Intra-articular Ozone Research Articles

The effect of intra-articular ozone injection combined with home-based exercise on pain and function in daily living activities of patients with mild to moderate knee osteoarthritis, a randomized double-blinded controlled clinical trial

BackgroundKnee osteoarthritis is the most common arthritis. Various treatments such as analgesics, exercise therapy, and surgery in high-grade OA have been shown to reduce pain and improve patients' function; however, determining the optimal treatment remains a challenge. Ozone therapy is one of the injection techniques used for symptom relief in these patients. Therefore, this study aimed to evaluate the effect of ozone injection in mild to moderate knee osteoarthritis. MethodsThirty-three patients with grade II-III knee osteoarthritis based on the Kellgren-Lawrence classification were involved in the study, by block randomisation. Totally 42 knees were included. All patients received exercise therapy, 500 mg of acetaminophen tablets (up to 2 g per day as needed), and healthy nutrition. In a double-blinded method, the intervention group received Ozone injections, but the control group received placebo injections. Functional tests, including timed-up-and-go and 6-min walk tests, were assessed at baseline and immediately after the 6-week intervention. In addition, the pain was measured by VAS score, and stiffness and activity of daily living (ADL) were evaluated by KOOS questionnaire before and after a 6-week intervention and then one and six months afterwards. FindingsImprovements in pain and KOOS scores were seen in both groups in the 6th week of injections (p < 0.05), with significant differences between groups. However, the effects on pain and KOOS scores disappeared in the 1st and 6th months of follow-ups in the control group. Nevertheless, the effects persisted in the intervention group compared to the baseline and control group, which means that in the mentioned time points intervention group showed significant improvement compared to the control group (p < 0.05). In addition, functional tests showed significant differences between the two groups in the 6th week of injections (p < 0.001). InterpretationOzone injection is a non-surgical treatment for mild to moderate knee osteoarthritis that could decrease pain and improve function and ADL of patients in the short to mid-term (3–6 months), so it seems that adding Ozone injection to the routine exercise therapy in management of patients with knee OA could improve outcomes.

EFFECTIVE NONSURGICAL MANAGEMENT OF EARLY OSTEOARTHRITIS OF THE KNEE JOINT IN A TERTIARY CARE HOSPITAL — A PROSPECTIVE SINGLE-BLIND RANDOMIZED COMPARATIVE STUDY

Purpose: Osteoarthritis (OA) is a complex disease of joints presenting with pain, swelling, stiffness, crepitus, deformation and limitation of function. There are both conservative and surgical modes of treatment for OA. This study is done to compare the therapeutic efficacy of intra-articular ozone, platelet-rich plasma (PRP) and 25% dextrose in the treatment of OA of the knee joint in early stages.Methods: A total of 120 patients with symptomatic Kellgren and Lawrence grade 2 and 3 of knee OA were studied. They were randomized into three groups and each group received three doses of intra-articular injections of either ozone or PRP or 25% dextrose at intervals of 2 weeks. Patients were advised physiotherapy and analgesics were avoided. Western Ontario and McMaster Universities Arthritis Index and Visual Analog Score for pain were used to evaluate the clinical outcomes for 6 months.Results: Ozone provided significant relief from pain and improved functionality but was short-lived. PRP and 25% dextrose results were slower initially but gave better results for a longer duration.Conclusion: Conservative treatment with intra-articular injections has promising results in the treatment of OA. This can be used in patients who are not willing or not fit for surgery.

The Efficacy of Ozonized Water Versus Ringer Lactate Arthrocentesis for the Treatment of Temporomandibular Joint Internal Derangement.

