Journal of Orthopedics and Joint Surgery

Register      Login

VOLUME 4 , ISSUE 2 ( July-December, 2022 ) > List of Articles

Original Article

Efficacy of Single Intra-articular Injection of Hyaluronic Acid for Osteoarthritis of the Knee Joint in South Indian Population

Vetrivel Chezian Sengodan, Jenny J Pynadath

Citation Information : Sengodan VC, Pynadath JJ. Efficacy of Single Intra-articular Injection of Hyaluronic Acid for Osteoarthritis of the Knee Joint in South Indian Population. 2022; 4 (2):61-65.

DOI: 10.5005/jp-journals-10079-1094

License: CC BY-NC 4.0

Published Online: 31-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Background: Intra-articular viscosupplements are one of the effective and safe approaches for clinical management of osteoarthritis (OA). Hyaluronic acid is one such viscosupplement which results in pain relief, reduces use of NSAIDS and delays joint-replacement surgeries. Methods: This study evaluated the efficacy of Hylan GF 20 which is approved for use in India since 2010, in a south Indian population under public health care system. Patients above 40 years of age with osteoarthritis of grade 2, 3, 4 based on KL classification were included. WOMAC score (Western Ontario and McMaster Osteoarthritis Index) was used to evaluate pain, stiffness and functioning of the knee joint. Results: Single intra articular administration of hyaluronic acid progressively decreased the WOMAC score as early as 2 weeks, with the score continued to decline until 6 months of follow up. Compared to the baseline, a 43 percent improvement in WOMAC score was observed at 6 months, reflecting a significant clinical efficacy of Hylan GF 20. Most drastic reduction in the WOMAC score observed in the grade 2 OA subgroup followed by grade 3 and 4 OA subgroups. Conclusion: The results of this study supports the use of Hylan GF 20 for the treatment osteoarthritis of knee as a single injection which can be easily adopted to public health service measures as a day care procedure.


HTML PDF Share
  1. Carr AJ. Beyond disability: measuring the social and personal consequences of osteoarthritis. Osteoarthritis and Cartilage 1999;7(2):230–238. DOI: 10.1053/joca.1998.0154
  2. Pal CP, Singh P, Chaturvedi S, et al. Epidemiology of knee osteoarthritis in India and related factors. Indian journal of orthopaedics. 2016;50(5):518–522. DOI: 10.4103/0019-5413.189608
  3. Mathers CD, Bernard C, Iburg KM, et al. Global programme on evidence for health policy. Discussion paper no. 54. 2003. Accessed 06 June 2019.
  4. Fransen M, Bridgett L, March L, et al. The epidemiology of osteoarthritis in Asia. International journal of rheumatic disease 2011;14(2):113–121. DOI: 10.1111/j.1756-185X.2011.01608.x
  5. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012;64(4): 465–474. DOI: 10.1002/acr.21596
  6. Funck-Brentano T, Cohen-Solal M. Subchondral bone and osteoarthritis. Curr Opin Rheumatol 2015;27(4):420–426. DOI: 10.1097/BOR.0000000000000181
  7. Webb D, Naidoo P. Viscosupplementation for knee osteoarthritis: a focus on Hylan GF 20. Orthop Res Rev 2018;10:73–81. DOI: 10.2147/ORR.S174649
  8. Goldberg VM, Goldberg L. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. Journal of pain research 2010;3:51–56. DOI: 10.2147/jpr.s4733
  9. Weiss C, Band P. Musculoskeletal applications of hyaluronan and hylan. Potential uses in the foot and ankle. Clinics in podiatric medicine and surgery 1995;12(3):497–517
  10. Carpenter B, Motley T. The role of viscosupplementation in the ankle using hylan GF 20. The Journal of foot and ankle surgery 2008;47(5):377–384. DOI: 10.1053/j.jfas.2008.06.013
  11. Balazs EA, Watson D, Duff IF, et al. Hyaluronic acid in synovial fluid. I. Molecular parameters of hyaluronic acid in normal and arthritic human fluids. Arthritis Rheum 1967;10(4):357–376. DOI: 10.1002/art.1780100407
  12. Souich PD. Absorption, distribution and mechanism of action of SYSADOAS. Pharmacol Ther 2014;142(3):362–374. DOI: 10.1016/j.pharmthera.2014.01.002
  13. Campbell J, Bellamy N, Gee T. Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hylan in osteoarthritis of the knee. Osteoarthritis Cartilage 2007;15(12): 1424–1436. DOI: 10.1016/j.joca.2007.01.022
  14. Altman R, Asch E, Bloch D, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 1986;29(8):1039–1049. DOI: 10.1002/art.1780290816
  15. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis 1957;16(4):494–502. DOI: 10.1136/ard.16.4.494
  16. Chevalier X, Sheehan B, Whittington C, et al. Efficacy and safety of hylan GF 20 versus intra-articular corticosteroids in people with knee osteoarthritis: a systematic review and network meta-analysis. Clin Med Insights Arthritis Musculoskelet Disord 2020;13:1179544120967370. DOI: 10.1177/1179544120967370
  17. Brown TJ, Laurent UB, Fraser JR. Turnover of hyaluronan in synovial joints: elimination of labelled hyaluronan from the knee joint of the rabbit. Exp Physiol 1991;76(1):125–134. DOI: 10.1113/expphysiol.1991.sp003474
  18. Pal S, Thuppal S, Reddy KJ, et al. Long-term (1-year) safety and efficacy of a single 6-mL injection of Hylan GF 20 in Indian patients with symptomatic knee osteoarthritis. Open Rheumatol J 2014;8(1):54–68. DOI: 10.2174/1874312901408010054
  19. Davis III JM, Moder KG, Hunder GG. History and physical examination of the musculoskeletal system. InKelley's Textbook of Rheumatology 2013:559-576. WB Saunders.
  20. Yavuzer G, Sonel B, Süldür N, et al. Effects of intra-articular hylan GF 20 injections on clinical and biomechanical characteristics of the knee in osteoarthritis. Int J Rehabil Res 2005;28(4):371–374. DOI: 10.1097/00004356-200512000-00013
  21. Hunter DJ. Viscosupplementation for osteoarthritis of the knee. N Engl J Med 2015;372(11):1040–1047. DOI: 10.1056/NEJMct1215534
  22. Wind Jr WM, Smolinski RJ. Reliability of common knee injection sites with low-volume injections. J Arthroplasty 2004;19(7):858–861. DOI: 10.1016/j.arth.2004.02.042
  23. Tapasvi S, Mohanty SS, Acharya KK, et al. Viscosupplementation for Management of Knee Osteoarthritis from an Indian Perspective: An Expert Consensus Report. Pain Ther 2019;8(2):217–231. DOI: 10.1007/s40122-019-0131-3
  24. Raynauld JP, Goldsmith CH, Bellamy N, et al. Effectiveness and safety of repeat courses of hylan GF 20 in patients with knee osteoarthritis. Osteoarthritis Cartilage 2005;13(2):111–119. DOI: 10.1016/j.joca.2004.10.018
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.