Comparison of efficacy of arthroscopic lavage plus administration of corticosteroids, arthroscopic lavage plus administration of placebo, and joint aspiration plus administration of corticosteroids in arthritis of the knee: A randomized controlled trial.
ABSTRACT To compare the efficacy of arthroscopic lavage plus administration of corticosteroids (ALC), arthroscopic lavage plus administration of placebo (ALP), and joint aspiration plus administration of corticosteroids (JAC) in knee arthritis, and to evaluate whether clinical or histologic characteristics determine outcome.
Patients with knee arthritis (not due to gout, osteoarthritis, or septic arthritis) were randomized over 3 treatment arms: ALC, ALP, and JAC. The primary end point was event-free survival, with events defined as 1) recurrence or persistence of symptomatic knee swelling necessitating local re-treatment, or 2) nonimprovement of the knee joint score. Synovial tissue specimens were collected and analyzed histologically to identify predictive factors of responsiveness.
A total of 78 patients were enrolled; 3 patients did not receive their allocated therapy and 3 were lost to followup. The median time until recurrence was 9.6 months after ALC, 3.0 months after JAC, and 1.0 month after ALP, corresponding to a relative risk (RR) of arthritis recurrence of 2.2 for JAC (95% confidence interval [95% CI] 1.2-4.2, P = 0.02) and 4.7 for ALP (95% CI 2.3-9.4, P < 0.0001) compared with ALC. A high versus low synovial extent of fibrosis conferred an RR for recurrence of 5.7 (95% CI 1.6-20.5, P < 0.01) after ALC.
Arthroscopic lavage plus administration of corticosteroids was more effective than arthroscopic lavage plus administration of placebo or joint aspiration plus injection of corticosteroids. The absence of fibrosis was a histologic predictor of a beneficial response.
Article: [Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study].[show abstract] [hide abstract]
ABSTRACT: 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.acta orthopaedica et traumatologica turcica 02/2008; 42(4):221-7. · 0.34 Impact Factor