Is intraarticular enjections effective on pain management in patients with late stage primer gonarthrosis during COVID-19 pandemic? A single centre experience
Abstract
Background: Primary gonarthrosis is a progressive disease that increases with age and leads to limitations in activities of daily living. Until surgery is performed, nonsteroidal anti-inflammatory drugs, intraarticular injections, and physical therapy methods are used.
Purpose: This study aims to compare the clinical outcomes of intra- articular corticosteroid (CCS) and hyaluro nic acid (HA) injections for pain relief in primary gonartrhosis in COVID -19 pandemic period.
Study Design: Retrospective Cohort Study.
Methods: In this study, 88 patients who underwent intra-articular CCS and HA injection between August 2020 and March 2021 due to Kellgren-Lawrence stage 2 and higher gonarthrosis were investigated. Patients were divided into two groups. Group I represents the patients who received HA injections, and group II represents the patients who received CCS injection. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS) scores were used for the preoperative and postoperative functional evaluations of the patients.
Results: Group I included 40 patients and group II included 48 patients. The mean age was 59.4 ± 7.3 years, and the average follow-up period was 12 ± 2,6 months. The pre-intervention WOMAC scores were 13,5 in Group I and 13.6 in Group II, KSS scores were 26,5 in Group I and 25,2 in Group II. While there was a significant change in the control at month 1 in both groups, no difference was found between the groups. At the 6th month control, the improvement in group 1 continued at a significant level compared to the pre-injection period, while group 2 returned to the pre-injection level. (p<0,01). After the injection, three patients in group 1 were hospitalized for one day because of sudden onset of pain and then discharged. Apart from this situation, no patient had septic arthritis or hemarthrosis.
Conclusion: Our study shows that both injections have a similar effect in the first month, but the palliative effect of IAHA may be beneficial for a longer period of time.
References
- 1. Annaniemi J, Pere J, Giordano S. Platelet-rich plasma versus hyaluronic acid injections for knee osteoarthritis: a propensity-score analysis. Scandinavian Journal of Surgery. 2019;108(4):329-37.
- 2. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. Bmj. 2004;328(7444):869.
- 3. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. The Journal of rheumatology Supplement. 1993;39:3-9.
- 4. Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta‐analysis. Arthritis Care & Research. 2009;61(12):1704-11.
- 5. Barbieri E, Capparucci I, Mannello F, Annibalini G, Contarelli S, Vallorani L, et al. Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids. Muscles, Ligaments & Tendons Journal (MLTJ). 2019;9(4).
- 6. Bostan B, Ufuk S, Gunes T, SAHİN S, Cengiz S, Erdem M, et al. Comparison of intra-articular hyaluronic acid injections and mud-pack therapy in the treatment of knee osteoarthritis. Acta orthopaedica et traumatologica túrcica. 2010;44(1):42-7.
- 7. Buckwalter JA, Stanish WD, Rosier RN, Schenck Jr RC, Dennis DA, Coutts RD. The increasing need for nonoperative treatment of patients with osteoarthritis. Clinical Orthopaedics and Related Research®. 2001;385:36-45.
- 8. Caborn D, Rush J, Lanzer W, Parenti D, Murray C, Group SS. A randomized, single-blind comparison of the efficacy and tolerability of hylan GF 20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. The Journal of rheumatology. 2004;31(2):333-43.
- 9. Chang Liang Z, Wang W, Murphy D, Po Hui J. The Orthopaedic Forum Novel coronavirus and orthopaedic surgery. J Bone Joint Surg. 2020.
- 10. Conrozier T, Jerosch J, Beks P, Kemper F, Euller-Ziegler L, Bailleul F, et al. Prospective, multi-centre, randomised evaluation of the safety and efficacy of five dosing regimens of viscosupplementation with hylan GF 20 in patients with symptomatic tibio-femoral osteoarthritis: a pilot study. Archives of orthopaedic and trauma surgery. 2009;129(3):417-23.
- 11. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Canadian Family Physician. 2004;50(2):241-8.
- 12. JAIN VK, IYENGAR KP, UPADHYAYA GK, VAISHYA R, NUNE A. Nonoperative Strategies to Manage Pain in Osteoarthritis during COVID-19 Pandemic. Journal of Clinical & Diagnostic Research. 2020;14(11).
- 13. Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. Intra‐articular corticosteroid for knee osteoarthritis. Cochrane Database of Systematic Reviews. 2015(10).
- 14. Karasavvidis T, Hirschmann MT, Kort NP, Terzidis I, Totlis T. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. Journal of Experimental Orthopaedics. 2020;7(1):1-7.
