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1.
Acta ortop. bras ; 31(6): e271857, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527642

ABSTRACT

ABSTRACT Objective: To describe the efficacy of using viscosupplementation in patients with hemophilic arthropathy (HA), on pain, limb functionality, and quality of life. Methods: A systematic review of the literature was performed following the PRISMA guidelines without limitations of language or year of publication. The search was performed on the following medical databases: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost, and PROQUEST in April 2020. The search used the following word: (hemophilia AND joint diseases) OR (haemophilic arthropathy OR hemophilic arthropathy) AND viscosupplementation. Results: The systematic review identified 127 articles, 10 of which were selected for data extraction and qualitative analysis. The 10 selected articles included 297 joints with HA in 177 hemophilic subjects. Our review showed positive results in alleviating pain and improving functional capacity, and quality of life. No major adverse effects were observed. Conclusion: There is a lack of scientific evidence regarding viscosupplementation with hyaluronic acid, but the results presented in this research suggest that it is an effective and safe therapeutic option to alleviate pain and improve functional capacity in patients with HA. Level of Evidence II, Systematic Review.


RESUMO Objetivo: Descrever o uso da viscossuplementação com ácido hialurônico em pacientes com artropatia hemofílica (HA), sua eficácia na dor, a funcionalidade do membro e a qualidade de vida após sua aplicação. Métodos: Revisão sistemática da literatura (RSL) que seguiu as diretrizes PRISMA, sem limitação de idioma ou ano de publicação. A pesquisa foi realizada em abril de 2020 nas seguintes bases de dados médicas: PubMed, Cochrane Library, EMBASE, BVS/BIREME, Scopus, Web of Science, EBSCOhost e ProQuest. A estratégia de pesquisa foi: (hemofilia AND joint disease) OR (artropatia hemofílica OU artropatia hemofílica) E viscossuplementação. Resultados: A RSL identificou 127 artigos, dos quais 10 foram selecionados para extração de dados e análise qualitativa. Os 10 artigos selecionados incluíram 297 articulações com AH em 177 indivíduos hemofílicos. Nossa revisão mostrou resultados positivos na melhora da dor, na capacidade funcional e na qualidade de vida. Não foram observados efeitos adversos importantes. Conclusão: A evidência científica atual a respeito da viscossuplementação com ácido hialurônico é escassa, mas os resultados apresentados nesta pesquisa sugerem que é uma opção terapêutica eficaz e segura para diminuir a dor e melhorar a capacidade funcional em pacientes com AH. Nível de Evidência II, Revisão Sistemática.

2.
J. bras. econ. saúde (Impr.) ; 14(Suplemento 2)20220800.
Article in English | LILACS, ECOS | ID: biblio-1412749

ABSTRACT

Objective: To evaluate the micro-costing of viscosupplementation procedures compared to different infiltration regimens. Methods: This study compared, through the Time-Driven ActivityBased Costing method, the micro-costing of these different application regimens using national cost averages as a basis for calculation in a medium-sized outpatient service. Results: The results demonstrated that the difference in costs with the single application is 31.47% less for three and 119.13% for five applications. Conclusions: No study showed a superiority of the five-application regimen over the three-application regimen, which leads one to believe that there is no justification for this procedure from an economic or quality-of-life point of view.


Objective: Avaliar o microcusteio dos procedimentos de viscossuplementação do joelho em diferentes regimes de aplicação. Métodos: Este estudo comparou, por meio do método Time-Driven Activity-Based Costing, o microcusteio desses diferentes regimes de aplicação, usando com base de cálculo médias nacionais de custo em um serviço ambulatorial de porte médio. Resultados: Os resultados encontrados demonstraram que a diferença nos custos com a aplicação única é 31,47% menor para três aplicações e 119,13% para cinco aplicações. Conclusão: Em nenhum estudo houve superioridade do regime de cinco aplicações ao regime de três, fato que leva a acreditar que não há nenhuma justificativa para esse procedimento do ponto de vista econômico ou de qualidade de vida do paciente.


Subject(s)
Osteoarthritis , Cost Allocation , Viscosupplementation
3.
Acta ortop. bras ; 30(5): e250414, 2022.
Article in English | LILACS-Express | LILACS | ID: biblio-1403041

ABSTRACT

ABSTRACT Objective: The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field. Methods: A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure. Conclusion: Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended. Level of Evidence V, Expert Opinion.


