Increased cartilage volume after injection of hyaluronic acid in osteoarthritis knee patients who underwent high tibial osteotomy

Keerati Chareancholvanich, Chaturong Pornrattanamaneewong, Rapeepat Narkbunnam, Keerati Chareancholvanich, Chaturong Pornrattanamaneewong, Rapeepat Narkbunnam

Abstract

Purpose: High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints.

Methods: Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48).

Results: MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p < 0.001) compared to the baseline. However, no difference was found between the two groups. The study group had significantly lower amounts of diclofenac consumption (p = 0.017).

Conclusion: Based on the findings of the present study, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO.

Level of evidence: Therapeutic study, Level I.

Figures

Fig. 1
Fig. 1
High tibial osteotomy was performed by the medial opening-wedge technique
Fig. 2
Fig. 2
Femoral and tibial articular cartilage structures of each subject were manually segmented in the sagittal plane slide by slide (range 80–100 slides per subject)
Fig. 3
Fig. 3
The 3D voxel models were generated and wrapped with a triangular mesh to create a virtual solid model of each specific structure
Fig. 4
Fig. 4
Study flow chart. IA intra-articular, HAs hyaluronic acid
Fig. 5
Fig. 5
Osteotomy site showing good progression of bone healing at 1 year after surgery

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Source: PubMed

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