Injection Of Sodium Hyaluronate Research Articles

Сравнительная эффективность внутрисуставных инъекций гиалуроната натрия в комбинации с хондроитина сульфатом и пероральных симптоматических препаратов медленного действия у пациентов с первичным и посттравматическим остеоартритом коленных суставов

Сравнительная эффективность внутрисуставных инъекций гиалуроната натрия в комбинации с хондроитина сульфатом и пероральных симптоматических препаратов медленного действия у пациентов с первичным и посттравматическим остеоартритом коленных суставов

Prolonged pain reducing effect of sodium hyaluronate-carboxymethyl cellulose solution in the selective nerve root block (SNRB) of lumbar radiculopathy: a prospective, double-blind, randomized controlled clinical trial

The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain. The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone. Double blinded randomized controlled clinical trial. A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study. Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36. A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months. VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure. Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure.

Sodium Hyaluronate and Platelet-Rich Plasma for Partial-Thickness Rotator Cuff Tears.

ABSTRACTPurposeThe treatment of partial-thickness rotator cuff tears (PTRCT) remains controversial. Few studies have focused on the conservative and new measurements of small to medium PTRCT. The use of sodium hyaluronate (SH) or platelet-rich plasma (PRP) as a method for rotator cuff repair requires further investigation. The aim of this study was to evaluate the combined use of SH and PRP in the treatment of small to medium PTRCT.Study DesignA double-blinded randomized trial was used in this study.MethodsIndividuals with PTRCT detected by clinical examination and magnetic resonance imaging (MRI) were included in this study. The patients were randomly assigned to receive subacromial injections of normal saline, SH, PRP, or SH + PRP once a week for 4 wk. The primary outcome measure was the Constant score, and the secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and the visual analog scale scores. All of the clinical outcomes were assessed at pretreatment and 1, 3, 6, and 12 months posttreatment. MRI was used to evaluate the evolution of the cuff defect after 1 yr.ResultsThe PRP group and the SH + PRP group showed a significantly higher Constant score and ASES score after the treatments. There were significant differences between the SH + PRP group and the SH or PRP group at 12 months in the Constant, visual analog scale, and ASES scores. MRI results showed that the tear size significantly decreased in both the PRP and the SH + PRP groups, especially in the SH + PRP group.ConclusionOur study provided evidence of the efficacy of PRP injection in the healing of small to medium PTRCT. Moreover, the combined injection of SH and PRP yielded a better clinical outcome than SH or PRP alone.

Highly selective peripheral nerve radio frequency ablation for the treatment of severe knee osteoarthritis

The objective of the present study was to investigate the effect of highly selective peripheral nerve radiofrequency (RF) ablation for the pain caused by severe knee osteoarthritis (OA). A total of 96 patients with knee OA were randomly divided into two groups. The 49 patients in group A were treated with highly selective peripheral nerve RF ablation group and the 47 patients in group B were treated with sodium hyaluronate injection. Visual analogue scale (VAS), Lysholm knee score (LKS), and pain relief before treatment and at 3 days and 3, 6, 9, and 12 months after treatment were compared. At each time point after treatment in group A, both VAS and LKS scores were significantly different compared with before treatment (P<0.05). At 3 days, and at 3 and 6 months after treatment in group B, VAS scores were significantly different from before treatment (P<0.05) and at 9 and 12 months after treatment, the scores were not significantly different from those before treatment. In addition, LKS scores were only significantly different at 3 months after treatment compared with before treatment (P<0.05) and not significantly different after that time point. Furthermore, compared with group B, the rates of effective pain relief in group A were significantly higher at each time point after treatment (P<0.05). Compared with sodium hyaluronate injection, highly selective peripheral nerve RF ablation of the knee was more effective, easy to operate and had no significant adverse effects for the treatment of knee OA.

Clinical Outcome of Sodium Hyaluronate Injection into the Superior and Inferior Joint Space for Osteoarthritis of the Temporomandibular Joint Evaluated by Cone-Beam Computed Tomography: A Retrospective Study of 51 Patients and 56 Joints.