Temporomandibular disorders are musculoskeletal conditions characterized by facial pain and impaired temporomandibular joint function, limited mouth opening, joint and muscular pain, and noises during mandibular movements are some of the most common symptoms. The most frequent cause of temporomandibular joint dysfunction is internal derangement (ID), which refers to an alteration in the normal pathways of motion of the joint that largely involves the function of the articular disc, therefore, these alterations have been also referred to as disc derangement. Arthrocentesis is a minimally invasive technique, less expensive than surgical treatment. Adhesions are released after arthrocentesis of the upper joint space under sufficient hydraulic pressure. Intra-articular ozone gas injection is used as conservative treatment modalities for ID of the temporomandibular as it possesses anti-inflammatory, analgesic effects, enhancement the host defense mechanism and accelerates the healing process of the damaged cells. The aim of this study was to compare the effectiveness of ozonized water against lactated ringer solution in the arthrocentesis of the temporomandibular joint. Sixty patients were used in this study, suffered from ID of the temporomandibular joint treated by arthrocentesis under hydraulic pressure and were allocated into 2 groups; the study group (A), which included 30 patients, managed by arthrocentesis utilizing ozonized water and the control group (B) with 30 patients also treated by the same procedure using ringer lactate solution. Visual analog scale pain scores, temporomandibular joint sounds, and maximal mouth opening were assessed preoperatively and at different intervals postoperatively. The age in this study ranged from 14 to 66 years. The mean age of group A was 29.93 years with an SD of ±11.79. For group B, the mean age was 27.56 years and the SD was ±10.80, the prominent percentage in both groups was < 30 years. Regarding sex, 45 patients were females, whereas the males were 15 with a ratio of 3:1. Group A registered the highest reduction in the visual analog scale at all postoperative intervals. With respect to the mouth opening, there was no significant difference in maximal mouth opening between the 2 groups after 1 week and 12 weeks in comparison with the preoperative measurements. The temporomandibular joint sounds improved in all patients in group A after 12 weeks, whereas in group B the sounds dropped to 33.3%. The data from the present study suggested more favorable treatment outcomes for ozonized water lavage and it is a promising new treatment modality for the relief of symptoms associated with the ID of the temporomandibular joint.

Intra-articular ozone slows down the process of degeneration of articular cartilage in the knees of rats with osteoarthritis

BackgroundOsteoarthritis (OA) is a joint disease of multifactorial etiology, affecting mainly the knees. We aimed to evaluate the effects of two different doses of gaseous ozone intra-articularly on the knee cartilage morphology of rats with osteoarthritis (OA). MethodsThe articular lesion was induced by sodium monoiodoacetate (MIA). 40 Wistar rats were divided into 4 groups: G1 control (without lesion and without treatment), G2 articular lesion (AL) (only lesion MIA-induced), G3 AL + treatment with 5 μg/mL of ozone intra-articular, and G4 AL + treatment with 10 μg/mL of ozone intra-articular. The experiment was carried out for 60 days. ResultsBoth doses of ozone intra-articular demonstrated less reduction in joint space (G3 and G4) compared to the G2, formation of osteophytes, but without subchondral sclerosis. Ozone decreased the volumetric density of the articular lesion (VV(AL)) of tibial. The treatments recovered VV(AL) of the femur similar to G1. Ozone lower dose (G3) showed lower tibia and femur macroscopic scores. ConclusionIntra-articular gaseous ozone can delay the degeneration of articular cartilage and can represents an integrative therapy in the OA treatment of knee after 60 days of treatment. For the first time the role of ozone in articular cartilage degeneration was evaluated helping to understand this therapy.

Intra Articular Ozone Modulates Inflammation and Has Anabolic Effect on Knee Osteoarthritis: IL-6 and IGF-1 as Pro-Inflammatory and Anabolic Biomarkers

