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Ong KL, Runa M, Xiao Z, Ngai W, Lau E, Altman RD. Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis. Cartilage 2021; 13:1474S-1486S. [PMID: 32063023 PMCID: PMC8808807 DOI: 10.1177/1947603520905113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Concerns have been raised about severe acute localized reactions (SALR) following intra-articular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA). We compared surrogate SALR measures between hylan G-F 20 and non-hylan G-F 20 HA patients and evaluated corresponding SALR risk factors for hylan G-F 20 patients. DESIGN Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users. Occurrences of surrogate SALR measures including inflammation/infection, intra-articular corticosteroid (CS) injections, arthrocentesis/aspiration, and office visits were evaluated within 3 days of HA use. Risk factors were evaluated using logistic regression. RESULTS The cohort involved 748,428 HA patients (23.2% in the hylan G-F 20 group). Inflammation/infection rate was 0.001% for hylan G-F 20 and 0.002% for non-hylan G-F 20 HA groups. Risk of CS injection (any diagnosis) was greater for hylan G-F 20 patients by 28% (P < 0.001). Combined rates of CS injection and arthrocentesis/aspiration (any diagnosis) were comparable for both groups (hylan G-F 20, 2.2%; non-hylan G-F 20 HA, 2.6%). The risk of any visit or studied responses was lower for the hylan G-F 20 cohort by 12% (P < 0.001). Clinical characteristics, such as CS injections within 1 week before HA and fluoroscopic imaging, were associated with the outcomes. CONCLUSIONS The diagnosis of inflammations or infections within 3 days of the HA injection was extremely rare. The overall risk of surrogate SALR measures was similar for hylan G-F 20 and non-hylan G-F 20 HA patients.
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Affiliation(s)
- Kevin L. Ong
- Exponent, Inc., Philadelphia, PA,
USA,Kevin L. Ong, Exponent, Inc., 3440 Market
Street, Suite 600, Philadelphia, PA 19104, USA.
| | | | | | | | | | - Roy D. Altman
- School of Medicine, University of
California, Los Angeles, CA, USA
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Comparison of Minimally Invasive Procedures to Treat Knee Pain Secondary to Osteoarthritis: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2021; 33:238-248.e4. [PMID: 34822993 DOI: 10.1016/j.jvir.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 11/01/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To review and indirectly compare the outcomes of minimally invasive therapies for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS A literature search via Medline and Cochrane Central databases was completed for randomized control studies published between January 2000 to April 2020 for the following therapies: Rezum, Urolift, Aquablation, and prostate artery embolization (PAE). Data on the following variables were included: international Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and post-void residual (PVR). Standard mean differences between treatments were compared through a meta-analysis using transurethral resection of the prostate (TURP) to assess differences in treatment effect. RESULTS No significant difference in outcomes between therapies were noted for IPSS at the 3-, 6-, and 12-month follow-ups. Although outcomes for rezum were only available out to 3 months, there were no consistently significant differences in outcomes when comparing Aquablation vs PAE vs Rezum. TURP PVR was significantly better than Urolift at 3-, 6-, and 12 months. No significant differences in minor or major AEs were noted. CONCLUSION Although significant differences in outcomes were limited, aquablation and PAE were the most durable at 12 months. PAE has been well studied on multiple randomized control trials with minimal adverse events while aquablation has limited high quality data and has been associated with bleeding-related complications.
