Intra-articular Injection Of Sodium Hyaluronate Research Articles

The clinical observations and comparion on using the sodium hyaluronate intraarticular injection purely and that combined with Chinese medicine fumigating and washing for 166 case of knee joint ostearthritis

Objective To observe and compare the curative effect of sodium hyaluronate intraarticular injection purely and that combined with Chinese medicine fumigating and washouting therapy for knee joint ostearthritis.Methods 126 cases (206 knees) were divided randomly into two groups.Control group was treated with sodium hyaluronate intraarticular injection,and Experimental group was treated with sodium hyaluranate intraarticular injection combined with Chinese medicine fumigating and washing therapy,then observe and compare the curative effect.Results The disparity of total effective rate between these two groups was significant (P＜0.05).In the aspects of improving ache,tenderness,and chilly limbs,the comparison of these two sets is significant(P＜0.01).In the aspects of improving the swell and funcation of movement,comparison of these two sets is non-significant(P＞0.05),the curative effect was equal.Conclusions The treatment of knee joint osteoarthritis with sodium hyaluronate intraarticul injection combined with Chinese medicine fumigating and washing therapy can effectively alleviate ache,symptnm,etc.And improve function of the joint,raise the sufferer's quality of life.There is obvious advantage in keeping away of reeidivation.It was a kind of safe,effective nonoperative therapeutic alliance method of traditional Chinese and western medicine,which with small poisonous side effect and low relapse rate. Key words: Knee joint osteoarthritis; Sodiam Hyaluronate; Chinese medicine fumigating and washing therapy; Nonoperative therapeutic alliance

Hylan G-F 20 Has Better Pain Relief and Cost-effectiveness than Sodium Hyaluronate in Treating Early Osteoarthritic Knees in Taiwan

Intra-articular injection of hyaluronan (hyaluronic acid; HA) products is available to treat early osteoarthritis (OA) of the knee in Taiwan. We tested whether HA products with different molecular weights have significantly different effects on clinical efficacy and cost-effectiveness. Thirty-seven patients with mild to moderate OA of both knees underwent five weekly intra-articular injections of sodium hyaluronate (Artz) in one knee and three weekly intra-articular injections of chemically cross-linked Hylan G-F 20 (Synvisc) in the other. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne's index, and Hospital for Special Surgery (HSS) knee scores were compared initially and at the last injection, and at 8, 12, 16, 20, and 26 weeks after the first injection. VAS, WOMAC, WOMAC-A1 (pain when walking on a flat surface) scores before week 16, HSS scores before week 12, and Lequesne's index scores except at week 26 all showed that HA significantly improved the scores time-dependently. In VAS scores, Synvisc showed better improvement before week 20, while this effect appeared at week 12 for the WOMAC-A1 scores. The incremental cost-effectiveness ratio of the Taiwan National Health Insurance Program, of the patient, and both of these was lower for Synvisc, which also reduced the number of additional hospital visits for injections by two. Synvisc possesses better symptom-modifying ability and cost-utility in treating early OA of the knee in Taiwan.

Intraarticular Hyaluronic Acid Injection for the Treatment of Reducing and Nonreducing Disc Displacement of the Temporomandibular Joint

Temporomandibular dysfunction (TMD) has been established as a therapeutic challenge in the plastic and maxillofacial clinics. The current treatment recommendations for TMD include resting the jaw, soft diet, and pain medication with nonsteroidal analgesic agents. If conservative and noninvasive techniques do not work, more invasive techniques may be considered. The main goal of this study was to assess the safety and clinical utility of intraarticular injection of sodium hyaluronate for the treatment of symptoms associated with internal derangement of the temporomandibular joint (TMJ). In this prospective study, 40 TMJs of 33 patients who have TMD were treated with intraarticular sodium hyaluronate injections at weekly intervals for 3 weeks. Pre- and postinjection pain intensity, the presence of joint sounds, and interincisial distance were documented. The follow-up period was 12 months. There was a statistically significant reduction of pain intensity (P < 0.01) and joint sound (P < 0.05) in all patients. This study shows that intraarticular hyaluronic acid injection for the treatment of reducing and nonreducing disc displacement of TMJ is an effective and safe management.