Objectives: (1) to demonstrate the anti-inflammatory and anabolic effect of Ozone by determining in serum samples the biochemical levels of IL-6 and IGF-1 in knee osteoarthritis (OA) patients in a real world rehabilitation setting; (2) to differentiate Ozone effect in diabetic (DM)/obese and non-DM/non-obese patients; (3) to evaluate clinical effectiveness by visual analog scale (VAS) and WOMAC scale, and biochemical effect by C-reactive protein (CRP), uric acid and erythrocyte sedimentation rate (ESR). Material and methods: 65 patients with knee OA Kellgren Lawrence (KL) grade 2 or more were analyzed in a retrospective observational study. The study ran from January 2018 to September 2021. Inclusion criteria: (a) patients 18 years or older; (b) with knee OA KL 2° or more; (c) biochemical analysis before-and-after treatment; (d) pain more than 3 on VAS. Exclusion Criteria: (a) previous knee surgery; (b) favism; (c) pregnancy; (d) any other disease that originates lack of collaboration for infiltration. Primary Outcome variables: (a) IL-6; (b) IGF-1 in diabetes mellitus (DM)/obese and non-DM/non-obese patients; both before-and-after Ozone treatment. Secondary Outcome variables: (a) CRP, (b) ESR, (c) uric acid, (d) VAS pain, (e) WOMAC pain, function and stiffness. Ozone protocol consisted of four sessions (once a week) of an intra-articular infiltration of 20 mL (20 µg/mL concentration) of a gas mixture of Oxygen-Ozone 95-5% (produced by Ozone generator Ozonosan-α Plus®). For biochemical evaluation, SNIBE MAGLUMI ™ IL-6 (CLIA) and SNIBE MAGLUMI ™ IGF-1 (CLIA) kits were used. CRP and uric acid were analyzed by a Abbott Alinity c kit; and ESR was evaluated by DIESSE VES MATIC CUBE 30. Results: There is a linear correlation between age and OA severity. IL-6 decreased both in DM and non-DM patients and in all OA KL grades (from 2.70 to 1.59 pg/mL). IGF-1 decreased in total group (OA + DM + obesity) from 112.09 to 107.19 ng/mL. When only non-DM/non-obese knee OA patients were analyzed, Ozone improved IGF-1 levels (from 100.17 to 102.03 ng/mL). Ozone decreased CRP, ESR, uric acid, and improved VAS pain, WOMAC pain, function and stiffness (p &lt; 0.05). Conclusions: Ozone is a valid option for the management of knee osteoarthritis in a real world rehabilitation setting, because of its anti-inflammatory, metabolic and anabolic properties. Ozone tends to downregulate pro-inflammatory IL-6 cytokine. Ozone has a metabolic/hypoglycemic effect on obese/diabetic knee osteoarthritis patients by reducing IGF-1. Ozone has an anabolic effect on non-diabetic/non-obese patients by improving IGF-1. Ozone reduces other biomarkers of inflammation (CRP, ESR and uric acid) and improves, pain, function and quality of life.

Ozone or hyaluronic acid in the intra-articular treatment of knee osteoarthritis?

Aim: Both intra-articular ozone and hyaluronic acid injections are commonly used for treatment of knee osteoarthritis (KOA). It was aimed to evaluate and compare the effectiveness of intra-articular ozone and hyaluronic acid (HA) injections on pain and functional limitations of participants with KOA.Methods: One hundred and eight consecutive patients (eighty-four women, twenty-four men) aged 40-75 years visited to outpatient clinic with knee pain for longer than 3 months. HA injections were performed as a single dose, and ozone injections were administered once a week as three doses in total. The Visual Analog Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were performed before treatment, one and three months after treatment.Results: Seventy-six participants were included in the study. The randomization was done as Hyaluronic Acid (n=39) and Ozone (n=37) groups. No significant difference was found in terms of WOMAC-total, WOMAC-pain, and VAS (p&gt;0.05) at all stages among groups. WOMAC-stiffness score was found significantly different between first month and third month follow-ups (p=0.011). Also, there was a significant change in WOMAC-function scores between before treatment and first month follow-ups (p=0.008), and before treatment and third month follow-ups (p=0.002) in inter-group analysis.Conclusion: Both ozone and HA injections were effective treatment methods for KOA. However, intraarticular HA injection had a longer-lasting effect on pain and function than ozone injection.

