Abstract
BackgroundAlthough viscosupplementation is an effective symptomatic treatment for knee osteoarthritis (OA), the effect of longer term administration on articular cartilage has not been fully explored. We examined the effect of viscosupplementation with Hylan G-F 20 on knee cartilage over 2 years in patients with knee OA.MethodsIn this prospective, single-blind, parallel control group pilot study, 78 patients with symptomatic knee OA (Kellgren-Lawrence grade II and III) were assigned to either intervention group (n = 39 receiving 4 courses of 3 × 2.0 ml of intra-articular Hylan G-F 20 injections at 6 month intervals) or control group (n = 39 receiving usual care for knee OA without injections). Magnetic resonance imaging of the study knee was performed at baseline, 12 and 24 months. Cartilage volume and defects were assessed using validated methods.ResultsFifty-five subjects (71%) completed 24 month follow up. Over 24 months, the intervention group had a reduced annual percentage rate of medial and lateral tibial cartilage volume loss (mean ± SD, -0.3 ± 2.7% and -1.4 ± 4.3%) compared with the control group (2.3 ± 2.6% and 1.4 ± 2.6%, P = 0.001 and 0.005 for difference, respectively). The intervention group also showed reduced cartilage defect score increment in the medial tibiofemoral compartment (0.1 ± 1.3) compared with the control group (0.8 ± 1.5, P = 0.05).ConclusionsSix monthly intra-articular injections of Hylan G-F 20 administered to patients with symptomatic knee OA have a beneficial effect on knee cartilage preservation measured by both cartilage volume and cartilage defects. Hylan G-F 20 warrants further evaluation in larger clinical trials as a possible disease-modifying agent in the treatment of knee OA.Trial RegistrationThe study was registered with ClinicalTrials.gov (NCT00393393).
Highlights
Viscosupplementation is an effective symptomatic treatment for knee osteoarthritis (OA), the effect of longer term administration on articular cartilage has not been fully explored
The only study examining the effect of intra-articular hyaluronic acid on articular cartilage assessed by magnetic resonance imaging (MRI) found no significant difference in patellofemoral cartilage changes between the treatment and control groups over 8 weeks [16]
There were no significant baseline differences between the two groups apart from the prevalence of medial tibiofemoral bone marrow lesions (BMLs) being higher in the control group compared with the intervention group (Table 1)
Summary
Viscosupplementation is an effective symptomatic treatment for knee osteoarthritis (OA), the effect of longer term administration on articular cartilage has not been fully explored. Intra-articular injections of different forms of hyaluronic acid are safe and effective in relieving pain and improving function in knee OA over the short to medium term [5,6]. Whilst intra-articular hyaluronic acid injection is registered as a device to treat symptomatic knee OA [5,6], evidence suggests that it may retard disease progression and be a potential disease-modifying agent. The only study examining the effect of intra-articular hyaluronic acid on articular cartilage assessed by magnetic resonance imaging (MRI) found no significant difference in patellofemoral cartilage changes between the treatment and control groups over 8 weeks [16]. The duration may be too short to detect differences in cartilage changes
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