BackgroundThe aim of this study was to determine the clinical effects of sodium hyaluronate injection into the superior and inferior joint space for osteoarthritis of the temporomandibular joint (TMJ) and to evaluate the joint changes using cone-beam computed tomography (CBCT).Material/MethodsA retrospective observational clinical study included 51 patients and 56 TMJs, with a diagnosis of osteoarthritis. All patients received sodium hyaluronate injections into the superior and inferior TMJ joint spaces (articular cavities). At baseline and post-treatment the condylar bony changes were evaluated by CBCT. To evaluate TMJ function, maximum mouth opening (MMO), and Helkimo’s index was used, which included an anamnestic index (Ai) and a clinical dysfunction index (Di). Patients were divided into short-term (<one year) and long-term (>one year) follow-up groups.ResultsIn both patient follow-up groups, sodium hyaluronate injection of the superior and inferior TMJ space significantly improved MMO, the Ai, and the Di (P<0.05). There were no significant differences between the two groups in condylar bony changes of the TMJ seen by CBCT (sclerosis, erosion, hyperplasia, and flattening) (P>0.05). CBCT showed a good predictive ability on post-treatment symptom relief following sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis of the TMJ (P=0.024).ConclusionsThe findings of this clinical and CBCT imaging study showed that sodium hyaluronate injection into the superior and inferior TMJ space in patients with osteoarthritis improved clinical symptoms, but did not control the progression of osteoarthritic joint destruction.

Outcome of fixed volume intracameral sodium hyaluronate 1.4% injection for early postoperative hypotony after Baerveldt glaucoma implant.

Using an ophthalmic viscoelastic device to manage early postoperative hypotony after Baerveldt glaucoma implant (BGI). To determine the outcome of intracameral sodium hyaluronate injection for early postoperative hypotony treatment after BGI. A retrospective study. One-hundred-and-thirty-eight patients (176 eyes) had BGI from January 2012 to November 2015. Those who had hypotony within 3 months postoperatively were studied. Hypotonous eyes were injected with 0.1 mL sodium hyaluronate 1.4% intracameral on the slit-lamp. The patients were followed up weekly and the injection repeated up to 3 times if hypotony persisted. The tube was tied surgically as a last resort. The intraocular pressure and best-corrected visual acuity at week 1, 2, 3, 4, 6 and month 4 were assessed. Thirty (17.0%) out of 176 eyes developed early postoperative hypotony. The median intraocular pressure and median best-corrected visual acuity when hypotony first presented were 3 mmHg and 0.8 logMAR. Two eyes were excluded as they had more than 0.1 mL injection. Eight (29%) of the 28 hypotonous eyes resolved after one injection, seven (25%) required two and 10 (36%) needed three injections. Three (11%) eyes had surgical tube tie. The median intraocular pressures were 5, 7, 8, 10, 11 and 13 mmHg at week 1, 2, 3, 4, 6 and month 4 post-injection. The median best-corrected visual acuity were 0.60, 0.50, 0.50, 0.45, 0.40 and 0.40 logMAR for the same period. Standardised intracameral 0.1 mL sodium hyaluronate 1.4% is an effective and safe way to manage early postoperative hypotony after BGI.

Ultrasonographic guided subacromial sodium hyaluronate injection for rotator cuff disease

Rotator cuff disease is a common cause of shoulder pain. There are studies about the effectiveness of sodium hyaluronate injection on shoulder and knee pain, but few studies demonstrating the efficacy of sodium hyaluronate ultrasonography guided injection for rotator cuff disease. This study evaluates effectiveness of ultrasonography guided subacromial sodium hyaluronate injection in patients with impingement syndrome without rotator cuff complete tear. This prospective, double-blind, placebo controlled clinical trial study was performed among 40 patients with subacromial impingement syndrome without complete tear of rotator cuff. Patients randomly injected ultrasonography guided in 2 groups: case group by 20 mg of sodium hyaluronate and control group by 0.9% normal saline. Both groups received 3 weekly injections. The pain score (100 mm visual analogue score [VAS]) was evaluated before first injection and one week after each injection. The constant score was evaluated before first and 12 week after last injection. Data was analyzed statistically by Independent t -test. In both groups mean VAS has decreased, but more significantly in case group ( P < 0.001). Mean constant score was significantly higher in case group 12 weeks after last injection ( P < 0.001). The constant score improved 12 weeks after the last injection in both groups with a significantly better result in case group ( P < 0.001). Subacromial injections of sodium hyaluronate are effective in treating rotator cuff disease without complete tears.

