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

Keerati Chareancholvanich,Chaturong Pornrattanamaneewong,Rapeepat Narkbunnam

doi:10.1007/s00167-013-2735-1

Keerati Chareancholvanich, Chaturong Pornrattanamaneewong + Show 1 more

Open Access

https://doi.org/10.1007/s00167-013-2735-1

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Abstract

PurposeHigh 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.MethodsForty 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).ResultsMRI 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).ConclusionBased 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 evidenceTherapeutic study, Level I.

Highlights

Knee osteoarthritis (OA) is a progressive disease that results in cartilage degradation due to mechanical and biochemical factors
We hypothesized that intraarticular hyaluronic acid may increase the restoration of cartilage volume and improve the post-operative clinical outcome after High tibial osteotomy (HTO) compared to a control group
Data from this study showed that cartilage volumes of the medial tibiofemoral joint were increased in both groups, which demonstrates the reparative effect of HTO surgery

Summary

Introduction

Knee osteoarthritis (OA) is a progressive disease that results in cartilage degradation due to mechanical and biochemical factors. Malalignment can create abnormal load distribution through the knee joint, leading to increased stress on a focal area of articular cartilage. This change is simultaneously aggravated by a local biochemical response to an increased variety of degradation products, such as pro-. The benefits of intra-articular hyaluronic acid injections include restoration of the elastic and viscous properties of the synovial fluid, anti-inflammatory effects, anti-nociceptive effects and normalized hyaluronic acid synthesis [11, 20, 27] These treatment modalities could be used in combination to create synergistic effects to improve repair or delay the progression of OA in the knee. We hypothesized that intraarticular hyaluronic acid may increase the restoration of cartilage volume and improve the post-operative clinical outcome after HTO compared to a control group

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