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Özden F, Nadiye Karaman Ö, Tuğay N, Yalın Kilinç C, Mihriban Kilinç R, Umut Tuğay B. The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis. J Clin Orthop Trauma 2020; 11:S512-S517. [PMID: 32774020 PMCID: PMC7394788 DOI: 10.1016/j.jcot.2020.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of the study was to investigate the relationship between pain, function and quality of life with radiographic findings in patients with knee osteoarthritis (OA). METHODS A total of 86 patients diagnosed with knee OA were included in the study. Demographic, physical, and pathological information was collected. Visual analog scale (VAS) was used to determine pain levels. The evaluation of radiographic findings was conducted by Kellgren-Lawrence (K&L) rating scale. The Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to evaluate the patient's disability and functional status. The objective functional status was assessed using the commonly used physical performance test, the Timed up and Go Test (TUG). The Turkish version of the Short Form 36 (SF-36) questionnaire was used for quality of life assessment. The "Spearman rank correlation coefficient" was used to investigate the relationship between pain, function and quality of life with radiographic findings. RESULTS The mean age of the participants was 61.08 ± 9.27 years. There was a strong correlation between VAS at activity and K&L (p < 0.05). There was a negative correlation between Physical Function (PF) (p < 0.05) and General Health (GH) (p < 0.05) subscore of the SF-36 with K&L. In addition, K&L and TUG were positively correlated (p < 0.05). CONCLUSION Radiographic findings were associated with pain in activity and functional status based on physical performance, but not with clinical results based on Patient Reported Outcome Measures (PROMs). As the patient's radiographic findings worsened, the level of pain increased and functionality decreased.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Elderly Care Department, Köyceğiz, Muğla, Turkey
| | - Özgür Nadiye Karaman
- Muğla Sıtkı Koçman University, Training and Research Hospital, Physical Therapy and Rehabilitation Unit, Kötekli, Muğla, Turkey
| | - Nazan Tuğay
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kötekli, Muğla, Turkey
| | - Cem Yalın Kilinç
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Orthopedics and Traumatology, Kötekli, Muğla, Turkey
| | - Rabia Mihriban Kilinç
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Radiology, Kötekli, Muğla, Turkey
| | - Baki Umut Tuğay
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kötekli, Muğla, Turkey
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Özden F, Nadiye Karaman Ö, Tuğay N, Yalın Kilinç C, Mihriban Kilinç R, Umut Tuğay B. The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis. J Clin Orthop Trauma 2020; 11:S512-S517. [DOI: https:/doi.org/10.1016/j.jcot.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Altay N, Sarıkaya B, Karahan MA, Büyükfırat E, Binici O, Ertürk C, Altay MA. Comparison of efficacy between combined periarticular and incisional injections versus periarticular injection alone of bupivacaine for pain control after total knee arthroplasty: A prospective randomized controlled trial. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:402-407. [PMID: 32554365 DOI: 10.5152/j.aott.2020.20212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of combined periarticular and incisional injections versus periarticular injection alone of bupivacaine in reducing post-operative pain after total knee arthroplasty (TKA). METHODS In this prospective, randomized, double-blind comparative study, 90 patients with primary osteoarthritis who underwent TKA were enrolled. The patients were then randomly divided into 3 groups (30 in each): group 1, without injection; group 2, with periarticular injection of 20 mL 0.5% bupivacaine hydrogen chloride (HCl) (100 mg) after implantation; and group 3, periarticular injection of 20 mL 0.5% bupivacaine HCl (100 mg) after implantation and incisional injection of 10 mL 0.5% bupivacaine HCl (50 mg) before wound closure. Post-operative pain levels were measured using a 100-mm visual analogue scale (VAS) (0 mm: no pain and 100 mm: worst pain) at 30 min and 1, 2, 4, and 6 h, post-operatively. RESULTS The mean VAS score in group 3 (the combined group-periarticular and incisional injections) within the first 4 h was lower than that in group 1 and group 2 (p<0.001). The mean VAS scores at the first 30 min were 65.21±9.46 in group 1, 51.86±5.96 in group 2, and 29.33±8.55 in group 3 (p<0.001). The mean VAS scores at the first 1 h were 64.43±9.32 in group 1, 47.26±4.77 in group 2, and 31.66±7.37 in group 3 (p<0.001). The mean scores at the 2 h were 61.46±8.62 in group 1, 48.33±4.66 in group 2, and 30.83±6.76 in group 3 (p<0.001). The mean scores at the 4 h were 64.72±8.91 in group 1, 47.53±4.35 in group 2, and 34.36±6.64 in group 3 (p<0.001). The differences were not significant at 6 h between group 2 (44.91±4.12) and group 3 (41.83±6.71) (p>0.001). However, the values were significantly lower than those of the control group (63.56±9.73) (p<0.001). In addition, VAS scores at all follow-up times were significantly higher in the control group compared with the other groups (p<0.001). CONCLUSION Evidence from this study revealed that the combined injection of bupivacaine is more effective than its periarticular injection alone and provides effective post-operative pain management after TKA. LEVEL OF EVIDENCE Level I, Therapeutic study.