Treatment of Knee Osteoarthritis with Acupuncture plus Intra-articular Injection of Sodium Hyaluronate

To examine the clinical benefits of acupuncture combined with intra-articular injection of sodium hyaluronate for knee osteoarthritis (KOA) patients. A total of 150 KOA patients were randomized into simple medication and acupuncture plus medication (combined treatment) groups (n＝75 in each). For all the patients, intra-articular injection of sodium hyaluronate (2 mL) was performed once a week for 5 weeks, and for patients of the combined treatment group, filiform needles were separately inserted into unilateral or bilateral Zusanli (ST 36), Liangqiu (ST 34), Yanglingquan (GB 34), Yinlingquan (SP 9), Xiyangguan (GB 33), Dubi (ST 35), Neixiyan (EX-LE 4) and Xuehai (SP 10) according to the focus, and manipulated with the uniform reinforcing and reducing technique, followed by retaining the needles for 30 min. The acupuncture treatment was given once every day or every other day, 5 weeks in total. The visual analog scale (VAS) was used to assess the pain severity of knee-joint, and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) employed to assess the 1) pain severity during various positions or movements (20 points), 2) severity of joint stiffness (8 points), and 3) difficulty in performing daily functional activities (68 points). The therapeutic effect was evaluated according to the decreased level of WOMAC subscale scores and improvement of daily activities. After the treatment, the VAS scores of both medication and combined treatment groups were decreased significantly in comparison with their own pre-treatment in each group (P<0.05), and that of the combined treatment group was significantly lower than that of the medication group (P<0.05). WOMAC and daily activity fin-dings showed that of the two 75 KOA patients in the medication and combined treatment groups, 16 (21.33%) and 32 (42.67%) experienced marked improvement, 46 (61.33%) and 38 (50.67%) were improved, and 13 (17.33%) and 5 (6.67%) ineffective, with the total effective rates being 82.67% and 93.33%, respectively. The therapeutic effect of the combined treatment group was apparently superior to that of the simple medication group (P<0.05). Acupuncture combined with intra-articular injection of sodium hyaluronate is effective in improving KOA patients' pain severity and other symptoms as well as functional activities.

Rho- Kinase Inhibitor Y-27632 Decreases the Thickness of Trabecular Meshwork in Juvenile Rats Mod-el Injected with Sodium Hyaluronate

Most glaucoma drugs lower the intraocular pressure (IOP) by decreasing the aqueous humor production and increasing the outflow through uveoscleral pathway. None of these drugs work mainly on increasing outflow through the trabecular pathway. Consequently, the experiment to develop glaucoma drugs directly target at the trabecular outflow pathway is highly required. The purpose of this study is to reveal the effect of rho-kinase inhibitor Y-27632 on the thickness of trabecular meshwork in juvenile rats model injected with sodium hyalu-ronate. This study was an experimental study with posttest only control group design. Twenty-four rats were included in this study. Each eye of the rat would be considered as one sample. Samples were divided into 6 groups, negative control group, positive control I group with intracameral sodium hyaluronate injection, posi-tive control II group with topical Y-27632 10 mM, and three experimental groups with intracameral injection of sodium hyaluronate and Y-27632 10-1 mM, 1 mM, and 10 mM respectively. After the procedures all rats were sacrificed and enucleated. Trabecular meshwork tissue was stained with Hematoxilene-Eosin and evalu-ated under 400× microscopic magnification. Quantitative measurements were taken using computerized image analysis with dot slide program. There were significant statistic differences among the positive control I group and the experimental groups (p-value < 0.05) as well as the positive control II group and the experi-mental groups (p-value < 0.05). The highest mean of decreasing trabecular meshwork thickness was noted in the group given by sodium hyaluronate and Y-27632 10 mM with value of 118.42 µm. There was decreasing thickness of trabecular meshwork due to the effect of rho- kinase inhibitor Y-27632 in juvenile rats injected with sodium hyaluronate.