RESUMO Objetivo: O Consenso Brasileiro de Viscossuplementação do Quadril visa gerar uma fonte referencial a partir do conhecimento teórico e da experiência clínica de especialistas da área. Métodos: Um painel multidisciplinar foi formado com quinze especialistas (médicos do esporte, ortopedistas, fisiatras e reumatologistas), com base na experiência clínica e acadêmica no uso da viscossuplementação do quadril. Foram elaboradas, discutidas e votadas doze afirmativas. Cada membro do painel deu um valor entre 0 e 10 numa escala tipo Likert, especificando seu nível de concordância com a afirmação. Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação do quadril, destacando-se: a melhor indicação é para tratar artrose de quadril leve a moderada; pode ser indicada para casos graves; os resultados podem variar de acordo com o viscossuplemento utilizado; não deve ser realizada como procedimento isolado, mas em conjunto com outras medidas reabilitadoras e farmacológicas; a melhor técnica para infiltração no quadril deve se basear nas referências anatômicas combinadas com guiagem por imagem; a viscossuplementação do quadril é um procedimento custo-efetivo. Conclusão: A viscossuplementação é uma alternativa terapêutica segura e eficaz na osteoartrite do quadril, mesmo em casos graves. Recomenda-se o uso de métodos guiados. Nível de Evidência V, Opinião do Especialista.

4.
Acta ortop. bras ; 30(1): e244410, 2022. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1355573

ABSTRACT

ABSTRACT Introduction The aim of this study was to evaluate the effect of using an intra-articular injection of hylan G-F 20 (HA group) on primary shoulder osteoarthritis compared with an intra-articular triamcinolone injection (T group). Materials and Methods The patients were randomized into 2 groups: in the HA group a single dose of intra-articular hylan G-F 20 was administered and in the T control group a dose of triamcinolone 20 mg was administered. The participants were evaluated at 1 week, 1, 3, and 6 months after the procedure. The patients were evaluated for pain, range of motion, Constant score, modified UCLA score, and SPADI. Results Seventy patients met the inclusion criteria and were randomized to the HA (38) and T (32) groups. Improvements in range of motion were significant (p > 0.05). We observed decreases in the general visual analog scale (VAS) for pain in both groups, especially in the cases of mild and moderate arthritis that received hyaluronic acid (mean values from 8.1 initially to 4.9 after 6 months) (p = 0). Conclusions Both injections led to a decrease in pain and an increase in patient satisfaction. The results tend to be better and longer lasting in patients receiving hyaluronic acid. Level of evidence II b; Cohort study.


RESUMO Introdução O objetivo deste estudo foi avaliar o efeito do uso de uma injeção intra-articular de Hilano G-F 20 (Grupo HA) na osteoartrite primária do ombro em comparação com injeção intra-articular de triancinolona (Grupo T). Material e Método Os pacientes foram randomizados em dois grupos: no Grupo HA foi administrada uma dose única de Hilano G-F 20 intra-articular e no Grupo controle T foi administrada uma dose de 20 mg de triancinolona. Os participantes foram avaliados 1 semana, 1, 3 e 6 meses depois do procedimento. Os pacientes foram avaliados quanto à dor, amplitude de movimento, escore de Constant, escore UCLA modificado e índice SPADI. Resultados Setenta pacientes satisfizeram os critérios de inclusão e foram randomizados para os Grupos HA (38) e T (32). As melhoras da amplitude de movimento foram significativas (p > 0,05). Observamos diminuições na escala visual analógica (EVA) geral para dor em ambos os grupos, principalmente nos casos de artrite leve e moderada que receberam ácido hialurônico (valores médios de 8,1 inicialmente a 4,9 depois de 6 meses) (p = 0). Conclusões Ambas as injeções reduziram a dor e aumentaram a satisfação do paciente. Os resultados tendem a ser melhores e mais duradouros em pacientes que recebem ácido hialurônico. Nível de evidência II b; Estudo de Coorte.