CT vođena minimalno invazivna oksigen ozonska terapija kod pacijenata sa degenerativnim promenama lumbosakralnog segmenta kičmenog stuba

Degenerative spine conditions involve the gradual loss of normal structure and function of spine over time. They are usually caused by aging, but may also be the result of tumors, infections or arthritis. Pressure on the spinal cord and nerve roots caused by degeneration can be caused by herniated discs. Degenerative disc disease is one of the most common causes of low back and neck pain, and also one of the most misunderstood ones. Low back pain (LBP) is a common disorder affecting an increasing number of people worldwide, whose diagnosis is focused on the identification of triggering causes. First line therapy usually starts from conservative approaches, whereas second line treatments include a spectrum of minimally invasive techniques, before resorting to more invasive surgical approaches. Among minimally invasive techniques, percutaneous oxygen-ozone injections represent one of the most common and cost-effective procedures. Oxygen-ozone therapy is a minimally invasive treatment for lumbar disc herniation that uses the biochemical properties of the gas mixture of oxygen and ozone. Intradiscal, periradicular or intraarticular ozone therapy is used in patients that do not respond to standard conservative therapies for low back pain due to degenerative disc-induced lumbar disc herniation (LDH) or other degenerative process of nearby structures such as zygapophyseal articulations. All the interventional procedures for low back pain may be guided by ultrasound, computerized tomography or fluoroscopy.

A Comparison Between Low-Level Laser Therapy and Intra-articular Ozone Injection in Knee Osteoarthritis Treatment: A Randomized Clinical Trial.

Introduction: Knee osteoarthritis (KOA) is a common degenerative joint disease, causing deformity, pain and a limited joint range of motion. Modification of the lifestyle and an exercise training program are the cornerstone of treatment. Alternative therapies such as laser or ozone are commonly used, but there is not any comparative study of low-level laser therapy (LLLT) versus ozone therapy. The aim of the study was to compare the efficacy and safety of the LLLT versus ozone in patients with KOA. Methods: In this single-blinded randomized clinical trial, 60 patients with KOA were assigned to LLLT or ozone groups (n=30). The First basic pain severity, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and physical function were determined. Then in the LLLT group, the patients were provided with 12 sessions of LLLT. In the ozone group, 6 sessions of intra-articular injection of ozone were organized (in each session a mixture of 10 mL of bupivacaine 0.25% with 15 mL of ozone 30 μg/mL). In the middle and at the end of the intervention period, we reassessed the joint pain and physical function and the degree of improvement compared between the two groups. Results: In the middle and at the end of the treatment period in both groups, the joint pain decreased significantly. The same as pain, the self-administrated WOMAC score and the range of joint motion improved significantly in both groups. All of these variables exposed more improvement in the ozone group patients. Conclusion: The study showed that both LLLT and ozone are acceptable non-invasive methods in the non-surgical treatment of KOA. Compared to LLLT, the ozone was more effective. These methods must be considered in any patient who is not suitable for surgical interventions or does not experience enough improvement in symptoms following long periods of common exercise training programs.

Changes of the cytokine profile in patients with traumatic synovitis on the background of ozone therapy

