groups were compared. The groups with the 2 different treatment modalities were compared according to the surgical operation rates at the end of a 1-year period. Results: While 9 of the 68 IAHA-treated patients with grade 2 OA had a surgical intervention within the year, 22 of the 172 patients with grade 2 OA in group 2 were operated on (13.2% versus 12.8%, P = 0.927). A surgical intervention was performed in 7 of the 78 IAHA-treated patients with grade 3 OA at the end of 1 year, and in 18 of the 164 patients with grade 3 OA (group 2) (8.9% versus 10.9%, P = 0.629). Of the 51 IAHA-treated patients with grade 4 OA, 4 underwent a surgical intervention within the year, whereas 22 of the 151 patients in group 2 were operated on (7.8% versus 14.6%, P = 0.222). Conclusion: Although there was no statistically significant difference between the groups, a lower percentage of IAHA-treated patients with grade 4 OA underwent surgical interventions. At the end of 1 year, the rates of surgical operations between the patients receiving IAHA and antiinflammatory treatment in the other 2 groups (knee grades 2 and 3 OA) showed no statistically significant difference.

Comparison of the effects of intraarticular hyaluronic acid and antiinflammatory drug treatments on the surgical intervention rates in patients with gonarthrosis

The aim of this study was to compare the frequencies of surgical interventions between patients receiving intraarticular hyaluronic acid (IAHA) injection and those receiving only oral antiinflammatory drug treatment at the end of a 1-year follow-up period. Materials and methods: A total of 705 patients diagnosed with knee osteoarthritis (OA) between 2007 and 2009 were included in this study. Their records were investigated retrospectively. We divided 218 of the patients into 3 groups according to the Kellgren–Lawrence criteria, and they received sodium hyaluronate once a week for 3 weeks. Another 487 patients with gonarthrosis served as group 2 and were treated with nonsteroidal oral antiinflammatory drugs and exercises. The surgical rates between the IAHA groups and the control groups were compared. The groups with the 2 different treatment modalities were compared according to the surgical operation rates at the end of a 1-year period. Results: While 9 of the 68 IAHA-treated patients with grade 2 OA had a surgical intervention within the year, 22 of the 172 patients with grade 2 OA in group 2 were operated on (13.2% versus 12.8%, P = 0.927). A surgical intervention was performed in 7 of the 78 IAHA-treated patients with grade 3 OA at the end of 1 year, and in 18 of the 164 patients with grade 3 OA (group 2) (8.9% versus 10.9%, P = 0.629). Of the 51 IAHA-treated patients with grade 4 OA, 4 underwent a surgical intervention within the year, whereas 22 of the 151 patients in group 2 were operated on (7.8% versus 14.6%, P = 0.222). Conclusion: Although there was no statistically significant difference between the groups, a lower percentage of IAHA-treated patients with grade 4 OA underwent surgical interventions. At the end of 1 year, the rates of surgical operations between the patients receiving IAHA and antiinflammatory treatment in the other 2 groups (knee grades 2 and 3 OA) showed no statistically significant difference.