Poster 231: Comparison of Sono-Guided Intraarticular Injection of Triamcinolone and Sodium Hyaluronate in Patients With Adhesive Capsulitis of the Shoulder

Objective: To compare the effects of sono-guided intraarticular injection of triamcinolone and sodium hyaluronate in patients with adhesive capsulitis of the shoulder. Design: Randomized clinical trial. Setting: Physical medicine and rehabiliation department of Sanggye Paik Hospital. Participants: 38 patients with adhesive capsuitis of the shoulder were selected as study subjects. Interventions: Patients with adhesive capsuitis of the shoulder were selected as study subjects and assigned randomly into 2 groups, group A and B.

Influence of sodium hyaluronate on iNOS expression in synovium and NO content in synovial fluid of rabbits with traumatic osteoarthritis

To observe the influence of intra-articular injection of sodium hyaluronate (SH) on the expression of inducible nitric oxide synthase (iNOS) in the synovium and nitric oxide (NO) content in synovial fluid of rabbits with traumatic osteoarthritis (OA). Sixteen white rabbits underwent unilateral anterior cruciate ligament transection and were randomly divided into 2 groups 5 weeks after the operation. Rabbits in the experimental group received intra-articular injection of 0.3 ml of 1% SH, once a week for 5 weeks. Animals in the control group were treated under the same conditions using physiological saline. All the animals were sacrificed at the 10th week after surgery. The mRNA expression of iNOS in the synovium was analyzed using reverse transcription-polymerase chain reaction. The content of NO in the synovial fluid was assayed. The level of iNOS expression of the synovium in the experimental group was lower than that in control group (0.47+/-0.09 vs. 0.65+/-0.12, t equal to 3.45, P less than 0.01). Compared with control group, the content of NO decreased significantly in synovial fluid of SH injection group (134.11 micromolar/L +/- 12.47 micromolar/L vs. 152.17 micromolar/L +/- 15.69 micromolar/L, t equal to 2.55, P less than 0.05). SH significantly decreases the content of NO in the synovial fluid of rabbits with traumatic OA. SH may exert the effect on synovial fluid NO level as a result of the suppression of iNOS expression in the synovium. It may be one of the mechanisms of the therapeutic effect of SH on early traumatic OA.

Treatment of Persistent Shoulder Pain with Sodium Hyaluronate: A Randomized, Controlled Trial

Presently, there are no approved nonoperative therapies for the ongoing treatment of persistent shoulder pain. Preliminary data suggest that intra-articular sodium hyaluronate injections may be beneficial for the treatment of persistent shoulder pain resulting from various etiologies. The present study evaluated the efficacy and safety of sodium hyaluronate (Hyalgan; molecular weight, 500 to 730 kDa) for these patients. Six hundred and sixty patients with persistent shoulder pain and limitation resulting from glenohumeral joint osteoarthritis, rotator cuff tear, and/or adhesive capsulitis who had had a failure of conventional therapy were enrolled in this double-blind, randomized, phosphate-buffered saline solution-controlled study, and 456 patients completed twenty-six weeks of follow-up. Patients were randomized to receive either five weekly intra-articular injections of sodium hyaluronate, three weekly intra-articular injections of sodium hyaluronate followed by two weekly intra-articular injections of saline solution, or five weekly intra-articular injections of saline solution. The main outcomes were improvement in terms of shoulder pain on movement at thirteen weeks after the initiation of treatment (as assessed with use of a 100-mm visual analog scale) and the treatment effect throughout twenty-six weeks. For the overall intent-to-treat population, patients who were managed with sodium hyaluronate had greater pain relief than controls did; significant differences were noted at Week 7 (for the five-injection hyaluronate group), Week 17 (for the three and five-injection hyaluronate groups), and Week 26 (for the three-injection hyaluronate group). Analysis of the stratified populations clearly established that this effect was due to benefits experienced by the patients with osteoarthritis. The treatment effect through twenty-six weeks was significant in patients with osteoarthritis in the three-injection (p = 0.003) and five-injection (p = 0.002) groups, with no significant difference for either regimen in patients without osteoarthritis. The safety profile was very favorable, with no product-related serious adverse effects and no between-group differences for any reported adverse event. Although the primary end point of this study (that is, improvement in terms of shoulder pain at thirteen weeks) was not achieved, the overall findings, including secondary end points, indicate that sodium hyaluronate (500 to 730 kDa) is effective and well tolerated for the treatment of osteoarthritis and persistent shoulder pain that is refractory to other standard nonoperative interventions.

Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study

The purpose of this study was to evaluate the effect of intra-articular hyaluronic acid (HA) injections after arthroscopic debridement on pain and functional parameters in patients with mild-to-moderate knee osteoarthritis. Sixty-seven patients (21 men, 46 women; mean age 56 years; range 40 to 65 years) who underwent standard arthroscopic debridement for primary knee osteoarthritis of Kellgren-Lawrence grade II-III were randomly assigned to HA injections (n=33) or to only follow-up as controls (n=34). Intra-articular sodium hyaluronate injections (Orthovisc) were started three weeks after arthroscopic debridement, totaling three injections interspersed with a week. The two groups were evaluated with the pain and physical function subscales of the WOMAC osteoarthritis index before and after 6, 12, and 24 weeks of arthroscopic debridement. Improvement in pain scores at 6 weeks did not differ between the two groups (HA 21%, control 16%; p=0.478), whereas improvement in function scores was significantly higher in the HA group (23% vs 9.2%; p=0.018). The rates of improvement in pain and function scores increased in subsequent evaluations, but these did not differ significantly between the two groups. The percentages of patients who exhibited at least 30% and 40% improvement from baseline function scores were significantly greater in the HA group only at six weeks (p=0.025 and p=0.038, respectively). Intra-articular HA injections after arthroscopic debridement provide additional short-term benefits, but this combination therapy should be justified by further controlled studies with longer follow-up and larger patient groups.

Efficacy and Safety of Hyaluronan Treatment in Combination Therapy With Home Exercise for Knee Osteoarthritis Pain

Stitik TP, Blacksin MF, Stiskal DM, Kim JH, Foye PM, Schoenherr L, Choi E-S, Chen B, Saunders HJ, Nadler SF. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain. Objective To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee. Design Single-blinded, parallel-design, 1-year clinical study with sequential enrollment. Setting University-based outpatient physiatric practice. Participants Sixty patients (18 men, 42 women; age, ≥50y) with moderate-to-severe pain associated with OA of the knee. Interventions (1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP). Main Outcome Measures The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales. Results The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL ( P<.01) and 5-HYL groups ( P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events. Conclusions The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.

Sodium Hyaluronate in the Treatment of Hallux Rigidus. A Single-Blind, Randomized Study

The purpose of this study was to evaluate the effectiveness and safety of intra-articular sodium hyaluronate (Ostenil)mini) compared to intra-articular triamcinolone acetonide (Trigon depot) in the treatment of painful hallux rigidus. Thirty-seven patients (ages 40 to 80 years) with painful early stage hallux rigidus were enrolled in the study. One group received an intra-articular injection with 1.0 ml sodium hyaluronate (SH); the other received an intra-articular injection of 1.0 ml triamcinolone acetonide (TA). Patients were evaluated on days 0, 14, 28, 56 and 84. Effectiveness was measured using the following parameters: joint pain at rest or on palpation (VAS), with passive motion, and gait pain; AOFAS hallux metatarsophalangeal score; use of analgesics and global assessment of the treatment by the patient and investigator. Safety was evaluated by the outcome of tolerance to treatment and observation of adverse events. Statistical analyses were performed using the Chi-square test, Mann-Whitney U test, Wilcoxon test and Friedman test. Thirty-seven patients (40 feet) were evaluated. Pain at rest or with palpation and pain on passive mobilization decreased significantly in both treatment groups in comparison to baseline (p<0.01), but no significant between-group differences were observed (p>0.05). Gait pain improved substantially in the sodium hyaluronate group with significant differences compared to the triamcinolone group at days 28 and 56 (p<0.05). The AOFAS total score improved significantly in the SH group compared to the TA group (p<0.05). This was mainly due to improvements in the pain subscale. No between-group differences were seen regarding the use of analgesics. Global assessment of treatment by patients was good in both groups, and there was a significant between-group difference favoring SH when areas under the curves (AUC) were calculated (p < 0.05). Tolerance was good in both groups. Adverse events occurred in three patients. Intra-articular injections of sodium hyaluronate are effective and safe in decreasing hallux rigidus pain. The AOFAS scores in the SH group were significantly better than in the TA group.