Objectives the cytokine profile research in patients with posttraumatic synovitis during intravenous and intra-articular ozone therapy.&#x0D; Material and methods.The research involved 69 patients with traumatic knee joint damage complicated by posttraumatic synovitis.&#x0D; Patients in Group I (35 people) received a traditional treatment. Patients in Group II (34 people) along with the traditional therapy had intravenous injection of 200 ml of ozonated solution of sodium chloride in ozone concentration 2 mg/l once daily for 10 days, and intra-articular injection of 20 ml ozone-oxygen mixture in ozone concentration of 15 mg/l once every second day, in an amount of 5 injections.&#x0D; During arthroscopy, the lavage of the joint cavity was performed with ozonated saline solution at a concentration of 2.0 mg/l.&#x0D; The cytokine profile was evaluated by the content of pro-inflammatory cytokines (TNF-, IL-1, IL-6, IL-17), regulatory (IL-2), IL-1 receptor antagonist, and anti-inflammatory (IL-4, IL-10) cytokines by solid-phase enzyme immunoassay with peroxidase as an indicator. Statistical analysis of the results was carried out using the Student t-test.&#x0D; Results.The use of intravenous and intra-articular ozone therapy contributed to synchronous decrease of the levels of pro-inflammatory cytokines with simultaneous reduction of anti-inflammatory mediators of inflammation. TNF-content decreased by 24.6% (p20.001), IL-17 by 17.3% (p20.01), IL-6 by 20.1% (p20.001), IL-1 by 19.1% (p20.001), IL-2 by 25.7% (p20.001), IL-1RА by 24.4% (p20.001), IL-10 by 21.3%(p20.001), IL-4 by 25.7% (p20.001) in comparison to traditional treatment.&#x0D; Conclusion.The complex ozone therapy led to the decrease of inflammation, which was reflected in the depression dynamics of the studied cytokines. These results allow us to evaluate it as an effective treatment method for post-traumatic synovitis which effectively reduces the secondary posttraumatic alteration of tissue structures.

The effect of intra-articular ozone injection on pain and physical function in knee osteoarthritis: A prospective study

Introduction: This study aims to evaluate the effect of intra-articular ozone treatment on pain and physical functionality by measuring Numerical Pain Rating Scale (NRS), WOMAC Osteoarthritis Index (WOMAC-OI), and Active Joint Range of Motion (AROM) in patients diagnosed with osteoarthritis. Material and methods: A total of 30 patients diagnosed with stage 2-3 osteoarthritis according to the Kellgren-Lawrence Classification System (K-L) were included in the study. Ozone gas was administered (10 ml of 10 mcg/ml per session) twice weekly for a total of four sessions. AROM examination was performed at pre-treatment baseline (BL), post-treatment (PT), and two weeks after treatment (PT2). During these periods, NRS was assessed and WOMAC-OI questionnaire was administered. Results: Significant improvement in NRS and WOMAC-OI total index scores were observed at PT and PT2 periods compared to BL (6.9±1.2; 2.1±1.3; 3.3±1.1; WOMAC-OI total index: 48.1±10.1; 25.5±10.4; 29.1±11.1 respectively; p˂0.001 for all). However, in both of these evaluation methods, the recovery at PT2 had decreased compared to the PT period (NRS p˂0.001; WOMAC-OI p˂0.05). Significant improvement was observed in the AROM values measured during the PT and PT2 periods, compared to baseline (105.6 ± 10.4°; 118.8 ± 8.1°; 117.5 ± 9.2°, respectively) (p˂0.001). There was no difference between the PT and PT2 periods in terms of AROM measurements (p˃0.05). Conclusion: Our study demonstrates that intra-articular ozone injection treatment provides improvement in pain and physical functionality in osteoarthritis patients. In our two-month follow-up assessment, although evaluation methods indicated that there was regression in recovery, AROM measurements showed that there was no regression in function. Therefore, we believe that future studies may include AROM as an objective measurement among evaluation methods.

Ultrasound-Guided Intra-Articular Ozone Injection as a Therapeutic Option for Hip Osteonecrosis

Ultrasound-Guided Intra-Articular Ozone Injection as a Therapeutic Option for Hip Osteonecrosis

Ozone therapy: underestimated opportunities in the treatment of large joint diseases

Osteoarthritis (OA) and other large joint diseases remain an unsolved problem of modern orthopedics and rheumatology. The use of intra-articular injections of various drugs, including hyaluronic acid, is widespread in both our and foreign countries; however, the efficiency of treatment is not always sufficient, despite its high cost. One of the most effective and inexpensive methods for treating OA is intra-articular ozone therapy that has recently become widespread. The ability of ozone to suppress joint inflammation, to improve blood supply, including that to the subchondral bone, and to reduce pain is considered to be the main advantages of this method. The safety and low risk of adverse reactions allow ozone to be used in a wide range of patients.