- 15. Leighton R, Åkermark C, Therrien R, Richardson J, Andersson M, Todman M, et al. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis and cartilage. 2014;22(1):17-25.
- 16. Liebensteiner M, Khosravi I, Hirschmann M, Heuberer P, Thaler M. Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic an online survey of almost 1400 orthopaedic surgeons in Austria, Germany and Switzerland. Knee Surg Sport Traumatol Arthrosc. 2020.
- 17. Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 2017;25(10):703-14.
- 18. Meng Z, Liu J, Zhou N. Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2022:1-13.
- 19. Migliorini F, Driessen A, Quack V, Sippel N, Cooper B, El Mansy Y, et al. Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2020:1-18.
- 20. Migliorini F, Rath B, Colarossi G, Driessen A, Tingart M, Niewiera M, et al. Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature. Archives of orthopaedic and trauma surgery. 2020;140(7):853-68.
- 21. Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. European Journal of Orthopaedic Surgery & Traumatology. 2019;29(4):947-55.
- 22. Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-articular, single-shot hylan GF 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. JBJS. 2016;98(11):885-92.
- 23. Wang C-T, Lin J, Chang C-J, Lin Y-T, Hou S-M. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee: a meta-analysis of randomized controlled trials. JBJS. 2004;86(3):538-45.
COVID-19 pandemisi sürecinde ileri evre gonartrozu olan hastalarda eklem içi enjeksiyonlar ağrı yönetiminde etkili midir? Tek merkez deneyimi.
Abstract
Giriş: Primer gonartroz, yaşla birlikte artan ve günlük yaşam aktivitelerinde kısıtlamalara yol açan ilerleyici bir hastalıktır. Ameliyat yapılana kadar nonsteroid antiinflamatuar ilaçlar, eklem içi enjeksiyonlar ve fizik tedavi yöntemleri kullanılır.
Amaç: Bu çalışma, COVID-19 pandemi döneminde primer gonartrozda ağrının giderilmesi için eklem içi kortikosteroid (CCS) ve hyalüronik asit (HA) enjeksiyonlarının klinik sonuçlarını karşılaştırmayı amaçlamaktadır.
Çalışma Tasarımı: Retrospektif Kohort Çalışması.
Yöntemler: Bu çalışmada Kellgren-Lawrence sınıflamasına göre evre 2 ve üzeri gonartrozu olan ve Ağustos 2020 ile Mart 2021 tarihleri arasında eklem içi CCS ve HA enjeksiyonu yapılan 88 hasta incelendi. Hastalar iki gruba ayrıldı. Grup I, HA enjeksiyonu yapılan hastaları, grup II ise CCS enjeksiyonu yapılan hastaları içermektedir. Hastaların ameliyat öncesi ve ameliyat sonrası fonksiyonel değerlendirmelerinde Western Ontario ve McMaster Universities Arthritis Index (WOMAC) ve Knee Society Score (KSS) skorları kullanıldı.
Bulgular: Grup I'de 40 hasta ve grup II'de 48 hasta yer aldı. Ortalama yaş 59.4 ± 7.3 yıl, ortalama takip süresi 12 ± 2,6 ay idi. Enjeksiyon öncesi WOMAC skorları Grup I'de 13,5 ve Grup II'de 13.6, KSS skorları Grup I'de 26,5 ve Grup II'de 25,2 idi. Her iki grupta 1. ayda kontrolde anlamlı bir değişiklik varken, gruplar arasında fark bulunmadı. 6. ay kontrolünde, grup 1'deki iyileşme enjeksiyon öncesi döneme göre anlamlı düzeyde devam ederken, grup 2 enjeksiyon öncesi seviyeye döndü. (p<0,01). Enjeksiyondan sonra grup 1'deki üç hasta ani başlayan ağrı nedeniyle bir gün hastanede yatırılarak taburcu edildi. Bu durum dışında hiçbir hastada septik artrit veya hemartroz görülmedi.
Sonuç: Çalışmamız, her iki enjeksiyonun ilk ay içerisinde benzer etkisinin olduğunu ancak IAHA'nın palyatif etkisinin daha uzun süre faydalı olabileceğini göstermektedir
References
- 1. Annaniemi J, Pere J, Giordano S. Platelet-rich plasma versus hyaluronic acid injections for knee osteoarthritis: a propensity-score analysis. Scandinavian Journal of Surgery. 2019;108(4):329-37.
- 2. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. Bmj. 2004;328(7444):869.
- 3. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. The Journal of rheumatology Supplement. 1993;39:3-9.
- 4. Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta‐analysis. Arthritis Care & Research. 2009;61(12):1704-11.