5.
Rev. colomb. cienc. pecu ; 34(3): 212-223, July-Sept. 2021. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1408022

ABSTRACT

Abstract Background: Osteoarthritis is a complex degenerative disease with several factors contributing to joint damage. Objective: To compare the potential effect of hyaluronic acid (HA) and triamcinolone acetonide (TA), alone or combined, on the in vitro chondrogenic differentiation process of mesenchymal stem cells (MSCs). Methods: MSCs were divided into four groups: Control, HA, TA, and HA/TA combined. Each treatment group was cultured for 14 days in chondrogenic differentiation medium. The chondrogenic differentiation potential was assessed by histology and immunohistochemistry. Results: The HA and HA/TA-treated MSCs presented histological characteristics similar to native chondrocytes. The extracellular matrix (ECM) of TA-treated MSCs was compact and organized. Glycosaminoglycan staining was intense in Control, moderate in TA, slight in HA/TA, and undetectable in HA. Type II collagen immunoreactivity was high in the TA-treated ECM and MSCs. Conclusions: Histological analysis shows that HA influences morphological development similar to chondrocytes of the MSCs, but with low expression of specific cartilage molecules. The TA promotes formation of a compact and organized ECM.


Resumen Antecedentes: La osteoartritis es una enfermedad degenerativa compleja en la cual varios factores contribuyen al daño articular. Objetivo: Comparar el efecto del ácido hialurónico (HA) y acetónido de triamcinolona (TA), solos o en combinación, en el proceso de diferenciación condrogénica in vitro de células madre mesenquimales (MSCs). Métodos: Las MSCs fueron divididas en cuatro grupos: Control, HA, TA y HA/TA, y cultivadas por 14 días en medio de diferenciación condrogénica para cada tratamiento. El potencial de diferenciación condrogénica fue analizado por medio de histología e inmunohistoquímica. Resultados: Las MSCs tratadas con HA y HA/TA, presentaron características histológicas similares a los condrocitos nativos, y la matriz extracelular (ECM) de MSCs tratadas con TA fue más compacta y organizada. La tinción de glicosaminoglicanos fue intensa en el Control, moderada en TA, ligera en HA/TA, y sin tinción en HA. La inmunoreactividad para colágeno tipo II fue más alta en las MSCs y ECM tratadas con TA. Conclusión: El análisis histológico muestra que el HA influencia un desarrollo morfológico similar a los condrocitos de las MSCs, pero con baja expresión de moléculas específicas de cartílago. La TA promueve la formación de una ECM compacta y organizada.


Resumo Antecedentes: A osteoartrite é uma doença degenerativa complexa, na qual vários fatores contribuem ao dano articular. Objetivo: Comparar o efeito do ácido hialurônico (HA) e Triancinolona acetonida (TA), só ou combinado no processo de diferenciação condrogênica in vitro de células tronco mesenquimais (MSCs). Métodos: MSCs foram divididas em 4 grupos: Controle, HA, TA y HA/TA e cultivadas por 14 dias com meio de diferenciação condrogênica e seus respectivos tratamentos. O potencial de diferenciação condrogênica foi acessado por meio de histologia e imunohistoquímica. Resultados: Histologicamente, MSCs tratadas com HA e HA/TA apresentaram características semelhantes de condrócitos nativos, e a matriz extracelular de MSCs tratadas com TA foi mais compacta e organizada. A coloração para glicosaminoglicanos foi intensa no Controle, moderada no TA, leve no HA/TA e sem coloração com HA. Para os grupos tratamento, a imunoreatividade para colágeno tipo II foi maior nas células e matriz extracelular tratadas com TA. Conclusão: Mediante análise histológica, o HA influenciou o desenvolvimento morfológico semelhante a condrócitos das MSCs, mas com baixa expressão de moléculas específicas de cartilagem. A TA promoveu a formação de uma matriz extracelular compacta e organizada.

6.
J. oral res. (Impresa) ; 10(2): 1-10, abr. 30, 2021. ilus, tab
Article in English | LILACS | ID: biblio-1382212

ABSTRACT

Objetive: The degenerative diseases of the tempo-romandibular joint (TMJ) are characterized by a progressive destruction of the articular tissues of the condyle and the glenoid fossa. The main aim of this review is to describe the effectiveness of the hyaluronic acid (HA) in the treatment of degenerative diseases of the TMJ in accordance with the available scientific evidence. Material and Methods: A literature search was made in the following databases EBSCO, Pubmed, Cochraneand Trip Database, using the keywords hyaluronic, hyaluronan, NaH, hyaluronate, TMJ, TMD, CMD, craniomandibular, orofacial pain and temporomandibular. There were no date or language restrictions applied. Results: After applying inclusion and exclusion criteria, 14 studies were included in this review (11 randomized controlled clinical trials and 3 non-randomized clinical trials). Conclusion: The studies reported a decrease in pain and improvement in functional parameters after treatment of TMJ osteoarthritis with HA . The use of arthrocentesis associated with the administration of HA provides effects synergistic, reaching a superiority the protocols with multiple injections with respect to those of a single session. The adverse effects related to the injection of HA with or without associated arthrocentesis were minor and transitory.