Different effects of high molecular weight sodium hyaluronate and NSAID on the progression of the cartilage degeneration in rabbit OA model

We examined the effects of nonsteroidal anti-inflammatory drug (NSAID) and intra-articular injections of sodium hyaluronate (HA) on cartilage degeneration in rabbit knee osteoarthritis (OA) model induced by partial meniscectomy. Loxoprofen sodium (LOX) was used as the NSAID, administered p.o. once daily for 14 days at a dose of 4 mg/kg, starting from the day of meniscectomy. Suvenyl(SVE) was used as the high molecular weight HA, injected intra-articularly into injured knee every 3 days from the day of surgery. The effect on pain was assessed by an Incapacitance Tester, and the damage of cartilage was evaluated by visual assessment and histopathology at 14 days after the surgery. Hind paw weight bearing on the injured paw decreased time-dependently in the control group. In other three groups, the decrease of hind paw weight distribution was suppressed, demonstrating an analgesic effect. Visible damage and histopathological findings of cartilage degeneration were evident in the cartilages of the control group at day 14. In the SVE group, the damaged cartilage area decreased and cartilage degeneration was ameliorated. In contrast, in the LOX group, the cartilage degeneration was augmented compared with the control group. And, this exacerbated cartilage degeneration induced by LOX was reversed by the concomitant use of SVE. Our data show that the treatment with high molecular weight HA from earlier stage is strongly recommended to preserve the structure of cartilage.

Prevention of chondrocyte apoptosis following acute osteochondral injury

目的 探讨关节软骨创伤后软骨细胞凋亡情况及其预防方法.方法 32只新西兰大白兔,4只行膝关节囊切开,不损伤软骨(正常组),另28只双侧膝关节钻孔造成软骨急性损伤,一侧关节腔在术毕和术后每周1次注射1%透明质酸钠1 mL(治疗组),另一侧不做处理作为损伤对照(损伤组);利用TUNEL、流式细胞仪两种方法检测软骨受损区软骨细胞凋亡情况.结果 损伤后软骨细胞出现坏死和凋亡,至第4天软骨细胞凋亡率最大,凋亡细胞全层分布;透明质酸钠治疗组软骨细胞凋亡较损伤组明显减少,差异有极显著性意义(P＜0.01).结论 创伤后关节软骨细胞发生凋亡会导致创伤后骨关节炎的发生.早期关节腔内注射透明质酸钠能有效抑制软骨细胞凋亡,可能对预防和降低创伤后骨关节炎的发生有重要意义。

PR_115: A Randomized Double-Blinded Crossover Trial of Acromioclavicular Joint Intra-Articular Sodium Hyaluronate for the Treatment of Chronic Shoulder Pain Due to Acromioclavicular Joint Osteoarthritis

Objective: To evaluate the effects of intra-articular sodium hyaluronate injections for chronic shoulder pain from acromioclavicular joint (ACJ) osteoarthritis (OA). Design: Randomized double-blinded crossover trial. Setting: University-based outpatient musculoskeletal physiatric practice. Participants: 19 subjects with chronic shoulder pain were enrolled as their pain was primarily due to ACJ OA, based on a positive response (>50% pain relief within 20min) after a diagnostic ACJ injection. Interventions: 3 weekly fluoroscopically guided intra-articular injections of sodium hyaluronate or saline, and monthly follow-up visits were conducted.

Short-term therapeutic outcome of intra-articular high molecular weight hyaluronic acid injection for nonreducing disc displacement of the temporomandibular joint

In a patient with temporomandibular disorder who does not respond to conservative treatment, treatment with intra-articular injection of high molecular weight sodium hyaluronate can be suggested. In our study, 27 patients with nonreduced disc displacement were diagnosed clinically and confirmed by magnetic resonance imaging. The age range was from 21 to 63 years old, with a mean of 39.3 years. Two cycles of injection of high molecular weight sodium hyaluronate was performed on alternative weeks. Pain intensity was measured by the visual analog scale. Maximal mouth opening, clicking joint noise, and lateral movement were measured before and after injection for more than 6 months. Reduction of pain intensity and improvement in the maximum mouth opening parameter was statistically significant. In conclusion, this intra-articular injection using high molecular weight sodium hyaluronate looks very positive for patients affected by nonreduced disc displacement and is encouraged to be used as a primary treatment of temporomandibular joint dysfunction.