Analysis of therapeutic effect of sodium hyaluronate intra-articular injection combined with oral Yanghe decoction in the treatment of knee osteoarthritis

Objective To investigate the curative effect of sodium hyaluronate intraperitoneal injection combined with oral Yanghe decoction in the treatment of knee osteoarthritis. Methods 80 patients with knee osteoarthritis were randomly divided into two groups, 40 cases in each group.The control group was given intra-articular injection of sodium hyaluronate, and the study group was treated with Yanghe decoction in addition.The TCM symptom score, knee joint index, overall treatment effect and quality of life were compared between the two groups. Results The total score of TCM symptoms after treatment in the study group was (7.08±1.18)points, which was significantly lower than (10.42±2.01)points in the control group(t=9.063, P<0.01). The VAS score and WOMAC score after treatment in the study group were (1.48±0.59)points, (19.10±3.08)points, respectively, which were significantly lower than (3.70±1.12)points and (23.40±3.56)points in the control group(t=11.091, 5.777, all P<0.01). The HSS score after treatment in the study group was (83.04±10.49)points, which was significantly higher than (71.81±9.67)points in the control group(t=4.978, P<0.01). The physiological function, physical function, physical pain, mental health and energy scores after 6 months treatment in the study group were significantly higher than those in the control group (t=5.190, 8.535, 4.569, 3.266, 6.694, all P<0.01). The effective rate and total effective rate of the study group were 72.5% and 95.0%, respectively, which were significantly higher than those of the control group(50.0%, 77.5%), the differences were statistically significant(χ2=4.266, 5.165, all P<0.05). Conclusion Sodium hyaluronate injection combined with oral Yanghe decoction is effective in the treatment of knee osteoarthritis. Key words: Osteoarthritis, knee; Joint capsule; Sodium hyaluronate; Medicine, Chinese traditional

Clinical research of acupuncture moxibustion and traditional Chinese medicine external treatment of severe knee osteoarthritis

Objective To study the effect of moxibustion acupuncture and Chinese medicine external treatment for the severe knee osteoarthritis. Methods A total of 86 severe knee osteoarthritis patients were enrolled between December 2014 and December 2016, in Department of Integrated TCM & Western Medicine, Shijiazhuang first hospital. According to the enrolled sequency, patients were divided into observation group and control group, 43 in each group. The control group was treated with intra-articular injection of sodium hyaluronate of 2ml, and the observation group was treated with the combined acupuncture moxibustion and traditional Chinese medicine external treatment on the basis of the control group. Two groups were performed for 3 months of follow-up. The clinical effect, WOMAC values, VAS score and Lysholm scale, and the serum high sensitivity C reactive protein (hs-CRP), interleukin 1 (IL-1) and tumor necrosis factor a (TNF-a) changes before and after the treatment were observed and compared. Results The total effective rate of observation group was 93.0% (40/43), while control group total effective rate was 76.7% (33/43), and the differences between two groups was statistically significant (χ2=4.441, P=0.035). After treatment, the WOMAC joint stiffness scores (3.2 ± 1.2 vs. 4.8 ± 2.1, t=4.338), joint pain (4.2 ± 1.3 vs. 5.9 ± 1.7, t=4.903), daily activities (14.5 ± 2.8 vs. 18.7 ± 2.9, t=6.832) in observation group were significantly lower than those in the control group. The VAS score (2.5 ± 0.8 vs. 4.1 ± 1.2, t=7.275) in observation group was significantly lower than the control group, while the Lysholm score (74.2 ± 3.7 vs. 67.4 ± 3.9, t=8.295) was significantly higher than the control group (P<0.05). The serum hs-CRP (8.34 ± 2.24 mg/L vs. 13.67 ± 2.54 mg/L, t=10.321), IL-1 (0.85 ± 0.11 ng/L vs. 1.32 ± 0.42 ng/L, t=7.099), TNF-a (98.67 ± 15.74 ng/L vs. 178.44 ± 26.53 ng/L, t=16.955) in the observation group patients were significantly lower than those in the control group (P<0.05). Conclusions The acupuncture combined moxibustion and traditional Chinese medicine external treatment could treat severe knee osteoarthritis, improve the function of knee joint. Key words: Osteoarthritis, knee; Acupuncture; Direct moxibustion; Hot compress; Inflammatory cytokines

Efficacy of Sodium Hyaluronate for Temporomandibular Joint Disorder by Single-Puncture Arthrocentesis.