Resumen: Objetivo: Las enfermedades degenerativas de la articulación temporomandibular (ATM) se caracterizan por una destrucción progresiva de tejidos articulares en el cóndilo y la fosa glenoidea. El objetivo principal de esta revisión es describir la efectividad del uso de ácido hialurónico en el tratamiento de enfermedades degenerativas de la articulación temporomandibular de acuerdo con la evidencia científica disponible. Material y Métodos: Se realizó una búsqueda de la literatura en las bases de datos electrónicas EBSCO, PubMed, Cochrane y Trip Database, utilizando las palabras claves hyaluronic, hyaluronan, NaH, hyaluronate, tmj, tmd, cmd, craniomandibular, orofacial pain y temporomandibular, sin límite de fecha ni de idioma hasta Mayo del año 2020, complementada con una búsqueda retrógrada. Resultados: Con base en los criterios de inclusión y exclusión, 14 estudios fueron incluidos en esta revisión (11 ensayos clínicos controlados aleatorizados y 3 ensayos clínicos controlados no aleatorizados). Conclusión: Los estudios reportaron una disminución del dolor y mejora en los parámetros funcionales luego del tratamiento de osteoartritis de la ATM con AH. El uso de artrocentesis asociada a la administración del AH provee efectos sinérgicos, alcanzando una superioridad los protocolos con múltiples inyecciones con respecto a aquellos de una sola sesión. Los efectos adversos relacionados con la inyección de AH con o sin artrocentesis asociada fueron menores y transitorios.


Subject(s)
Humans , Osteoarthritis/drug therapy , Temporomandibular Joint Disorders/drug therapy , Hyaluronic Acid/administration & dosage , Facial Pain , Viscosupplementation , Arthrocentesis
7.
Clinics ; 76: e2840, 2021. tab
Article in English | LILACS | ID: biblio-1249590

ABSTRACT

OBJECTIVES: Arthrocentesis is the simplest surgical intervention for the temporomandibular joint (TMJ). It can be performed on an outpatient basis at a low cost and with low morbidity. The objective is to release the articular disc by disrupting the adhesion formed between its surfaces and the mandibular fossa through hydraulic pressure generated by irrigation of the upper compartment of the TMJ. Viscosupplementation with hyaluronic acid during or after arthrocentesis improves clinical outcomes, increases mouth opening, and reduces pain levels. The aim of this study was to evaluate the efficiency of arthrocentesis plus hyaluronic acid viscosupplementation through clinical examination and preoperative magnetic resonance imaging in patients with unilateral disc displacement without reduction (DDwoR). METHODS: This analytical retrospective cross-sectional study clinically and radiologically evaluated 72 patients of both sexes with unilateral DDwoR. The following data were collected: sex, pain, age, duration of pain, maximum mouth opening, and patient pain perception on a visual analog scale. TMJ arthrocentesis was performed only once for each of the indicated joints. Data were collected before arthrocentesis (baseline) and at 7, 14, 30, 60, 90, and 180 days after the procedure (final evaluation). RESULTS: Between the baseline and final evaluation, there was a significant reduction in pain (p=0.001) and restoration of articular function. In addition, there was a significant increase in maximum mouth opening (p=0.001). CONCLUSION: Patients with DDwoR undergoing arthrocentesis combined with hyaluronic acid injection showed significant improvement in the perceived pain and maximum mouth opening in the mid-term follow-up periods.


Subject(s)
Humans , Male , Female , Joint Dislocations , Viscosupplementation , Cross-Sectional Studies , Retrospective Studies , Range of Motion, Articular , Treatment Outcome , Temporomandibular Joint Disc , Arthrocentesis
8.
Acta ortop. bras ; 28(6): 280-286, Nov.-Dec. 2020. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1142044

