Intraarticular Na-hyaluronate (Orthovisc) injection in knee osteoarthritis: comparison of different injection techniques and short term efficacy

Abstract

The first aim of this study is to compare the efficacy of sodium hyaluronate (HA) injection which is done by classical method from the patellofemoral (PF) joint and the efficacy of HA injection which is done to different knee joint compartments in conjuction with manual medicine. The second aim of the study is to establish the short term efficacy and to compare the results of different techniques. One hundred patients admitted to the outpatient clinic of the Department of Physical Medicine and Rehabilitation, Istanbul Medical Faculty, and who had grade 2 and 3 osteoarthritis (OA) according to the clinical and radiological data of Osteoarthritis Research Society (OARS), were included in the study. Two groups have been constructed by the randomisation tables, however 16 patients were drooped from the study and 84 patients had completed the study. 2 ml Orthovisc injection which is a derivative of HA, was done by fluoroscopy to the first group only to the PF joint space 3 times, every consecutive week. For the second group, 3 injections were done in the similar pattern, but first to the two tibiofemoral compartments then to the PF compartment with the aid of traction. Patients were evaluated by a blind investigator, before and 1 week after the three injections. Before the treatment no difference has been found between the two groups according to the parameters; namely pain severity at rest, pain in walking and standing scored by Visual Analog Scale (VAS), daily analgesic consumption, duration of morning stiffness in minutes (min), painless walking distance in meters(m) and duration (min), Range of Motion (ROM) of passive and active knee flexion and extension (p>0.05). All of the above parameters improved in both groups after the treatment, the difference being statistically significant (p<0.0001). There was no difference between the two groups when the results of the treatments were compared (p>0.05). Therefore, PF joint space can be chosen for routine application since it is easier to perform and may be less traumatic.