The term temporomandibular joint internal derangement has characteristic clinical findings such as restricted mouth opening, pain, irregular deviated jaw function and clicking sounds. The technique of TMJ arthrocentesis has gained widespread acceptance as a simple and effective technique for the treatment of acute persistent closed lock of the TMJ. Arthrocentesis is known as the lavage and lysis of upper joint compartment. To evaluate the efficacy of sodium hyaluronate followed by single-puncture arthrocentesis. Sodium hyaluronate is the sodium salt of hyaluronic acid which is a polysaccharide of the glycosaminoglycans family, found in many extracellular tissues, including synovial fluid and cartilage. Exogenous hyaluronate can stimulate the synthesis of endogenous hyaluronic acid. In our study, a sample of 10 patients (7 females and 3 males) with TMJ disorder was selected. Arthrocentesis was done followed by sodium hyaluronate injection for all the patients. On follow-up ranging from 1 to 3 months, pain at rest and pain on mastication had substantially decreased in all patients and mandibular function and mouth opening had significantly improved. Our study shows that single-puncture Ringer's lactate arthrocentesis followed by sodium hyaluronate injection is effective in the management of the internal derangement of the temporomandibular joint.

Effectiveness and safety of arthroscopic debridement for treatment of degenerative knee osteoarthritis in elderly patients: study protocol for a non-randomized controlled trial

Background and objectives: The main treatment goals for degenerative knee osteoarthritis are to relieve pain, restore knee function, improve quality of life, delay knee replacement, and reduce the number of revisions. Knee replacement is currently the most common treatment for degenerative knee osteoarthritis; however, the cost is high, and the procedure is often associated with prosthesis loosening and shedding and many adverse reactions. Therefore, we hypothesize that knee-preserving arthroscopic debridement for treatment of knee degenerative osteoarthritis in elderly patients is lower-cost, effective, safe, and reliable.Design: Prospective, single-center, open-label, non-randomized controlled trial.Methods: In total, 212 elderly patients (knees) with degenerative knee osteoarthritis who receive treatment in the Second Hospital of Chaoyang (Liaoning Province, China) will be included in this study. These patients will be assigned to two groups according to each patient’s condition and wishes (n = 106/group). In the control group, intra-articular injection of sodium hyaluronate will be performed, followed by oral administration of nonsteroidal anti-inflammatory drugs, conventional physiotherapy, and quadriceps functional exercise. In the arthroscopic debridement group, arthroscopic debridement will be performed, followed by oral administration of nonsteroidal anti-inflammatory drugs, conventional physiotherapy, and quadriceps functional exercise. All patients will be followed up at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years.Outcome measures: The primary outcome measure is the percentage of patients with a Hospital for Special Surgery (HSS) knee score of ≥ 85 points at 2 years after surgery, which will be used to evaluate knee function recovery. The secondary outcome measures are the percentage of patients with an HSS knee score of ≥ 85 points before surgery and at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery; the HSS score, visual analog scale score, Western Ontario and McMaster Universities Osteoarthritis Index, knee range of motion, hospitalization costs, and knee X-ray morphology before surgery and 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery; medical costs after 2 years of treatment; and incidence of adverse reactions at 1 week, 1 month, 3 months, 6 months, 1 year, and 2 years after surgery.Discussion: The findings from this study will reveal whether arthroscopic debridement for the treatment of degenerative knee osteoarthritis in elderly patients has the advantages of fewer adverse reactions and lower treatment costs with effective restoration of knee function.Ethics and dissemination: This study was approved by Medical Ethics Committee of Second Hospital of Chaoyang of China (approval No. 2017-08-01). The study will be performed in accordance with the Declaration of Helsinki. Participants provided signed informed consent regarding the study protocol prior to participation in the study. This study was designed in June 2017. Patient recruitment and data collection will begin in June 2018. Patient recruitment will end in December 2018. Data analysis will be performed in June 2021. The study will be completed in August 2021. Results will be disseminated through presentations at scientific meetings and/or by publication in a peer-reviewed journal.Trial registration: This trial was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800015208). Protocol version (1.0).

Deep vein thrombosis after sodium hyaluronate injection to knee joint: a case report

Deep vein thrombosis after sodium hyaluronate injection to knee joint: a case report

Effectiveness of Intra-Articular Injections of Sodium Hyaluronate or Corticosteroids for Intracapsular Temporomandibular Disorders: A Systematic Review and Meta-Analysis.