- 5. Barbieri E, Capparucci I, Mannello F, Annibalini G, Contarelli S, Vallorani L, et al. Efficacy of a Treatment for Gonarthrosis Based on the Sequential Intra-Articular Injection of Linear and Cross-Linked Hyaluronic Acids. Muscles, Ligaments & Tendons Journal (MLTJ). 2019;9(4).
- 6. Bostan B, Ufuk S, Gunes T, SAHİN S, Cengiz S, Erdem M, et al. Comparison of intra-articular hyaluronic acid injections and mud-pack therapy in the treatment of knee osteoarthritis. Acta orthopaedica et traumatologica túrcica. 2010;44(1):42-7.
- 7. Buckwalter JA, Stanish WD, Rosier RN, Schenck Jr RC, Dennis DA, Coutts RD. The increasing need for nonoperative treatment of patients with osteoarthritis. Clinical Orthopaedics and Related Research®. 2001;385:36-45.
- 8. Caborn D, Rush J, Lanzer W, Parenti D, Murray C, Group SS. A randomized, single-blind comparison of the efficacy and tolerability of hylan GF 20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. The Journal of rheumatology. 2004;31(2):333-43.
- 9. Chang Liang Z, Wang W, Murphy D, Po Hui J. The Orthopaedic Forum Novel coronavirus and orthopaedic surgery. J Bone Joint Surg. 2020.
- 10. Conrozier T, Jerosch J, Beks P, Kemper F, Euller-Ziegler L, Bailleul F, et al. Prospective, multi-centre, randomised evaluation of the safety and efficacy of five dosing regimens of viscosupplementation with hylan GF 20 in patients with symptomatic tibio-femoral osteoarthritis: a pilot study. Archives of orthopaedic and trauma surgery. 2009;129(3):417-23.
- 11. Godwin M, Dawes M. Intra-articular steroid injections for painful knees. Systematic review with meta-analysis. Canadian Family Physician. 2004;50(2):241-8.
- 12. JAIN VK, IYENGAR KP, UPADHYAYA GK, VAISHYA R, NUNE A. Nonoperative Strategies to Manage Pain in Osteoarthritis during COVID-19 Pandemic. Journal of Clinical & Diagnostic Research. 2020;14(11).
- 13. Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. Intra‐articular corticosteroid for knee osteoarthritis. Cochrane Database of Systematic Reviews. 2015(10).
- 14. Karasavvidis T, Hirschmann MT, Kort NP, Terzidis I, Totlis T. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. Journal of Experimental Orthopaedics. 2020;7(1):1-7.
- 15. Leighton R, Åkermark C, Therrien R, Richardson J, Andersson M, Todman M, et al. NASHA hyaluronic acid vs methylprednisolone for knee osteoarthritis: a prospective, multi-centre, randomized, non-inferiority trial. Osteoarthritis and cartilage. 2014;22(1):17-25.
- 16. Liebensteiner M, Khosravi I, Hirschmann M, Heuberer P, Thaler M. Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic an online survey of almost 1400 orthopaedic surgeons in Austria, Germany and Switzerland. Knee Surg Sport Traumatol Arthrosc. 2020.
- 17. Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and Treatment Response of Intra-articular Corticosteroid Injections in Patients With Symptomatic Knee Osteoarthritis. JAAOS - Journal of the American Academy of Orthopaedic Surgeons. 2017;25(10):703-14.
- 18. Meng Z, Liu J, Zhou N. Efficacy and safety of the combination of glucosamine and chondroitin for knee osteoarthritis: a systematic review and meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2022:1-13.
- 19. Migliorini F, Driessen A, Quack V, Sippel N, Cooper B, El Mansy Y, et al. Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis. Archives of Orthopaedic and Trauma Surgery. 2020:1-18.
- 20. Migliorini F, Rath B, Colarossi G, Driessen A, Tingart M, Niewiera M, et al. Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature. Archives of orthopaedic and trauma surgery. 2020;140(7):853-68.
- 21. Migliorini F, Tingart M, Niewiera M, Rath B, Eschweiler J. Unicompartmental versus total knee arthroplasty for knee osteoarthritis. European Journal of Orthopaedic Surgery & Traumatology. 2019;29(4):947-55.
- 22. Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-articular, single-shot hylan GF 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. JBJS. 2016;98(11):885-92.
- 23. Wang C-T, Lin J, Chang C-J, Lin Y-T, Hou S-M. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee: a meta-analysis of randomized controlled trials. JBJS. 2004;86(3):538-45.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Research |
| Authors | |
| Early Pub Date | October 1, 2022 |
| Publication Date | November 30, 2022 |
| Acceptance Date | August 17, 2022 |
| Published in Issue | Year 2022 Volume: 12 Issue: 6 |
