Use Of Hyaluronic Acid Injections Research Articles

Effectiveness of Non-Surgical Procedures for the Treatment of Black Triangle Cases in the Aesthetic Zone on the Height of the Interdental Papilla: Narrative Review

Background: The black triangle is a cervical embrasure to the proximal contact that is not filled with gingival tissue. Until, the treatment of black triangle cases has evolved to offer non-surgical procedures such as hyaluronic acid injection, Injectable Platelet Rich Fibrin (i-PRF), and photobiomodulation therapy. Various studies have also reported the use of hyaluronic acid, i-PRF and photobiomodulation therapy to increase the height of the interdental papillae.Method: Literature searches were carried out systematically from various international databases such as PubMed, ScienceDirect, Google Scholar, and Semantic Scholar. The literature selection stages are carried out through the process of identifying articles, screening, and fulfilling inclusion criteria. A total of 52 articles were published in 2012 – 2022 and have met the criteria for data extraction examination of various clinical parameters from the black triangle case.Result: The results of the review showed that the use of hyaluronic acid injection, i-PRF and photobiomodulation therapy showed significant treatment results in cases of black triangle class I and II. Conclusion: It was reported that the non-surgical procedure for the treatment of black triangle cases produce better result and predictable results, an easy technique, more effective time than surgical procedures and reduced discomfort and met the aesthetic demands of patients based on clinical parameters after 6 month injection.

COMPLICATIONS AFTER PENIS ENHANCEMENT WITH HYALURONIC ACID: A LITERATURE REVIEW

Introduction. The penis is a symbol of the primal sense of male fertility and sexual activity, which affects the sense of male personality and the ability to satisfy a partner. Some patients experience discomfort, even if their penis is within the normal size range from an anatomical point of view. The reason for the spread of penis enlargement procedures is related to the feeling of masculinity that the appearance of the genitals can give a man, as well as a changed perception of his body. Penis enlargement procedures are becoming more and more common among men who seek to achieve a more desirable aesthetic of their male organ. In addition, penis enlargement methods remain a controversial issue, as they do not have clear indications and can cause complications. Materials and methods. This study reviewed the literature on complications after penile enhancement with hyaluronic acid (HA). To achieve this goal, we conducted a systematic search for scientific medical information in English-language databases such as MEDLINE, Embase, AMED (Allied and Complementary Medicine), and HMIC (Health Management Information Consortium). We analyzed all articles that met the specified search parameters. In addition, we manually searched for relevant references in the found texts. Results. The use of HA injections for penis enlargement in men shows a low rate of complications both in the early- and long-term period after the procedure. In a small percentage of patients, early and expected side effects included swelling, bruising, subcutaneous nodules, and infections. In this work, radical ways of their correction are proposed for all types of complications, which makes the use of HA safe and effective for penis enlargement. Conclusions. Nowadays, there is a lack of high-level evidence-based information on complications after HA injections. Due to the growing demand for these procedures, the issue of their safety is relevant. According to the available statistics, the overall incidence of complications after HA injections is spontaneous without further side effects. If complications are detected, the prognosis after treatment is satisfactory. As a result, there are no standardized surgical protocols and recommendations for penile enhancement with hyaluronic acid in the world.

Effects of hyaluronic acid injections on pain and functioning in patients affected by tendinopathies: A narrative review.

Tendinopathies are overuse tendon injuries showing load-dependant pain, stiffness, weakness of movement in the affected area, and impairment in the movements. The scientific interest on the role of Hyaluronic Acid (HA) for the management of tendinopathies has been increased due to its anti-inflammatory and lubricative properties. To collect evidence regarding the effectiveness and safety of HA injections in reducing pain in patients affected by tendinopathies. A scientific literature search was conducted using the PubMed, Medline and PEDro electronic databases. The databases were searched since their inception until July 2021. The search was limited to English language articles. Different combinations of the terms and MeSH terms "tendinopathy", "tendinosis", "tendinitis", "hyaluronic acid", "hyaluronate", "infiltration", "hyaluronic injections", "viscosupplementation" connected with various boolean operators were used for other electronic databases. One hundred and one records were identified from the selected databases plus three additional papers identified by the authors through other sources. After removing duplicated papers and title/abstract screening, 19 studies were included in our review (eight papers on shoulder, three on elbow, four on hand, one on knee, and three on ankle). The results showed that none of the studies report severe adverse effects and most of them support the use of HA injections in tendinopathies, with a special attention to pain reduction and functional assessment. Further studies are warranted to better investigate effects and methods of administration of HA in tendinopathies.

Are We Actually Guided by Clinical Practice Guidelines?: Commentary on an article by Kevin Y. Zhu, BS, et al.: "Hyaluronic Acid Injections for Knee Osteoarthritis. Has Utilization Among Medicare Beneficiaries Changed Between 2012 and 2018?"