To assess the effectiveness of intra-articular injections of sodium hyaluronate (NaH) or corticosteroids (CS) for treatment of intracapsular temporomandibular disorders (TMD). Single- or double-blinded randomized controlled trials (RCTs) on the effectiveness of NaH or CS injections, compared to each other or to placebo, for the treatment of intracapsular TMD due to osteoarthritis and/or internal joint derangement were analyzed in this systematic review and meta-analysis. Electronic searches of MEDLINE through the PubMed, Web of Science, and Cochrane Library databases were conducted on March 17, 2015, and an updated search was conducted on June 7, 2017. Three reviewers independently extracted the data and assessed the risk of bias of included studies. An initial search yielded 245 studies, and 5 additional studies were identified through cross referencing. A total of 22 studies were identified as relevant based on the abstracts, but only 7 RCTs met the inclusion criteria. Six of the included studies had unclear risk of bias, and one had high risk of bias. Four studies were eligible for meta-analysis. Pooled results showed no significant difference in short- or long-term pain improvement with NaH compared to CS. The number of responders to NaH was significantly more than placebo in one study, but not significantly higher than CS in another study. Although there was no significant difference between the effectiveness of NaH and CS intra-articular injections, there was some evidence that NaH was better than placebo. Further research is needed to determine the minimum effective dose and long-term side effects of both injections.

Acupotomy versus sodium hyaluronate for treatment of knee osteoarthritis in rabbits

ObjectiveTo investigate the possible advantages of acupotomy over sodium hyaluronate injection for the treatment of knee osteoarthritis (KOA). MethodsTwenty rabbits were divided randomly into four groups (n = 5 in each): a control group, model group, acupotomy group, and sodium hyaluronate injection group. The model, acupotomy, and sodium hyaluronate groups underwent anterior cruciate ligament transection plus partial medial meniscectomy. Sodium hyaluronate injection and acupotomy were administered to the respective groups from weeks 5 to 8, and samples of the tibial plateau and medial condyle of the femur were collected in week 9. Vascular endothelial growth factor (VEGF) expression was assessed in cartilage and subchondral bone by immunohistochemical staining. ResultsArticular cartilage degeneration was less pronounced in the acupotomy compared with the model and sodium hyaluronate groups. VEGF expression levels in cartilage and subchondral bone were increased in the model group compared with the control group (P < 0.01), and acupotomy had a more pronounced therapeutic effect than sodium hyaluronate injection (P < 0.01). ConclusionAcupotomy and sodium hyaluronate injection may both reduce degeneration in the cartilage and subchondral bone in KOA based on the results from a rabbit model, but acupotomy improved the histopathology and reduced the VEGF content more effectively than sodium hyaluronate injection, probably by reducing venous stasis and intraosseous pressure. Acupotomy may improve KOA by lowering VEGF.

Efficacy and safety of single injection of cross-linked sodium hyaluronate vs. three injections of high molecular weight sodium hyaluronate for osteoarthritis of the knee: a double-blind, randomized, multi-center, non-inferiority study

BackgroundThis randomized, double-blind, multi-center, non-inferiority trial was conducted to assess the efficacy and safety of a cross-linked hyaluronate (XLHA, single injection form) compared with a linear high molecular hyaluronate (HMWHA, thrice injection form) in patients with symptomatic knee osteoarthritis.MethodsTwo hundred eighty seven patients with osteoarthritis (Kellgren-Lawrence grade I to III) were randomized to each group. Three weekly injections were given in both groups but two times of saline injections preceded XLHA injection to maintain double-blindness. Primary endpoint was the change of weight-bearing pain (WBP) at 12 weeks after the last injection. Secondary endpoints included Western Ontario and McMaster Universities Osteoarthritis index; patient’s and investigator’s global assessment; pain at rest, at night, or in motion; OMERACT-OARSI responder rate; proportion of patients achieving at least 20 mm or 40% decrease in WBP; and rate of rescue medicine use and its total consumption.ResultsMean changes of WBP at 12 weeks after the last injection were −33.3 mm with XLHA and −29.2 mm with HMWHA, proving non-inferiority of XLHA to HMWHA as the lower bound of 95% CI (−1.9 mm, 10.1 mm) was well above the predefined margin (−10 mm). There were no significant between-group differences in all secondary endpoints. Injection site pain was the most common adverse event and no remarkable safety issue was identified.ConclusionsThis study demonstrated that a single injection of XLHA was non-inferior to three weekly injections of HMWHA in terms of WBP reduction, and supports XLHA as an effective and safe treatment for knee osteoarthritis.Trial registrationClinicalTrials.gov (NCT01510535). This trial was registered on January 6, 2012.