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  • Garstang SV, Stitik TP. Osteoarthritis: epidemiology, risk factors, and pathophysiology.Am J Phys Med Rehabil2006; 85: 12–4.
  • Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc 2007; 15: 537–46.
  • Dahl LB, Dahl IM, Engström-Laurent, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis1985;44: 817–22.
  • Brandt KD, Smith GN Jr, Simon LS. Intraarticular injection of hyaluronan as treatment for knee osteoarthritis: what is the evidence? Arthritis Rheum 2000; 43: 192–203.
  • Pagnano M, Westrich G. Successful nonoperative management of chronic osteoarthritis pain of the knee: safety and efficacy of retreatment with intra-articular hyaluronans. Osteoarthritis Cartilage2005;13: 751–61.
  • Hashizume M, Koike N, Yoshida H, Suzuki M, Mihara M. High molecular weight hyaluronic acid relieved joint pain and prevented the progression of cartilage degeneration in a rabbit osteoarthritis model after onset of arthritis. Mod Rheumatol 2010; 20: 432–8.
  • Neustadt D, Caldwell J, Bell M, Wade J, Gimbel J. Clinical effects of intraarticular injection of high molecular weight hyaluronan (Orthovisc) in osteoarthritis of the knee: a randomized, controlled, multicenter trial. J Rheumatol2005; 32: 928–36.
  • Çipe G, Köksal HM, Yıldırım S, Celayir MF, Baykan A. Efficacy of hyaluronic acid - carboxymethyl cellulose membrane (Seprafilm®) and polylactic acid barrier film (Surgiwrap™) for the prevention of adhesions after thyroid surgery: an experimental model. Turk J Med Sci 2011; 41: 73–9.
  • Jİrgensen A, Stengaard-Pedersen K, Simonsen O, Pfeiffer- Jensen M, Eriksen C, Bliddal H et al. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year. Ann Rheum Dis 2010; 69: 1097– 102.
  • Lundsgaard C, Dufour N, Fallentin, Winkel P, Gluud C. Intra-articular sodium hyaluronate 2 mL versus physiological saline 20 mL versus physiological saline 2 mL for painful knee osteoarthritis: a randomized clinical trial. Scand J Rheumatol 2008; 7: 142–50.
  • Turajane T, Amphansap T, Labpiboonpong V, Maungsiri S. Total knee replacement following repeated cycles of intra-articular sodium hyaluronate (500-730 Kda) in failed conservative treatment of knee osteoarthritis: a 54-month follow-up. J Med Assoc Thai 2009; 92: 63–8.
  • Altman R, Asch E, Bloch D,Bole G, Borenstein D, Brandt K et al.Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986; 29: 1039–49.
  • Kellegren JH, Lawrence JH. Radiological assessment of osteoarthrosis. Ann Rheum Dis 1957; 1: 494–502.
  • Verkleij SP, Luijsterburg PA, Koes BW, Bohnen AM, Bierma- Zeinstra SM. Effectiveness of diclofenac versus acetaminophen in primary care patients with knee osteoarthritis: [NTR1485], DIPA-trial: design of a randomized clinical trial. BMC Musculoskelet Disord 2010; 11: 7.
  • Buffum M, Buffum JC. Nonsteroidal anti-inflammatory drugs in the elderly. Pain Manag Nurs 2000; 1: 40–50.
  • Altman RD, Moskowitz R. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol1998;25: 2203–12.
  • Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta- analysis of randomized controlled trials. J Bone Joint Surg Am 2004; 86: 538–45.
  • Dixon AS, Jacoby RK, Berry H, Hamilton EB. Clinical trial of intra-articular injection of sodium hyaluronate in patients with osteoarthritis of the knee. Curr Med Res Opin1988; 11: 205–13.
  • Gigante A, Callegari L. The role of intra-articular hyaluronan (Sinovial) in the treatment of osteoarthritis.Rheumatol Int 2011; 31: 427–44.
  • Henderson EB, Smith EC, Pegley F, Blake DR. Intra- articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy. Ann Rheum Dis 1994; 53: 529–34.
Turkish Journal of Medical Sciences-Cover
  • ISSN: 1300-0144
  • Yayın Aralığı: Yılda 6 Sayı
  • Yayıncı: TÜBİTAK
Sayıdaki Diğer Makaleler

Is placement of pelvic drain indispensable after radical cystectomy, extended lymph node dissection, and orthotopic neobladder substitution?

Ahmet Tunç ÖZDEMİR, Ege Can ŞEREFOĞLU, Ali Fuat ATMACA, Serkan ALTINOVA, Mevlana Derya BALBAY

Evaluation of the relationship between dental erosion and scintigraphically detected gastroesophageal reflux in patients with cerebral palsy

Özlem Martı AKGÜN, Günseli POLAT GÜVEN, Ceyhan ALTUN, İlker TURAN, Zülfikar POLAT

Comparison of latanoprost, brimonidine tartrate, and bimatoprost plus timolol maleate in fixed combinations

Sıtkı Samet ERMİŞ, Onur POLAT, Ümit Übeyt İNAN, Tuncay KÜSBECİ, Mahmut KARADAŞ, Güliz Fatma YAVAŞ

The effect of combined treatment of alpha-tocopherol, ascorbic acid, and pyridoxine with NMDA blocker memantine on penicillin-induced epileptiform activity in rats

Mehmet YILDIRIM, Mustafa AYYILDIZ, Erdal AĞAR, Duygu AYDIN

Intraarticular hydraulic distension with steroids in the management of hemiplegic shoulder

Neşe ÖZGİRGİN, Refika DEMİRTAŞ, Asuman DOĞAN

Alfacalcidol suppresses α-receptor mediated vasoconstriction via an endothelium dependent mechanism

Akif Hakan KURT, İsmail ÜN, Ali BATUŞ, Kansu BÜYÜKAFŞAR

Demonstration of mutations conferring resistance to lamivudine in liver tissue of chronic hepatitis B patients under lamivudine therapy

İsmail Yaşar AVCI, Can Polat EYİGÜN, Emine GÜNAL, Ayhan KUBAR, Hanefi Cem GÜL, Ömer COŞKUN, Hakan ERDEM, Levent GÖRENEK, Bülent Ahmet BEŞİRBELLİOĞLU

The effects of acetyl shikonin isolated from Onosma armeniacum on oxidative stress in ethanol-induced ulcer model of rats

Havva ERDEM, Halis SÜLEYMAN, Aysun TOKER, Ufuk ÖZGEN, Hülya AKSOY, Fatih AKÇAY

Plasma soluble thrombomodulin and soluble endothelial protein C receptor levels in colorectal cancer patients

Cemil BİLİR, Ayla GÖKMEN, Hüseyin ENGİN, Serap TİLKİ ÜNAL, Yücel ÜSTÜNDAĞ

Immunohistochemical distribution and gene expression of transforming growth factor alpha in ovarian tissue of rats treated with capsaicin in puberty

Sevda Eliş YILDIZ, Mümtaz NAZLI, Gökhan NUR