Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 01-06-2014 | Knee

Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy

Authors: Keerati Chareancholvanich, Chaturong Pornrattanamaneewong, Rapeepat Narkbunnam

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2014

Abstract

Purpose

High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints.

Methods

Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48).

Results

MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p < 0.001) compared to the baseline. However, no difference was found between the two groups. The study group had significantly lower amounts of diclofenac consumption (p = 0.017).

Conclusion

Based on the findings of the present study, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO.

Level of evidence

Therapeutic study, Level I.

Altman RD, Moskowitz R (1998) Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee; a randomized clinical trial. Hyalgan Study Group. J Rheuatol 25(11):2203–2212

Amendola A, Panarella L (2005) High tibial osteotomy for the treatment of unicompartmental arthritis of the knee. Orthop Clin North Am 36(4):497–504PubMedCrossRef

Amendola A, Bonasia DE (2010) Results of high tibial osteotomy: review of the literature. Int Orthop 34(2):155–160PubMedCentralPubMedCrossRef

ArrichJ PiribauerF, Mad P et al (2005) Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. Can Med Assoc J 172:1039–1043CrossRef

Bannuru RR, Natov NS, Obadan IE et al (2009) Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum 61:1704–1711PubMedCrossRef

Bowers ME, Trinh N, Tung GA, Crisco JJ, Kimia BB, Fleming BC (2008) Quantitative MR imaging using “LiveWire” to measure tibiofemoral articular cartilage thickness. Osteoarthr Cartil 16(10):1167–1173PubMedCentralPubMedCrossRef

Brandt KD, Block JA, Michalski JP et al (2001) Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. ORTHOVISC Study Group. Clin Orthop 385:130–143PubMedCrossRef

Buckwalter JA, Mankin HJ, Grodzinsky AJ (2005) Articular cartilage and osteoarthritis. Instr Course Lect 54:465–480PubMed

Divins JG, Zazulak BT, Hewett TE (2007) Viscosupplementation for knee osteoarthritis: a systematic review. Clin Orthop Relat Res 445:113–122CrossRef

10.

Fujisawa Y, Masuhara K, Shiomi S (1979) The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints. Orthop Clin North Am 10(3):585–608PubMed

11.

Ghosh P, Guidolin D (2002) Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent? Semin Arthritis Rheum 32:10–37PubMedCrossRef

12.

Goldberg VM, Coutts RD (2004) Pseudoseptic reactions to hylan viscosupplementation. Clin Orthop 419:130–137PubMedCrossRef

13.

Goldberg VM, Buckwalter JA (2005) Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthr Cartil 31:216–224CrossRef

14.

Goldberg VM, Goldberg L (2010) Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. J Pain Res 10(3):51–56CrossRef

15.

Gougoutas AJ, Wheaton AJ, Borthakur A et al (2004) Cartilage volume quantification via Live Wire segmentation. Acad Radiol 11:1389–1395PubMedCrossRef

16.

Heijink A, Gomoll AH, Madry H, Drobnič M, Filardo G, Espregueira-Mendes J, Van Dijk CN (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20(3):423–435PubMedCentralPubMedCrossRef

17.

Hui C, Salmon LJ, Kok A, Williams HA, Hockers N, van der Tempel WM, Chana R, Pinczewski LA (2011) Long-term survival of high tibial osteotomy for medial compartment osteoarthritis of the knee. Am J Sports Med 39(1):64–70PubMedCrossRef

18.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteoarthrosis. Ann Rheum Dis 16(4):494–502PubMedCentralPubMedCrossRef

19.

Kelly MA, Goldberg VM, Healy WL, Pagnano MW, Hamburger MI (2003) Osteoarthritis and beyond: a consensus on the past, present, and future of hyaluronans in orthopedics. Orthopedics 26(10):1064–1079PubMed

20.

Kikuchi T, Yamada H, Shimmei M (1996) Effect of high molecular weight hyaluronan on cartilage degradation in a rabbit model of osteoarthritis. Osteoarthr Cartil 4(2):99–110PubMedCrossRef

21.

Lohmander LS, Dalen N, Englund G et al (1996) Intra-articular hyaluronans injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicenter trial. Ann Rheum Dis 55:424–431PubMedCentralPubMedCrossRef

22.

Manek NJ, Lane NE (2000) Osteoarthritis current concepts in diagnosis and management. Am Fam Physician 61(6):1795–1804PubMed

23.

Navarro-Sarabia F, Coronel P, Collantes E, Navarro FJ, de la Serna AR, Naranjo A, Gimeno M, Herrero-Beaumont G (2011) A 40-month multicenter randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: the AMELIA project. Ann Rheum Dis 70(11):1957–1962PubMedCentralPubMedCrossRef

24.

Pelletier JP, Raynauld JP, Abram F et al (2008) A new non-invasive method to assess synovitis severity in relation to symptoms and cartilage volume loss in knee osteoarthritis patients using MRI. Osteoarthr Cartil 16(Suppl 3):S8–S13PubMedCrossRef

25.

Roemer FW, Eckstein F, Guermazi A (2009) Magnetic resonance imaging-based semiquantitative and quantitative assessment in osteoarthritis. Rheum Dis Clin North Am 35:521–555PubMedCrossRef

26.

Wang Y, Hall S, Hanna F, Wluka AE, Grant G, Marks P, Feletar M, Cicuttini FM (2011) Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskelet Disord 24(12):195

27.

Yoshioka M, Shimizu C, Harwood FL (1997) The effects of hyaluronans during the development of osteoarthritis. Osteoarthr Cartil 5:251–260PubMedCrossRef

Title: Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy
Authors: Keerati Chareancholvanich
Chaturong Pornrattanamaneewong
Rapeepat Narkbunnam
Publication date: 01-06-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2735-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 6/2014

Implantation of tissue-engineered cartilage-like tissue for the treatment for full-thickness cartilage defects of the knee

Osteochondral regeneration using a novel aragonite-hyaluronate bi-phasic scaffold in a goat model

Use of cell-free collagen type I matrix implants for the treatment of small cartilage defects in the knee: clinical and magnetic resonance imaging evaluation

Microfracture technique versus osteochondral autologous transplantation mosaicplasty in patients with articular chondral lesions of the knee: a prospective randomized trial with long-term follow-up

Surgical management of osteochondritis dissecans of the knee in the paediatric population: a systematic review addressing surgical techniques

T2 values of articular cartilage in clinically relevant subregions of the asymptomatic knee