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Affiliation(s)
- Nuray Altay
- Department of Anaesthesiology and Reanimation, Harran University, School of Medicine, Şanlıurfa, Turkey
| | - Baran Sarıkaya
- Department of Orthopedics and Traumatology, Harran University, School of Medicine, Şanlıurfa, Turkey
| | - Mahmut Alp Karahan
- Department of Anaesthesiology and Reanimation, Harran University, School of Medicine, Şanlıurfa, Turkey
| | - Evren Büyükfırat
- Department of Anaesthesiology and Reanimation, Harran University, School of Medicine, Şanlıurfa, Turkey
| | - Orhan Binici
- Department of Anaesthesiology and Reanimation, Harran University, School of Medicine, Şanlıurfa, Turkey
| | - Cemil Ertürk
- Deparment of Orthopedics and Traumatology, Health Sciences University Kanuni Sultan Süleyman Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Akif Altay
- Department of Orthopedics and Traumatology, Harran University, School of Medicine, Şanlıurfa, Turkey
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Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2019; 27:1974-1983. [PMID: 30046992 DOI: 10.1007/s00167-018-5071-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/18/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Intra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) have individually demonstrated efficacy for knee osteoarthritis (OA); however, both treatments are limited by the trajectory of symptom relief. The combination of CS and HA in the management of knee OA may provide improved symptomatic relief for patients who are candidates for intra-articular therapies. METHODS Electronic databases Medline, EMBASE and Cochrane Library were used to identify relevant publications. Randomized controlled trials (RCT) that evaluated intra-articular injections of combined CS and HA in comparison to HA alone were included. Outcomes eligible for meta-analysis were WOMAC pain, WOMAC total, OMERACT-OARSI responder rate, and treatment-related adverse events. Standardized mean differences (SMD) were calculated for continuous outcomes using an inverse variance method and a random-effects model. Odds ratios (OR) were calculated for dichotomous outcomes using the Mantel-Haenszel method and a random-effects model. Heterogeneity was assessed using the I2 statistic. RESULTS Eight trials (n = 751 patients) were included. Reduction in WOMAC pain scores at 2-4 weeks favoured the combined CS and HA group compared to HA alone [SMD 0.60, 95% CI (0.23, 0.97); p = 0.002, I2 = 75%]. Longer term improvements at 24-26 and 52 weeks WOMAC pain scores also favoured the combined CS and HA group {[SMD 0.25, 95% CI (0.09, 0.41); p = 0.002, I2 = 0%] and [SMD 0.39, 95% CI (0.01, 0.77); p = 0.05, I2 = 0%]} compared to HA alone, respectively. There were no significant differences in WOMAC total scores, OMERACT-OARSI responder rate, or treatment-related adverse events. CONCLUSION Combined intra-articular injections of CS and HA led to reductions in pain at 2-4, 24-26 and 52 weeks compared to HA injections alone. LEVEL OF EVIDENCE Level II-meta-analysis.