SODIUM HYALURONATE IN THE TREATMENT OF OSTEOARTHRITIS OF THE ANKLE

Background: Intra-articular injections of hyaluronans have been shown to be safe and effective for the treatment of pain associated with osteoarthritis of the knee. This pilot study was undertaken to gather preliminary data on the efficacy and safety of five weekly intra-articular injections of Hyalgan (sodium hyaluronate; molecular weight, 500 to 730 kDa) as compared with saline solution for the treatment of pain associated with osteoarthritis of the ankle. Methods: Twenty patients at two test sites were randomized with use of a double-blind (blinded observer), saline solution-controlled, parallel experimental design. Patients were randomized to receive five weekly intra-articular injections of either 1 mL of sodium hyaluronate (10 mg/mL) or 1 mL of phosphate-buffered saline solution into the ankle joint. The primary outcome measurement was the ankle osteoarthritis score. Several secondary outcome measures also were assessed. Results: Significant improvement in the mean ankle osteoarthritis score from baseline was seen at all follow-up visits from one to six months in both the sodium hyaluronate group and the saline solution group (p < 0.0001). In addition, five of nine patients in the sodium hyaluronate group had >30 mm of improvement in this score, compared with one of eight patients in the control group. No withdrawals were directly attributable to the injections of sodium hyaluronate or saline solution, and no severe medication-related adverse events were observed. Conclusions: The present study suggests that five weekly intra-articular injections of sodium hyaluronate (molecular weight, 500 to 730 kDa) are well tolerated, can provide sustained relief of pain, and can improve function in patients with osteoarthritis of the ankle. These findings are consistent with those of previously published studies involving intra-articular injections of sodium hyaluronate in other joints, but they require confirmation in a large, randomized, saline solution-controlled study. Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

Sodium Hyaluronate in the Treatment of Osteoarthritis of the Ankle

Intra-articular injections of hyaluronans have been shown to be safe and effective for the treatment of pain associated with osteoarthritis of the knee. This pilot study was undertaken to gather preliminary data on the efficacy and safety of five weekly intra-articular injections of Hyalgan (sodium hyaluronate; molecular weight, 500 to 730 kDa) as compared with saline solution for the treatment of pain associated with osteoarthritis of the ankle. Twenty patients at two test sites were randomized with use of a double-blind (blinded observer), saline solution-controlled, parallel experimental design. Patients were randomized to receive five weekly intra-articular injections of either 1 mL of sodium hyaluronate (10 mg/mL) or 1 mL of phosphate-buffered saline solution into the ankle joint. The primary outcome measurement was the ankle osteoarthritis score. Several secondary outcome measures also were assessed. Significant improvement in the mean ankle osteoarthritis score from baseline was seen at all follow-up visits from one to six months in both the sodium hyaluronate group and the saline solution group (p < 0.0001). In addition, five of nine patients in the sodium hyaluronate group had >30 mm of improvement in this score, compared with one of eight patients in the control group. No withdrawals were directly attributable to the injections of sodium hyaluronate or saline solution, and no severe medication-related adverse events were observed. The present study suggests that five weekly intra-articular injections of sodium hyaluronate (molecular weight, 500 to 730 kDa) are well tolerated, can provide sustained relief of pain, and can improve function in patients with osteoarthritis of the ankle. These findings are consistent with those of previously published studies involving intra-articular injections of sodium hyaluronate in other joints, but they require confirmation in a large, randomized, saline solution-controlled study.

Comparison of Intraarticular Injection of Depot Corticosteroid and Hyaluronic Acid for Treatment of Degenerative Trapeziometacarpal Joints

Trapeziometacarpal joint arthritis is a disabling condition presenting with pain at the base of the thumb causing impairment of hand function. Nonoperative treatment at an early stage includes intraarticular steroid injection. Although this treatment may bring about prompt symptomatic relief, its efficacy is unpredictable. There is previous evidence that injection of sodium hyaluronate is effective and safe in the treatment of knee arthritis. We proposed that intraarticular injection of sodium hyaluronate, for the symptomatic treatment of trapeziometacarpal joint arthritis, could provide symptomatic relief without the adverse effects of steroids. Fifty-two patients with trapeziometacarpal joint grade II arthritis were randomized prospectively either for methylprednisolone or hyaluronate intraarticular injections. Initial evaluation included an estimation of pain, grip, pinch strengths and the functional Purdue Pegboard Test (PPT). This evaluation was repeated after 1, 3, and 6 months and statistically compared with the initial evaluation. In both groups, the intraarticular injection produced a relief of pain after 1 month. Grip strength improved significantly in the group treated by the steroid during the whole evaluation period. The patients treated by hyaluronate showed improvement in grip strength after 6 months and in the pinch and the PPT after 3 months. Steroids and hyaluronate injections were found effective in reducing pain. Hyaluronate was more effective in the improvement of some aspects of fine hand function.