Intra-Articular Ozone Therapy in Osteoarthritis of Knee in Reducing Pain and Improving Function in a Tertiary Care Hospital in North-East India: A Randomized Controlled Study

Osteoarthritis (OA) is a chronic disorder of synovial joints in which there is progressive softening and disintegration of articular cartilage accompanied by new growth of cartilage and bone at the joint margins, cyst formation and sclerosis in the subchondral bone, mild synovitis and capsular .

Symptomatic (Pain and Inflammation) and Disease-Modifying Effect (Minimal Joint Space) of Intra-articular Ozone (O2-O3) in Osteoarthritis of the Knee: a Clinical Case

The objective of the clinical case is to report the symptomatic effect and, for the first time, the disease-modifying effect of ozone in a patient with osteoarthritis of the knee. A 67-year-old woman has been infiltrated with ozone 1 time/week for 4 weeks, using an oxygen-ozone volume of 20 ml, at a 20-µg/ml concentration. Another cycle of ozone treatment was boosted at 6 months follow-up. Clinical outcomes such as pain, function, and quality of life were measured by the Western Ontario and McMaster University Index for Osteoarthritis (WOMAC) scale. Biochemical markers of inflammation such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and uric acid were performed at the beginning and at the end of ozone (O2-O3) treatment protocol. Radiological outcome was evaluated as the change in minimal joint space at the medial compartment of joint space, at the beginning and at 12 months follow-up in both knees. In the first and second ozone cycles, clinical (pain, function, rigidity) and biochemical variables (CRP, ESR, uric acid) improved in our case report. Minimal joint space at medial compartment improved in both knees after 12 months follow-up. Intra-articular ozone (O2-O3) has shown a symptomatic effect and especially a disease-modifying effect in a patient with knee osteoarthritis, improving pain, function, and rigidity; decreasing inflammation biomarkers (CRP, ESR, and uric acid); and increasing the joint space of the medial component evidenced radiologically. The structural effect is reported for the first time in literature. No adverse effects have been observed after intra-articular ozone infiltrations.

The efficacy of intra-articular PRP, Ozone and Ozone+PRP injections in patients with osteoarthritis.

Osteoarthritis (OA) is the most common form of arthritis and some joints are effected more than others. The prevalence of OA increases with age and it represents the major problem for functional impairment in older patients. Non-surgical treatment with oral drugs is not suitable for many patients suffering from gastric disorders, high blood pressure or different heart diseases. Intra-articular injections are a promising solution in these cases.&#x0D; This study was performed to compare the efficacy and safety of ozone injections, PRP (platelet rich plasma) injections and combined ozone plus PRP injections in patients with symptomatic knee OA. &#x0D; 120 patients were diagnosed of OA according to the criteria of the American College of Rheumatology and included into this study. Patients were randomly divided into three equal groups (40 patients each group). We include patients whose VAS score was 5 or above. Patients with inflammatory, endocrine and metabolic disturbances, and patients who had meniscectomy within the past 10 years, extra articular surgery within the last year, arthrocentesis in last 6 months or any drug given intra-articular were not included. We did not include either patients with misalignment.&#x0D; Patients in the first group were treated with intra-articular injections of ozone/oxygen gas mixture 2 times/week, at 10 µg/mL concentration and a volume of 5 mL for a total of 12 injections.&#x0D; Patients in the second group were treated only with PRP injections once a week for a total of 3 times.&#x0D; Patients in the third group were treated with intra-articular injections of Ozone+PRP (10 µg/ml concentration, 5 ml volume) once a week for a total of 3 times.&#x0D; The pain levels of patients were measured with Visual Analog Scale (VAS). Side effects were collected using an open list record.&#x0D; All the groups improved their baseline VAS in a significant way, although the group with the best results was group 3 with the combination of ozone and PRP in the same injection.&#x0D; We are planning further studies including systemic ozone in order to improve more the pain in our patients.