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Towards reaching consensus on hyaluronic acid efficacy in knee osteoarthritis. Clin Rheumatol 2019; 38:2881-2883. [PMID: 31102086 DOI: 10.1007/s10067-019-04597-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 01/27/2023]
Abstract
Intra-articular injection of hyaluronic acid (HA) is a controversial treatment for knee osteoarthritis (OA). While clinical efficacy of HA relative to saline injections has been demonstrated in many studies, these results are of limited value in real-world clinical practice since saline injection is not a knee OA treatment. Instead, rigorous postmarket comparative studies of HA versus approved knee OA treatments are encouraged. The conduct of such studies is particularly important given the paucity and heterogeneous nature of current evidence regarding nonsurgical knee OA treatment. KEY POINTS: • Societal guidelines recommend nonsteroidal anti-inflammatory drugs and corticosteroid injections, but not hyaluronic acid injections, for knee osteoarthritis (OA) despite inconsistent supportive data. • This article encourages rigorous comparative post-approval studies to clarify the role of nonsurgical treatments used in clinical practice for knee OA.
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Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, Vaghi P, Rovati LC. Association of Pharmacological Treatments With Long-term Pain Control in Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis. JAMA 2018; 320:2564-2579. [PMID: 30575881 PMCID: PMC6583519 DOI: 10.1001/jama.2018.19319] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Even though osteoarthritis is a chronic and progressive disease, pharmacological agents are mainly studied over short-term periods, resulting in unclear recommendations for long-term disease management. OBJECTIVE To search, review, and analyze long-term (≥12 months) outcomes (symptoms, joint structure) from randomized clinical trials (RCTs) of medications for knee osteoarthritis. DATA SOURCES AND STUDY SELECTION The databases of MEDLINE, Scopus, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched until June 30, 2018 (MEDLINE alerts through August 31, 2018) for RCTs of patients with knee osteoarthritis that had treatment and follow-up lasting 1 year or longer. DATA EXTRACTION AND SYNTHESIS Data at baseline and at the longest available treatment and follow-up of 12 months' duration or longer (or the change from baseline) were extracted. A Bayesian random-effects network meta-analysis was performed. MAIN OUTCOMES AND MEASURES The primary outcome was the mean change from baseline in knee pain. Secondary outcomes were physical function and joint structure (the latter was measured radiologically as joint space narrowing). Standardized mean differences (SMDs) and mean differences with 95% credibility intervals (95% CrIs) were calculated. Findings were interpreted as associations when the 95% CrIs excluded the null value. RESULTS Forty-seven RCTs (22 037 patients; mean age range, mostly 55-70 years; and a higher mean proportion of women than men, around 70%) included the following medication categories: analgesics; antioxidants; bone-acting agents such as bisphosphonates and strontium ranelate; nonsteroidal anti-inflammatory drugs; intra-articular injection medications such as hyaluronic acid and corticosteroids; symptomatic slow-acting drugs in osteoarthritis such as glucosamine and chondroitin sulfate; and putative disease-modifying agents such as cindunistat and sprifermin. Thirty-one interventions were studied for pain, 13 for physical function, and 16 for joint structure. Trial duration ranged from 1 to 4 years. Associations with decreases in pain were found for the nonsteroidal anti-inflammatory drug celecoxib (SMD, -0.18 [95% CrI, -0.35 to -0.01]) and the symptomatic slow-acting drug in osteoarthritis glucosamine sulfate (SMD, -0.29 [95% CrI, -0.49 to -0.09]), but there was large uncertainty for all estimates vs placebo. The association with pain improvement remained significant only for glucosamine sulfate when data were analyzed using the mean difference on a scale from 0 to 100 and when trials at high risk of bias were excluded. Associations with improvement in joint space narrowing were found for glucosamine sulfate (SMD, -0.42 [95% CrI, -0.65 to -0.19]), chondroitin sulfate (SMD, -0.20 [95% CrI, -0.31 to -0.07]), and strontium ranelate (SMD, -0.20 [95% CrI, -0.36 to -0.05]). CONCLUSIONS AND RELEVANCE In this systematic review and network meta-analysis of studies of patients with knee osteoarthritis and at least 12 months of follow-up, there was uncertainty around the estimates of effect size for change in pain for all comparisons with placebo. Larger RCTs are needed to resolve the uncertainty around efficacy of medications for knee osteoarthritis.
