Prevention of post-traumatic osteoarthritis after intra-articular knee fractures using hyaluronic acid: a randomized prospective pilot study
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Based on the irreversible destruction of hyaline cartilage, post-traumatic osteoarthritis (PTOA) is a notorious sequelae after intra-articular knee fractures. This study evaluates the clinical efficacy and applicability of immediate post-operative intra-articular injection of hyaluronic acid (IA HA) into the knee joint with an intra-articular fracture.
Prospective randomized case-control study involving 40 patients (20 in each group) with intra-articular knee fracture with an average follow-up of 23 months (range 18–24 months). Twenty patients with intra-articular distal femoral or intra-articular proximal tibial fractures who met our inclusion criteria received three intra-articular hyaluronic acid injections weekly starting immediately after ORIF. Another 20 patients serving as a control group received no injection after ORIF. Patients were assessed functionally with Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) score. Plain X-rays and when indicated CT scans were used to assess radiological union.
The results showed patients treated with intra-articular hyaluronic acid injection after fixation had significantly less pain (KOOS) (p = 0.01). No significant difference was found between both groups in other KOOS-related outcome measures, complications, functional outcome, or quality of life.
These preliminary results support a direct role for hyaluronic acid in the acute phase of the inflammatory process that follows articular injury and provides initial evidence for the efficacy of IA HA.
KeywordsIntra-articular injection after trauma Intra-articular hyaluronic acid injection Hyaluronic acid (HA) Post-traumatic osteoarthritis
Compliance with ethical standards
This work was conducted at Cairo University Hospitals in accordance with the ethical standards of the Helsinki Declaration. All participating patients signed an informed consent regarding the procedure, possible complications, and alternative treatment modalities.
Conflict of interest
The authors declare that there is no conflict of interest.
- 2.Rossi R, Bardelli A (2005) Tibial plateau fractures. A review of classifications. MINERVA Ortop E Traumatol 56:457–463Google Scholar
- 8.Huang TL, Hsu HC, Yang KC, Yao CH, Lin FH (2010) Effect of different molecular weight hyaluronans on osteoarthritis-related protein production in fibroblast-like synoviocytes from patients with tibia plateau fracture. J Trauma 68:146–152. https://doi.org/10.1097/TA.0b013e3181a92cf8 CrossRefPubMedGoogle Scholar
- 9.Balazs EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol:3–9Google Scholar
- 15.Miller LE, Block JE (2013) US-approved intra-articular hyaluronic acid injections are safe and effective in patients with knee osteoarthritis: systematic review and meta-analysis of randomized, saline-controlled trials. Clin Med Insights Arthritis Musculoskelet Disord 6:57–63. https://doi.org/10.4137/CMAMD.S12743 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the International Knee Documentation Committee Subjective Knee Form. Am J Sports Med 29:600–613. https://doi.org/10.1177/03635465010290051301 CrossRefPubMedGoogle Scholar
- 18.Pelletier JP, McCollum R, Cloutier JM, Martel-Pelletier J (1995) Synthesis of metalloproteases and interleukin 6 (IL-6) in human osteoarthritic synovial membrane is an IL-1 mediated process. J Rheumatol 109–114Google Scholar
- 20.Campos ALS, E Albuquerque RSP, da Silva EB, Fayad SG, Acerbi LD, de Almeida FN, Ooka NHM, Franco JS, Gameiro VS (2017) Viscosupplementation in patients with severe osteoarthritis of the knee: six month follow-up of a randomized, double-blind clinical trial. Int Orthop 41:2273–2280. https://doi.org/10.1007/s00264-017-3625-9 CrossRefPubMedGoogle Scholar
- 21.Westrich G, Schaefer S, Walcott-Sapp S, Lyman S (2009) Randomized prospective evaluation of adjuvant hyaluronic acid therapy administered after knee arthroscopy. Am J Orthop (Belle Mead NJ) 38:612–616Google Scholar
- 27.Schiavone Panni A, Vasso M, Braile A, Toro G, De Cicco A, Viggiano D, Lepore F (2019) Preliminary results of autologous adipose-derived stem cells in early knee osteoarthritis: identification of a subpopulation with greater response. Int Orthop 43:7–13. https://doi.org/10.1007/s00264-018-4182-6 CrossRefPubMedGoogle Scholar
- 28.Hong Z, Chen J, Zhang S, Zhao C, Bi M, Chen X, Bi Q (2019) Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial. Int Orthop 43:1123–1134. https://doi.org/10.1007/s00264-018-4099-0 CrossRefPubMedGoogle Scholar
- 29.Di Matteo B, Marcacci M, Kon E (2019) Letter to the editor concerning the article: “Intra-articular injection of autologous adipose-derived stromal vascular fractions for knee osteoarthritis: a double-blind randomized self-controlled trial” (Hong et al. International Orthopaedics doi: 10.1007). Int Orthop 43:751–752. https://doi.org/10.1007/s00264-018-4134-1 CrossRefPubMedGoogle Scholar
- 30.Hernigou P, Auregan JC, Dubory A, Flouzat-Lachaniette CH, Chevallier N, Rouard H (2018) Subchondral stem cell therapy versus contralateral total knee arthroplasty for osteoarthritis following secondary osteonecrosis of the knee. Int Orthop 42:2563–2571. https://doi.org/10.1007/s00264-018-3916-9 CrossRefPubMedGoogle Scholar
- 32.Centeno CJ, Al-Sayegh H, Freeman MD, Smith J, Murrell WD, Bubnov R (2016) A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions. Int Orthop 40:1755–1765. https://doi.org/10.1007/s00264-016-3162-y CrossRefPubMedGoogle Scholar