Intra-articular ozone therapy efficiently attenuates pain in knee osteoarthritic subjects: A systematic review and meta-analysis

ObjectivesOzone (O3) gas is being used for chronic pain relief in knee osteoarthritis (KOA). However, there are controversies whether this gas can be medically useful in KOA pain treatments. The aim of this study was to evaluate the effectiveness of intra-articular ozone therapy for pain relief in KOA subjects using a systematic review and meta-analysis and standardized mean difference (SMD) as the effect size. MethodUsing specialized biomedical online databases of Pubmed Central, Pubmed, Medline, Google scholar, Scopus and Embase databases without the beginning date restriction until July 2018, the systematic review retrieved 10 studies for meta-analysis after fulfilling the inclusion and exclusion criteria. ResultsAnalysis of Q and I2% indices showed a high heterogeneity in the selected studies (2600.330 and 99.654, respectively), thus, the random-effects model was chosen for SMD calculation. The primary analysis for the main hypothesis found that the weighted pooled effect size for the impact of intra-articular ozone therapy for pain reduction was as follows: SMD= −28.551 (95% confidence interval, −32.553 to −24.549). The P-value for the significance of the combined SMD examined by the z-test was 0.000 and thus, it was clearly considered statistically significant. ConclusionThis meta-analysis presents evidence that intra-articular ozone therapy is an effective way for chronic pain management in KOA.

An investigation into the efficacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: a systematic review and meta-analysis.

PurposeThis study aimed to review and pool the current literature on intra-articular ozone injection in knee osteoarthritis (OA) patients.MethodsA systematic review of three big databases was performed to identify all English-language randomized clinical trials (RCTs) that evaluated the efficacy of intra-articular ozone injection vs a control injection for knee OA sufferers, using the following two measuring tools: pain VAS and Western Ontario and McMaster Universities Arthritis Index (WOMAC).ResultsA total of 428 patients in five RCTs were included, from which 53% (n=225) were in the ozone group and 47% in the control (hyaluronic acid [HA], dextrose, and air injection) group (n=203). The mean age of the patients in both groups was 64 years. Females were the majority. All studies had at least 2 months of follow-up (F/U). Mean difference (MD) between the groups for VAS in the first month was –0.23 with a P-value of 0.71 (negative value was in favor of ozone), whereas this difference in the third and sixth months reached 1.04 and 1.31, respectively, favoring the control group. These data demonstrated that control injection had a more prolonged pain relief period. A similar trend was seen regarding WOMAC scores; pooled results showed that ozone was slightly better than the control injections during the first month (MD =–7.84 [P=0.15]), but it declined to MD=2.55 and 8.23 at 2- to 3- and 4- to 6-month F/U, respectively, again in favor of control injections. Also, adverse events occurred homogeneously in both ozone (6/150 cases, 4%) and control groups (7/129 cases, 5.4%; P-value=0.31).ConclusionBased on the current meta-analysis, intra-articular ozone injection efficacy was significantly superior to placebo and slightly lower to other control injections with non-significant difference. Therefore, ozone could be recommended as an efficient non-surgical treatment, durable for at least 3–6 months, in mild or moderate knee OA management.

Intra Articular Ozone Reduces Serum Uric Acid and Improves Pain, Function and Quality of Life in Knee Osteoarthritis Patients: A Before-and-After Study