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Affiliation(s)
- Dario Gregori
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Clara Minto
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | | | - Francesca Gualtieri
- Scientific Information and Library Services, Rottapharm Biotech, Monza, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Paola Vaghi
- Department of Biostatistics, Rottapharm Biotech, Monza, Italy
| | - Lucio C. Rovati
- Department of Clinical Research, Rottapharm Biotech, Monza, Italy
- School of Medicine and Surgery, University of Milano – Bicocca, Monza, Italy
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Affiliation(s)
- Gwo-Chin Lee
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Di Sante L, Venditto T, Ioppolo F, Paoloni M, Mangone M, Alviti F. Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study. Muscles Ligaments Tendons J 2017; 7:331-337. [PMID: 29264345 DOI: 10.11138/mltj/2017.7.2.331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Meniscal subluxation results in the natural history of knee osteoarthritis (OA). Periarticular infiltration should minimize possible complications related to penetration of corticosteroids into the joint space in the treatment of knee OA.According to pain relief and improvement of function, the aim of this study is to evaluate the effectiveness of perimeniscal corticosteroid ultrasound guided injection in knee OA. Methods Thirty-two patients received an injection of 0.5 ml of methylprednisolone-acetate around perimeniscal tissues. Outcome measures were pain relief and knee function, assessed by Visual Analogue Scale (VAS) [24, 29, 30] measured at rest (VAS-R) and during stairs climbing (VAS-C) and by Italian-Western Ontario and McMaster Universities (WOMAC) scale. Clinical evaluation was performed at baseline, at 1 and 4 weeks of follow-up. Results Mean baseline values of VAS-R and VAS-C were 6.79 ± 1.17 and 7.6 ± 1.39, respectively. All subjects showed a significant reduction in pain over time (p<0.001). Mean baseline values of WOMAC pain, stiffness and physical function were 5.56 ± 1.32, 4.39 ± 1.91 and 4.63 ± 2.31, respectively. According to WOMAC stiffness and physical function was not found a significant improvement over time (p> 0.05). Conclusion Corticosteroid perimeniscal ultrasound guided injection can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA. Level of Evidence IV.
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Affiliation(s)
- Luca Di Sante
- Department of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy
| | - Teresa Venditto
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy
| | - Francesco Ioppolo
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy
| | - Marco Paoloni
- Department of Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Rome, Italy.,Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy
| | - Massimiliano Mangone
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy
| | - Federica Alviti
- Department of Anatomy, Histology, Forensic Medicine and Orthopedics, Board of Physical Medicine and Rehabilitation, "Sapienza" University, Rome, Italy
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Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis. PLoS One 2017; 12:e0187227. [PMID: 29155833 PMCID: PMC5695798 DOI: 10.1371/journal.pone.0187227] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 10/16/2017] [Indexed: 12/18/2022] Open
Abstract
Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden.
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12
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Is there a relationship between serum ox-LDL, oxidative stress, and PON1 in knee osteoarthritis? Clin Rheumatol 2017. [DOI: 10.1007/s10067-017-3732-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Belzile EL, Deakon RT, Vannabouathong C, Bhandari M, Lamontagne M, McCormack R. Cost-Utility of a Single-Injection Combined Corticosteroid-Hyaluronic Acid Formulation vs a 2-Injection Regimen of Sequential Corticosteroid and Hyaluronic Acid Injections. CLINICAL MEDICINE INSIGHTS. ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2017; 10:1179544117712993. [PMID: 28638242 PMCID: PMC5472395 DOI: 10.1177/1179544117712993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/10/2017] [Indexed: 12/18/2022]
Abstract
Research has shown early and sustained relief with a combination therapy of a corticosteroid (CS) and hyaluronic acid (HA) in knee osteoarthritis (OA) patients. This can be administered via a single injection containing both products or as separate injections. The former may be more expensive when considering only product cost, but the latter incurs the additional costs and time of a second procedure. The purpose of this study was to compare the cost-utility of the single injection with the 2-injection regimen. The results of this analysis revealed that the single-injection formulation of a CS and HA may be cost-effective, assuming a willingness-to-pay of $50 000 per quality-adjusted life year gained, for symptomatic relief of OA symptoms. This treatment may also be more desirable to patients who find injections to be inconvenient or unpleasant.
