Knee vs hip single-joint intra-articular hyaluronic acid injection in patients with both hip and knee osteoarthritis: a pilot study.
ABSTRACT This paper aims to compare the results of single-joint knee vs hip hyaluronic acid (HA) injections in patients with osteoarthritis (OA) involving both the knee and hip joints. Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled. Patients were divided into two groups to receive HA injection three times at 1-week intervals either to the hip or knee joints. Pain level during activities and rest was measured by using visual analog scale (VAS). Western Ontario and McMaster University Osteoarthritis Index (WOMAC 5-point Likert 3.0) was also used prior to the injections and 1 month after the 3rd injection. In the knee injection group, the intragroup analysis revealed significant improvements in VAS activity pain, VAS rest pain, and WOMAC pain values following injection when compared with preinjection values, while no significant difference was detected in WOMAC stiffness, WOMAC physical function, and WOMAC total values. In the hip injection group, VAS activity pain, VAS rest pain, WOMAC pain, WOMAC stiffness, WOMAC physical function, and WOMAC total values showed significant improvement after the injection when compared with preinjection values. Although statistically not significant (p > 0.05), the comparison of the differences (preinjection-postinjection) between the groups demonstrated higher values in the hip injection group. We imply that intra-articular single-joint HA injections either to the knee or hip joints in OA patients with involvement of both of these joints are effective with regard to pain and functional status.
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ABSTRACT: Osteoarthritis (OA) is a progressive degenerative condition of synovial joints in response to both internal and external factors. The relationship of OA in one joint of an extremity to another joint within the same extremity, or between extremities, has been a topic of interest in reference to the etiology and/or progression of the disease. The prevalence of articular cartilage lesions and osteophytes, characteristic of OA, was evaluated through visual inspection and grading in 1060 adult knee/tali pairs from 545 cadaveric joint donors. Joint degeneration increased more rapidly with age for the knee joint, and significantly more knee joints displayed more severe degeneration than ankle joints from as early as the third decade. Women displayed more severe knee degeneration than did men. Severe ankle degeneration did not exist in the absence of severe knee degeneration. The effect of weight on joint degeneration was joint-specific whereby weight had a significantly greater effect on the knee. Ankle grades increasingly did not match within a donor as the grade of degeneration in either the left or the right knee increased. Gender and body type have a greater effect on knee joint integrity as compared to the ankle, suggesting that knees are more prone to internal causative effects of degeneration. We hypothesize that the greater variability in joint health between joints within an individual as disease progresses from normal to early signs of degeneration may be a result of mismatched limb kinetics, which in turn might lead to joint disease progression.BMC Medicine 01/2010; 8:48. · 6.03 Impact Factor
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ABSTRACT: Bojiang Shen, Aiqun Wei, Divya Bhargav, Thomas Kishen, Ashish D DiwanOrthopaedic Research Institute, Department of Orthopaedic Surgery, St. George Hospital, The University of New South Wales, Sydney, AustraliaAbstract: Hyaluronan (HA) is a ubiquitous component of extracellular matrix in human tissues with diverse functions in skeletal biology. The biophysical properties of HA, such as high viscosity, elasticity and highly negative charge, make it useful in various therapeutic procedures. Although intra-articular administration of HA has been extensively used in the management of osteoarthritis (OA), there is a paucity of data on the clinical application of HA in intervertebral disc repair. This review discusses the biology and signaling mechanisms of HA, the pathophysiology of disc degeneration and summarises current evidence relating to the role of HA in cell phenotype maintenance, differentiation of chondrocytes, intervertebral disc cells and bone marrow stromal cells, and its application in tissue engineering. Based on recent advances in the clinical outcomes of OA treatment, HA has demonstrated potential as a bio-polymer filler, therapeutic agent and cell carrier in the management of intervertebral disc degeneration.Keywords: hyaluronan, cartilage, intervertebral disc, stromal cells, tissue engineering, back painOrthopedic Research and Reviews. 01/2010;