ABSTRACT

ABSTRACT Objective: To verify whether the use of Hylan G-F20 improves saline lavage and triamcinolone injection results in the treatment of hip osteoarthritis (HOA). Methods: 82 patients with HOA categorized as grades II and III severity, according to Kellgren and Lawrence criteria, were randomized into the groups: lavage and triamcinolone (G0); lavage, triamcinolone, and 2 mL of hylan G-F20 (G1); lavage, triamcinolone, and 4mL of hylan G-F20 (G2); lavage, triamcinolone, and 6mL of hylan G-F20 (G3). The VAS, range of motion (ROM), WOMAC, and Lequesne questionnaires were administered at baseline, one, three, six, and twelve months post-injection. Results: All groups showed clinically relevant improvements (> 20%) between baseline and first month post-injection, maintaining subjective results throughout the study period (p < 0.001). We found no differences between groups in any subjective evaluations (p > 0.05, for all). G2 and G3 obtained improved flexion results up to a year (p = 0.028). Hylan groups presented an improved external rotation since the first postoperative month and maintained the results up to a year (G1, p = 0.041; G2, p = 0.007), whereas G0 showed no improvement (p = 0.336). Conclusion: Hip lavage and triamcinolone injection, with or without the use of hylan, improves pain, function, and quality of life up to a year in HOA. Hylan may improve ROM up to one year. Level of Evidence IB, Randomized clinical trial.


RESUMO Objetivo: Verificar se o Hylan G-F20 melhora os resultados da lavagem e injeção de triancinolona na osteoartrite do quadril (OAQ). Métodos: 82 pacientes com HOA Kellgren e Lawrence graus II e III foram randomizados: lavagem e triamcinolona (G0); lavagem, triancinolona e 2 mL de Hylan G-F20 (G1); lavagem, triamcinolona e 4 mL de Hylan G-F20 (G2); lavagem, triancinolona e 6 mL de Hylan G-F20 (G3). A escala visual analógica (EVA), amplitude de movimento (ADM), questionários Womac e Lequesne foram obtidos no início, um, três, seis e doze meses após a injeção. Resultados: Todos os grupos apresentaram melhora clinicamente relevante (> 20%) entre o início e o primeiro mês, mantendo resultados subjetivos durante o estudo (p <0,001). Não foram encontradas diferenças entre os grupos nas avaliações subjetivas (p > 0,05). A flexão aumentou no G2 e G3 até um ano (p = 0,028). A rotação externa melhorou nos grupos Hylan no primeiro mês, mantendo os resultados até um ano (G1, p = 0,041; G2, p = 0,007), enquanto G0 nunca melhorou (p = 0,336). Conclusão: Lavagem do quadril e injeção de triancinolona, com ou sem Hylan, melhoram a dor, função e qualidade de vida até um ano na OAQ. Hylan pode melhorar a ADM até um ano. Nível de evidência IB, Ensaio clínico randomizado.

9.
Rev. bras. med. esporte ; 26(3): 258-261, May-June 2020. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1137888

ABSTRACT

ABSTRACT Introduction Viscosupplementation and strength training are proposed interventions in the treatment of knee osteoarthritis. Objective To describe the isokinetic response in women with knee osteoarthritis who underwent both interventions. Methods A double-blind, randomized clinical trial involving thirty women diagnosed with grade II and III bilateral knee osteoarthritis using the radiological criteria of Kellgren & Lawrence. The subjects were randomized into three groups of ten patients each: one group was submitted to viscosupplementation and strength training (VST), another was submitted to strength training (ST) only, and a third to viscosupplementation (VS) only. All evaluations followed the study phases defined as pre-procedure (PRE); after 48 hours of VS (POS-VS); after 12 weeks of training (POS T); and after eight weeks of detraining (POS D). Intra-articular knee infiltrations were performed with a single dose of Hylan GF-20 and isokinetic dynamometry to determine the maximum torque in knee extension and flexion. Pain was measured by the visual analogue scale (VAS). Results The interventions promoted improvements in the isokinetic response in all three groups and in both muscle groups, with advantage for the extensor group. A significant difference was noticed in the isokinetic response of the trained groups when compared only to the viscosupplemented group (p<0.005), and the VST group showed better isokinetic response compared to the ST group. Conclusion Combined treatment with viscosupplementation and strength training, and treatment with strength training only, presented better results in terms of isokinetic response and pain reduction than viscosupplementation alone. Level of evidence I; Therapeutic studies-Investigating the results of treatment.