Accuracy and Outcome of Sonographically Guided Intra-articular Sodium Hyaluronate Injections in Patients With Osteoarthritis of the Hip

The aim of this study was to evaluate the accuracy and outcome of sonographically guided intra-articular sodium hyaluronate injections in patients with osteoarthritis of the hip. The prospective study involved 10 patients who had the diagnosis of unilateral hip osteoarthritis. The mean age of the patients was 63.2 years (range, 27-80 years). Depending on patient body weight, either a 3.5- to 5-MHz convex transducer or a 5- to 12-MHz linear transducer was used to examine each affected joint. Every subject received 3 injections of sodium hyaluronate, 1 per week for 3 consecutive weeks. With real-time sonographic monitoring, each joint was penetrated with a 20-gauge Chiba needle. Contrast medium was injected initially, and proper intra-articular placement was verified with computed tomography before the hyaluronate injection. Each patient's outcome was assessed on the basis of visual analog scale results and Western Ontario and McMaster Universities osteoarthritis index findings that were recorded before the set of injections and 2, 4, and 6 months after the third injection. Computed tomography confirmed accurate placement in all 30 injections in the study. The visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index scores showed that 80% of the patients had less pain in the joint at 6 months after the last injection. Sonographically guided intra-articular injection of sodium hyaluronate for patients with hip osteoarthritis is easy to perform and is a safe, economical, and well-tolerated form of treatment. In contrast to fluoroscopic or computed tomographic guidance, the sonographic technique exposes neither the patient nor the physician to radiation.

Conservative treatment of temporomandibular joint osteoarthrosis: intra‐articular injection of sodium hyaluronate

Promising short-term results in the treatment of temporomandibular joint osteoarthrosis with intra-articular injections of sodium hyaluronate (SH) have been reported in preliminary studies. The present prospective study compared long-term outcomes of temporomandibular joint SH injections with those of a conventional non-surgical treatment (bite-plane). Data from three groups of 20 patients with degenerative temporomandibular joint disease were considered. Group A underwent one cycle of five injections of 1 mL SH. Group B underwent a bite-plane treatment for at least 6 months. We considered a control group of 20 patients who refused any treatments. The description of the outcomes was based on objective and subjective parameters after a 6-month follow-up. Sodium hyaluronate and bite-plane treatments significantly improved patients conditions in all considered parameters. No significant differences in outcomes were confirmed by the statistical analysis. The tolerability of SH treatment resulted to be significantly higher. The analysis of results of serial controls in the SH treated group disclosed a significant worsening in pain at rest by comparing 1 and 6 months follow-up. Sodium hyaluronate infiltration resulted a valid non-surgical treatment for temporomandibular joint degenerative disease. Five well-tolerated intra-articular SH injections achieved equivalent results to those of a 6 months bite-plane treatment. We did not diagnose any complications of SH intra-articular injections. Longer time follow-up is necessary to determine the stability of SH properties.

Arthrite septique du genou après injection intra-articulaire d'acide hyaluronique : à propos de deux cas

Abstract Intraarticular sodium hyaluronate injection to treat osteoarthritis is associated with minor side effects. Infections seem uncommon. We report two cases of septic knee arthritis. One patient was an 80-year-old woman who was admitted for Staphylococcus aureus knee arthritis after several intraarticular injections of sodium hyaluronate and corticosteroids. In the other patient, a 78-year-old woman, Neisseria mucosa knee arthritis occured after a single hyaluronate injection. Faultless Aseptic technique is essential when administering hyaluronate viscosupplementation. Patients should be informed of the risk of septic arthritis.

Septic knee arthritis after intra-articular hyaluronate injection: Two case reports

Intraarticular sodium hyaluronate injection to treat osteoarthritis is associated with minor side effects. Infections seem uncommon. We report two cases of septic knee arthritis. One patient was an 80-year-old woman who was admitted for Staphylococcus aureus knee arthritis after several intraarticular injections of sodium hyaluronate and corticosteroids. In the other patient, a 78-year-old woman, Neisseria mucosa knee arthritis occurred after a single sodium hyaluronate injection. Faultless aseptic technique is essential when administering hyaluronate viscosupplementation. Patients should be informed of the risk of septic arthritis.