The clinical study of middle and old age patients with knee osteoarthritis treated by abdominal acupuncture combined with sodium hyaluronate injected in intraarticular

Objective To explore the clinical efficacy of knee osteoarthritis treated by abdominal acupuncture combined with sodium hyaluronate injected in intraarticular. Methods 120 patients with knee osteoarthritis were randomly divided into observation group and control group, 60 patients in each group. The observation group was treated by abdominal acupuncture combined with sodium hyaluronate injected in intraarticular. The control group was treated with intraarticular injection of sodium hyaluronate alone. Results After a follow up of 6 months, the total effective rate of the treatment group was 95.00%, which was higher than 78.33% of the control group, the difference was statistically significant (χ2=7.21, P<0.01). Conclusion Abdominal acupuncture combined with intraarticular injection of sodium hyaluronate is a good way to treat middle and old age patients with knee osteoarthritis. Key words: Osteoarthritis, hip; Acupuncture; Sodium hyaluronate

Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intra-articular sodium hyaluronate (Hyalgan®) injections.

BackgroundGiven the poor long-term effectiveness of focused nonsurgical knee osteoarthritis (OA) treatments, alternative therapies are needed for patients who have unsuccessfully exhausted nonsurgical options.MethodsA telephone interview was conducted in patients who participated in a single 8-week multimodal knee OA treatment program (mean follow-up: 3.7 years, range: 2.7–4.9 years). The program consisted of five intra-articular knee injections of sodium hyaluronate (Hyalgan®), with each injection given 1 week apart, structured physical therapy, knee bracing, and patient education. Clinical outcomes included knee pain severity, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores, current medication use, and history of total knee arthroplasty. Base-case, subgroup, and sensitivity analyses were conducted to determine the incremental cost-effectiveness ratio (ICER) of the treatment program with comparisons made to historical literature controls undergoing usual care.ResultsA total of 218 patients (54%) provided long-term follow-up data. Knee pain severity decreased 60% and WOMAC subscores decreased 33%–42% compared to baseline (all p<0.001). Total knee arthroplasty was performed in 22.8% (81/356) of knees during followup. The treatment program was highly cost-effective compared to usual care with a base-case ICER of $6,000 per quality-adjusted life year (QALY). Results of subgroup analyses, one-way deterministic sensitivity analyses, and second-order probabilistic sensitivity analyses resulted in ICERs ranging from $3,996 to $10,493 per QALY. The percentage of simulations with an ICER below willingness-to-pay limits was 97.2%, 98.9%, and 99.4% for the $50,000, $100,000, and $150,000 per QALY thresholds, respectively.ConclusionParticipation in a single 8-week knee OA treatment program, which included one cycle of five intra-articular knee injections of sodium hyaluronate given at weekly intervals, is highly cost-effective and provides clinically meaningful reductions in patient symptoms that are maintained over 3.7 years mean follow-up.

Prospective Evaluation of Intra-Articular Sodium Hyaluronate Injection in the Ankle

Viscosupplementation by injection of hyaluronic acid into the ankle can be used to provide pain relief and to delay the need for surgery in patients with osteoarthritis of the ankle. In the present investigation, we prospectively evaluated 50 consecutive patients (25 males and 25 females) undergoing a 3-injection protocol of sodium hyaluronate viscosupplementation in the ankle from January 2014 to January 2015. The Foot and Ankle Outcomes Score was used to compare the patients’ pre- and post-treatment opinions about their ankle problems. The mean pretreatment Foot and Ankle Outcomes Score was 48 ± 6.3 (range 25 to 84) and the 6-month post-treatment score was 78 ± 5.8 (range 48 to 100). This difference was statistically significant (p = .003). From our findings in the present prospective cohort study, we have concluded that intra-articular injection of sodium hyaluronate viscosupplementation is a useful conservative therapy for osteoarthritis of the ankle.