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Affiliation(s)
| | | | | | - Mohit Bhandari
- Division of Orthopaedic Surgery, Centre for Evidence-Based Orthopaedics, McMaster University, Hamilton, ON, Canada
| | | | - Robert McCormack
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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Intra-Articular Hyaluronic Acid Compared to Traditional Conservative Treatment in Dogs with Osteoarthritis Associated with Hip Dysplasia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:2076921. [PMID: 27847523 PMCID: PMC5101385 DOI: 10.1155/2016/2076921] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/15/2016] [Accepted: 08/28/2016] [Indexed: 01/27/2023]
Abstract
The purpose of this study was to compare the efficacy of the intra-articular (IA) hyaluronic acid injection to traditional conservative treatment (TCT) in dogs with osteoarthritis (OA) induced by hip dysplasia. Sixteen dogs were distributed into two groups: Hyal: IA injection of hyaluronic acid (5-10 mg), and Control: IA injection with saline solution (0.5-1.0 mL) in combination with a TCT using an oral nutraceutical (750-1000 mg every 12 h for 90 days) and carprofen (2.2 mg/kg every 12 h for 15 days). All dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form (HCPI and CPBI) at the same time. The data were analyzed using unpaired t test, ANOVA, and Tukey's test (P < 0.05). Compared with baseline, lower scores were observed in both groups over the 90 days in the veterinarian evaluation, HCPI, and CPBI (P < 0.001). The Hyal group exhibited lower scores from 15 to 90 and 60 to 90 days, in the CBPI and in the veterinarian evaluation, respectively, compared to the Control group. Both treatments reduced the clinical signs associated with hip OA. However, more significant results were achieved with intra-articular hyaluronic acid injection.
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Ong KL, Anderson AF, Niazi F, Fierlinger AL, Kurtz SM, Altman RD. Hyaluronic Acid Injections in Medicare Knee Osteoarthritis Patients Are Associated With Longer Time to Knee Arthroplasty. J Arthroplasty 2016; 31:1667-73. [PMID: 26895820 DOI: 10.1016/j.arth.2016.01.038] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few nonoperative treatment options for knee osteoarthritis (OA) are available, but there is ongoing debate about the effectiveness of intra-articular (IA) hyaluronic acid (HA) injections. We investigated whether the formulation of IA HA, or its combined use with IA corticosteroid (CS), may be contributing to some of the reported variation in clinical outcomes. METHODS The 5% Part B Medicare data (2005-2012) were used to identify knee OA patients who underwent knee arthroplasty (KA). The time from diagnosis of OA to KA was compared between patients with (HA) and without (no HA) IA HA use, using quantile regression with propensity score adjustment. These were further stratified by type of IA HA. Patient factors associated with time to KA were also assessed using Cox regression. RESULTS The "HA" cohort was associated with a longer time to KA of 8.7 months (95% confidence interval: 8.3-9.1 months; P < .001) compared with the "no HA" cohort, with extended time to KA in the bioengineered Euflexxa IA HA cohort. Patient factors associated with longer time to KA included women, younger patients, minority patients, patients with fewer comorbidities, and IA CS injection use. Patients with both IA HA and IA CS had an additional 6.3 months (95% confidence interval: 5.5-7.0 months; P < .001) to KA over those with only IA HA. CONCLUSION In a large cohort of elderly patients undergoing KA, there was a significant longer time from diagnosis of OA to KA in those receiving IA HA. It is unclear if the extended time may lead to less KA utilization.
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Affiliation(s)
| | | | - Faizan Niazi
- Ferring Pharmaceuticals, Inc, Parsippany, New Jersey
| | | | | | - Roy D Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, California
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