Abstract
ObjectiveAn evaluation of safety and efficacy of high molecular weight hyaluronan (HA) delivered at the time of arthroscopic debridement of the osteoarthritic knee.MethodsThirty consecutive patients who met inclusion and exclusion criteria underwent arthroscopic debridement by a single surgeon and concomitant delivery of 6 ml/90 mg HA (Orthovisc®). These patients were evaluated preoperatively, at 6 weeks, 3 and 6 months post-operatively. Evaluations consisted of WOMAC pain score, SF-36 Physical Component Summary (PCS) score and complications.ResultsNo complications occurred during this study. Pre-op average WOMAC pain score was 6.8 +/- 3.5 (n = 30) with a reduction to 3.4 +/- 3.1 at 6 weeks (n = 27). Final average WOMAC pain score improved to 3.2 +/- 3.8 at six months (n = 23). No patients had deterioration of the WOMAC pain score. Mean pre-operative SF-36 PCS score was 39.0 +/- 10.4 with SF-36 PCS score of the bottom 25th percentile at 29.9 (n = 30). Post procedure and HA delivery, mean PCS score at 6 weeks improved to 43.7 +/- 8.0 with the bottom 25th percentile at 37.5 (n = 27). At 6 months, mean PCS score was 48.0 +/- 9.8 with the bottom 25th percentile improved to 45.8 (n = 23).ConclusionThe results show that concomitant delivery of high molecular weight hyaluronan (Orthovisc® – 6 ml/90 mg) is safe when given at the time of arthroscopic debridement of the osteoarthritic knee. By delivering HA (Orthovisc®) at the time of the arthroscopic debridement, there may be a decreased risk of joint infection and/or injection site pain. Furthermore, the combination of both procedures show efficacy in reducing WOMAC pain scores and improving SF-36 PCS scores over a six month period.
Highlights
Osteoarthritis (OA) is the most prevalent musculoskeletal disorder and the leading cause of disability in adults over the age 45 years [1,2,3]
The diagnosis of osteoarthritis was further confirmed at the time of arthroscopy with all included patients having at least a Grade II or III lesion per the International Cartilage Repair Society (ICRS) in one of the compartments of the knee
All thirty arthroscopy procedures were performed without any intra-operative complication
Summary
Osteoarthritis (OA) is the most prevalent musculoskeletal disorder and the leading cause of disability in adults over the age 45 years [1,2,3]. OA of the knee is extremely common, with some studies showing that OA of the knee occurs in at least 30% of people after the age of 50 years, and in 80% of people older than 75 years [4,5]. Of the patients with OA, over 80% will have limitation of movement and greater than 25% can not perform their activities of daily living [3]. Conservative treatment for knee OA has been symptomatic and includes basic analgesics, i.e. acetaminophen, non-steroidal anti-inflammatory drugs, intra-articular injection of glucocorticoids, activity modification, weight loss with exercise, and physical therapy. Surgical treatments for patient refractory to conservative management include arthroscopic debridement plus joint lavage or unicompartmental/total joint arthroplasty
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