Objectives: The objective of this study was to evaluate if ozone is capable of improving pain, function and quality of life, and to decrease serum uric acid in human knee osteoarthritis (OA) patients. Methods: Overall, 42 patients, 31 females (73.81%) and 11 males (26.19%) were enrolled in a prospective quasi experimental before-and-after study. Mean age of the sample was 66.9 ± 8.83 years. Treatment consisted of four sessions (one per week) of an intra articular infiltration of a medical mixture of oxygen-ozone (95% to 5%), 20 mL volume at a 20 µ/mL concentration, on the most symptomatic painful knee. Before and after the intervention, the researchers measured outcomes including serum uric acid and pain, function, and quality of life by the visual analogue scale (VAS) and by Western Ontario and Mac Master index for OA (WOMAC). The OA patients were graded by Kellgren-Lawrence radiological scale as 2° to 4° grades. Results: Serum uric acid decreased from 5.19 ± 1.22 mg/dL to 5.03 ± 1.22 (P = 0.0439). The WOMAC pain subscale score decreased from 14.26 ± 2.61 to 5.95 ± 2.97 points (P = 0.0001), WOMAC stiffness subscale diminished from 2.72 ± 1.63 to 1.04 ± 1.04 points (P = 0.0001), and WOMAC function subscale improved from 41.78 ± 10.17 to 24.61 ± 9.86 points (P = 0.0001). Conclusions: Intra articular ozone is capable of decreasing pain and stiffness and improving function and quality of life, as well as decreasing serum uric acid in knee OA patients.

Intra-articular ozone injection efficacy in knee osteoarthritis: A systematic review with meta-analysis

The main aim of this review was to discuss the literature on ozone intra-articular injection in knee osteoarthritis (OA) patients and to synthesize the available evidence as a meta-analysis. A systematic review of Pubmed, Google scholar and Cochrane Central Register of Controlled Trials was performed to identify all English-language RCTs that evaluated the efficacy of ozone intra-articular injection versus a control injection for knee OA patients. A Random effect model was used to compare efficacies among trials based on Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. From 231 records screened, only 26 one had relevant topics. Among them only five studies satisfied our inclusion criteria. A total of 428 patients were included which 53% of them ( n = 225) in the treatment group and 47% in the control [HA, hypertonicdextrose and air injection] group ( n = 203). The mean age of ozone groups was 64.5 years compared with 64.4 years for control group. Females were the majority in both treatment and control group (80% and 77%, respectively). All studies had at least 2 months follow-up. In almost all of them 3–4 weekly rounds of ozone injection were performed, with concentration of 15–30 ug/cm 3 . Intra-articular ozone in comparison to HA or hypertonic dextrose injections, may have quietly equal effects in the treatment of mild to moderate knee OA patients throughout short term period; However by 3–6 months after injection, this therapeutic effect would be disappeared, more earlier than other control injections.

Effectiveness of intra-articular ozone injections on outcomes of post-arthroscopic surgery for knee osteoarthritis.

The purpose of the present study was to evaluate intra-articular ozone injection following arthroscopic surgery for knee osteoarthritis (OA) with regard to its efficacy in pain reduction, joint function and quality of life improvement. The present study retrospectively evaluated 80 patients with symptomatic knee OA (Kellgren-Lawrence grade II or III), who either did or did not receive 20 ml of 20 µg/ml ozone as an intra-articular injection after arthroscopic surgery. The minimum follow-up period was 12 months. The outcomes evaluated for knee OA were pain on the Visual Analogue Scale (VAS), Lequesne Index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Clinical Global Impression (CGI). The VAS score in the ozone group was significantly better than that in the control group at all post-operative follow-up time-points (P<0.05). The ozone group also exhibited a significantly greater improvement in Lequesne Index scores (P<0.05). In the ozone group, the score on the WOMAC-pain, WOMAC-stiffness and WOMAC-function subscales, as well as the total WOMAC score decreased significantly (P<0.05). Furthermore, in the ozone group a significantly higher number of patients (P<0.05) with better CGI grades was encountered compared with that in the control group at the 12-month follow-up assessment, despite comparable baseline values in all aforementioned clinical measures between the two groups of patients. The present study suggests that intra-articular ozone injections after arthroscopic surgery may effectively improve the outcomes of arthroscopic surgery in terms of pain relief, functional improvement and quality of life in patients with knee OA of Kellgren-Lawrence grade II or III.