Commentary Medical practitioners are presented with substantial data regarding potential interventions for musculoskeletal problems. The American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines (CPGs) organize and summarize the available data regarding numerous nonoperative and operative treatments for musculoskeletal problems, including the management of knee osteoarthritis (OA). While the recommendations of the CPGs are often somewhat limited by the lack of quality research, the 2013 AAOS CPG cited moderate evidence against the routine use of hyaluronic acid (HA) injections for the management of symptomatic knee OA. The study by Zhu et al. provides an excellent evaluation of the use of HA injections in Medicare patients, both before and after the CPG was published, as well as an analysis of the financial impact of continued HA use. Knee OA remains highly prevalent and is a substantial economic burden in the United States. Intra-articular injections have long been a mainstay in the nonoperative treatment of the disease; however, recent publications have demonstrated some concerns with corticosteroid injections, particularly when they are performed close to the time of total knee arthroplasty (TKA)1. Unfortunately, similar risk has been demonstrated with HA injections2. The data surrounding the clinical efficacy of HA injections also are quite variable, but in most comparative studies, little benefit is seen over the use of nonsteroidal anti-inflammatory drugs, corticosteroid injections, biologics, or even normal saline solution3,4. The most important finding of the present study is that despite the moderate recommendation against the routine use of HA in the 2013 AAOS CPG, as well as its high cost and questionable clinical efficacy when compared with numerous other treatments, there has not been a significant decline in the use of HA in Medicare beneficiaries. This finding is supported by and expands on an earlier survey study that reported HA to be the most popular choice for management of moderate-grade knee OA5. This finding, while not surprising, is disappointing as it is clear that either the message of the CPG is not being effectively disseminated to the practitioners who are managing knee OA with HA injections, or the evidence is simply being ignored due to a lack of other options for this challenging population of patients. A second important finding of this study is the substantial financial burden that HA injections continue to pose on the health-care system. A cost averaging >$300 million a year is significant and worthy of highlighting. Zhu et al. demonstrated that this cost steadily increased throughout the study period and likely will continue to increase. Given the lack of demonstrated clinical efficacy in large systematic reviews and high-level studies, it is hard to justify these costs for HA use. Recent studies have shown that even emerging treatments such as biologics and platelet-rich plasma (PRP) may be more cost-effective than HA injections6. A finding of the study that may explain some of the discordance between the AAOS recommendations and HA utilization is that advanced practice providers (APPs) contributed significantly to the national increase in utilization that was seen over the study period. Many practices have transitioned interventions such as injections to APPs. It is very possible that evidence from the CPG has not effectively been distributed to APPs. The true cause is likely multifactorial. There are many patients with advanced knee OA who are simply not ready for TKA or are not good candidates for TKA since the requirements for optimization of medical comorbidities continue to become stricter. Many patients will not find any relief from corticosteroid injections, and as long as HA injections are available, they represent another possible therapeutic option, despite the evidence against the routine use of HA. While biologics such as PRP have shown promising benefits in the management of knee OA, insurance companies still do not cover this cost, and many patients cannot afford cash payments for prolonged treatment. Value-based care continues to be the focus of health-care practitioners, health systems, and insurers. When CPGs offer conclusive recommendations based on available evidence, it is worthwhile to evaluate their effects on practice patterns. The trends observed in the study by Zhu et al. demonstrated that despite the high cost and low clinical efficacy of HA injections, in addition to a CPG recommending against its routine use, there has been no appreciable decline in the use of HA injections among Medicare beneficiaries within the 5 years following publication of the CPG. This highlights the importance of wide dissemination of CPGs to physicians and APPs, as well as the need for more cost-effective treatments for knee OA.

NewsCAP: Despite lack of evidence of effectiveness, use of hyaluronic acid injections for knee osteoarthritis continues to increase.

NewsCAP: Despite lack of evidence of effectiveness, use of hyaluronic acid injections for knee osteoarthritis continues to increase.

Intra-articular injections in the treatment of osteoarthritis

Local methods are widely used in the treatment of osteoarthritis (OA) and play a significant role in the complex therapy of this disease. A special place among them belongs to intra-articular (i/a) administration of drugs. The most widely used for this purpose are glucocorticoids (GC) and hyaluronic acid (HA) drugs. When comparing the effectiveness of these drugs, it was shown that during the 1st month, HA had more favorable results, after 3 months the results did not differ significantly, and after 6 months, the effectiveness of HA was higher. Some authors believe that the optimal result can be obtained with the combined use of HA and GC.The efficacy and tolerability of HA drugs in patients with OA have been studied in numerous randomized controlled trials (RCTs), and the data obtained in these studies have been summarized in a number of meta-analyses. At the same time, both in RCTs and in meta-analyses, the results of such treatment were assessed differently. However, when summarizing the materials of various meta-analyses within the framework of a systematic review, it was shown that i/a injections of HA are an effective and safe method of local treatment of OA. However, there are no generally accepted recommendations for the use of HA in the treatment of OA, and the question of their administration in each case is decided individually, taking into account the history, clinical picture, OA phenotype, and tolerability of therapy. The Russian Association of Rheumatologists recommends the use of i/a HA injections in knee OA with synovitis and the use of HA injections to reduce pain and improve joint function.

Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial

BackgroundDegenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes.MethodNinety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months.ResultsThere was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035).ConclusionIntra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up.Trial registrationNCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.

Increased papilla between implant and tooth with TEH use of hyaluronic acid injection: A case report

The lack of dental papilla in the anterior maxila leaves unsightly smile and the dissatisfied patient. Several surgical techniques can be performed to gain interdental papilla, but few of them are predictable. This case report shows a multidisciplinary treatment alternative to increase disabled papillae in single-tooth implant in an aesthetic region with the use of injectable hyaluronic acid. Monitoring and evaluation of results was made by clinical and photographic monitoring of the progressive increase of the papilla in millimeter measurements through computer software. After 8 applications in 5 months, prosthetic emergence profile of adjacent tooth modification, papillary inflammatory process induction, we can observe 1,0 mm papilla gain. It can be concluded that the use of injectable hyaluronic acid in association with gingival prosthetic conditioning led to increased gingival papilla between tooth and dental implant and can be considered a treatment alternative for correction of minor defects papilla. Keywords: Implant, Aesthetic area, Papilla reconstruction, Hyaluronic acid.

Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections.

Consequences on Private Insurance Coverage: The AAOS Clinical Practice Guidelines and Hyaluronic Acid Injections.

Efficacy of intra-articular hyaluronic acid injections in the rehabilitation programme of Knee Osteoarthritis

Abstract Knee osteoarthritis (KOA) is a disease of wear and tear, leading to disability and ultimate surgical treatment. KOA has multiple etiologies and is considered a disorder of physiological processes that is manifested by progressive lesions of articular cartilage caused by chondrolysis, synovial membrane inflammation and subchondral osteophytes production. Modalities that limit the progression of the KOA and rehabilitation are a constant interest for clinicians and medical researchers. Various physical therapies and pharmacological strategies are currently used for pain management, with no clear benefit in terms of inhibiting disease progression. In this context, the use of exogenous hyaluronic acid (HA) (that is a vital component of the synovial fluid and involved in lubricating all synovial joints) has been explored as viable alternative to alleviate knee pain and temporarily restore knee function. In the following, we will review the use of HA injections associated with the physiotherapeutic recovery plan in the treatment of KOA. The therapeutic effects of the HA is still a matter of debate in the field, with no consensus being reached so far and thus, difficult to evaluate. However, much research has to be done to understand the therapeutic efficacy of HA alone or in combination with physical therapies and the role that other factors may play in unraveling its beneficial effects on the KOA. Key words: knee, osteoarthritis, hyaluronic acid, physiotherapy, rehabilitation,

Impact of Clinical Practice Guidelines on Use of Intra-Articular Hyaluronic Acid and Corticosteroid Injections for Knee Osteoarthritis.

The efficacy of corticosteroid and hyaluronic acid injections for knee osteoarthritis has been questioned. The purpose of this study was to determine the impact of the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines on the use of these injections in the United States and determine if utilization differed by provider specialty. Patients with knee osteoarthritis were identified within the Humana database from 2007 to 2015, and the percentage of patients receiving a knee injection relative to the number of patients having an encounter for knee osteoarthritis was calculated and was trended for the study period. The impact of each edition of the AAOS clinical practice guidelines on injection use was evaluated with segmented regression analysis. Injection trends were also analyzed relative to the specialty of the provider performing the injection. Of 1,065,175 patients with knee osteoarthritis, 405,101 (38.0%) received a corticosteroid injection and 137,005 (12.9%) received a hyaluronic acid injection. The rate of increase in hyaluronic acid use, per 100 patients with knee osteoarthritis, decreased from 0.15 to 0.07 injection per quarter year (p = 0.02) after the first clinical practice guideline, and the increase changed to a decrease at a rate of -0.12 injection per quarter (p < 0.001) after the second clinical practice guideline. After the first clinical practice guideline, the rate of increase in utilization of corticosteroids, per 100 patients with knee osteoarthritis, significantly lessened to 0.12 injection per quarter (p < 0.001), and after the second clinical practice guideline, corticosteroid injection use plateaued (p = 0.72). The trend in use of hyaluronic acid injections by orthopaedic surgeons and pain specialists decreased with time following the second-edition clinical practice guideline but did not change for primary care physicians or nonoperative musculoskeletal providers. Subtle but significant changes in hyaluronic acid and corticosteroid injections occurred following the publication of both clinical practice guidelines. Although the clinical practice guidelines did impact injection use, given the high costs of these injections and their questionable clinical efficacy, further interventions beyond publishing clinical practice guidelines are needed to encourage higher-value care for patients with knee osteoarthritis.

Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States.

Objective:A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria.Methods:The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios.Results:The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate.Conclusion:This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary—particularly in patient populations differentiated by OA severity—that may benefit the greatest from the use of HA injections for the treatment of knee OA.

A pilot study comparing the efficacy of radiofrequency and microwave diathermy in combination with intra-articular injection of hyaluronic acid in knee osteoarthritis.

[Purpose] This study aimed to compare the efficacy of radiofrequency diathermy with that of microwave diathermy in combination with intra-articular injection of hyaluronic acid into the knee of patients with osteoarthritis (OA). [Subjects] A total of 17 patients with knee OA were enrolled. The participants were randomly divided into two groups: a radiofrequency diathermy group (RF group, 9 subjects), and a microwave diathermy group (MW group, 8 subjects). [Methods] Subjects received radiofrequency or microwave thermal therapy 3 times at 1-week intervals. Intra-articular injection of hyaluronic acid was administered 10 min before every thermal therapy session. The outcome was evaluated using the Japan Orthopaedic Association (JOA) and the Lequesne Index (LI) at baseline, at weeks 1 (1 week after the first thermal therapy) and 3 (1 week after the last thermal therapy). [Results] The JOA scale increased significantly after three sessions of thermal therapy in the RF group, while no significant increase was observed in the MW group. LI decreased significantly after 3 weeks in the RF group. In the MW group, there was no significant difference in LI between the two time points. [Conclusion] This study revealed that symptom relief in patients with knee OA was greater with radiofrequency diathermy than with microwave diathermy with concurrent use of hyaluronic acid injection, presumably due to the different heating characteristics of the two methods.

Looking for Clinical Importance in the Use of Hyaluronic Acid Injections for the Treatment of Glenohumeral Arthritis

Looking for Clinical Importance in the Use of Hyaluronic Acid Injections for the Treatment of Glenohumeral Arthritis

Hyaluronic acid injection procedures and orthodontic practice

In France, the Public Health Code was amended in 2004, and now allows dentists to treat facial tissues adjacent to the mouth: and hence, they can now bridge the gap between maxillary sinuses and the mouth area by performing hyaluronic acid injection procedures in the perio-buccal soft tissues. Accordingly, the National Council of the Order of Dental Surgeons authorizes the practice of hyaluronic acid injection for therapeutic use. In this article, we will define the legal framework for which we will be held liable as it pertains to hyaluronic acid injection procedures. After explaining the physico-chemical properties of hyaluronic acid, we will study the mechanisms of ageing, the architecture of the face and various methods of injection. We will look at the indications and counter indications for the use of hyaluronic acid injection, particularly in terms of its therapeutic usefulness for rehabilitating soft tissue when transitioning from a maxillary full-arch prosthesis to an implant born bridge. Hyaluronic acid makes it possible to offset the lack of buccal margin of the resin-based removable prosthesis.

Introduction

Viscosupplementation by hyaluronic acid (HA) injections is frequently used for local treatment of osteoarthritis (OA), due to ease of use and good tolerance. A profusion of linear or reticulated HA derivates are marketed, with varied characters and levels of evidence. Viscosupplementation has demonstrated moderate but significant efficacy (20%) versus placebo in terms of pain and function, with a high rate of responders (60–70%) in knee osteoarthritis. It allows reduced administration of opioid analgesics and NSAIDs, with improved risk/benefit ratio, and may delay joint replacement. Cartilage protection remains to be proven. Clinical efficacy shows 1–4 weeks’ later onset than corticosteroids, but is maintained for 6 or even 12 months. Systematic association of corticosteroid and HA injection is not justified, and an interval has to be left before undertaking arthroplasty. Intra-articular injection of HA requires a skilled specialist, and may be difficult in a non-swollen joint; some tips and tricks may be helpful. In other joints than the knee, radiologic or ultrasound guidance is recommended. The efficacy of viscosupplementation is a matter of ongoing debate, after discordant findings in some meta-analyses. Some poor results may be due to inappropriate use of HA injections, poorly adapted to the patient's OA phenotype. Viscosupplementation is a treatment for chronic moderate symptomatic OA, and not for flares with joint swelling. Application in sport-related chondropathy has yet to be properly assessed. The optimal response profile remains to be determined. The ideal indication in the knee seems to be moderate femorotibial OA without swelling. Results have been generally disappointing in hip osteoarthritis but promising in OA of the ankle and shoulder (with and without rotator cuff tear). Further studies are needed to determine response profile and optimal treatment schedule, according to the joint.