RESUMO Introdução Viscossuplementação e treinamento de força são intervenções propostas no tratamento da osteoartrite de joelho. Objetivo Descrever a resposta isocinética em mulheres com osteoartrite de joelho submetidas a ambas intervenções. Métodos Ensaio clínico duplo-cego e randomizado envolvendo 30 mulheres com diagnóstico de osteoartrite bilateral de joelho de graus II e III utilizando os critérios radiológicos de Kellgren & Lawrence. Elas foram randomizadas em três grupos de dez pacientes cada: um grupo foi submetido à viscossuplementação e ao treinamento de força (VTF), o outro submetido ao treinamento de força (TF) e o terceiro grupo foi submetido apenas à viscossuplementação (VS). Todas as avaliações seguiram as fases do estudo definidas como pré-procedimento (PRE); após 48 horas da VS (POS-VS); após 12 semanas de treinamento (POS T) e após oito semanas de destreinamento (POS D). Foram realizadas infiltrações intra-articulares de joelho com uma dose única de Hilano GF-20 e dinamometria isocinética para determinar o torque máximo em extensão e em flexão do joelho. A dor foi medida através da escala visual analógica (EVA). Resultados As intervenções promoveram melhorias na resposta isocinética em todos os três grupos e em ambos grupos musculares, com vantagem para o grupo extensor. Observou-se uma diferença significativa na resposta isocinética dos grupos treinados quando comparados ao grupo somente viscossuplementado (p<0,005), além disso o grupo VTF apresentou melhor resposta isocinética quando comparado ao grupo TF. Conclusão O tratamento combinado de viscossuplementação e treinamento de força e o tratamento com o treinamento de força apenas apresentaram melhores resultados na resposta isocinética e na redução da dor do que o tratamento apenas com viscossuplementação. Nível de evidência I; Estudos terapêuticos-Investigação dos resultados do tratamento.


RESUMEN Introducción Viscosuplementación y entrenamiento de fuerza son intervenciones propuestas en el tratamiento de osteoartritis de rodilla. Objetivo Describir la respuesta isocinética en mujeres con osteoartritis de rodilla sometidas a ambas intervenciones. Métodos Ensayo clínico doble ciego y aleatorizado que involucró a 30 mujeres con diagnóstico de osteoartritis bilateral de rodilla de grados II y III utilizando los criterios radiológicos de Kellgren y Lawrence. Ellas fueron aleatorizadas en tres grupos con diez pacientes cada uno: un grupo fue sometido a viscosuplementación y al entrenamiento de fuerza (VEF), el otro sometido al entrenamiento de fuerza (EF) y el tercer grupo sometido sólo a la viscosuplementación (VS). Todas las evaluaciones siguieron las fases del estudio definidas como pre-procedimiento (PRE); después de 48 horas de la VS (POS-VS); después de 12 semanas de entrenamiento (POS E) y después de ocho semanas de desentrenamiento (POS D). Fueron realizadas infiltraciones intraarticulares de rodilla con una dosis única de Hilano GF-20 y dinamometría isocinética para determinar el torque máximo en extensión y en flexión de rodilla. El dolor fue medido a través de la escala visual analógica (EVA) Resultados: Las intervenciones promovieron mejoras en la respuesta isocinética en los tres grupos y en ambos grupos musculares, con ventaja para el grupo extensor. Se observ ó una significativa diferencia en la respuesta isocinética de los grupos entrenados cuando comparados solamente al grupo viscosuplementado (p<0,005), además el grupo VEF presentó mejor respuesta isocinética cuando comparado al grupo EF. Conclusión El tratamiento combinado de viscosuplementación y entrenamiento de fuerza y el tratamiento con entrenamiento de fuerza sólo presentaron mejores resultados en la respuesta isocinética y en la reducción del dolor que el tratamiento con sólo viscosuplementación. Nivel de evidencia I; Estudios terapéuticos-Investigación de los resultados del tratamiento.

10.
Adv Rheumatol ; 60: 26, 2020. tab, graf
Article in English | LILACS | ID: biblio-1130806

ABSTRACT

Abstract Background: Injection of Hylan G-F20 (HY) into joints may provoke local flares, which mechanisms may involve reaction to protein contaminants. We have previously developed a protein-free saline-soluble galactomannan derived from guar gum (GM) that displays both analgesia and chondroprotection in experimental osteoarthritis (OA). We now demonstrate that both GM and Hylan G-F20 (HY) promote mild synovitis with cytokine release after intra-articular injection. Methods: Mice received 100 μg/25 μL GM or HY or saline into the knees. Joint pain was evaluated using von Frey test; cell influx, interleukin (IL)-1, IL-6, and CXCL-1 (pg/mL) levels were assessed in joint lavage at 6 h. Synovia were excised for histopathology. Results: Neither GM nor HY after being given into mice knee joints induced pain albeit promoting mild cell influx into joint washings as well as mild synovitis at histology, with no damage to the underlying cartilage. HY but not GM promoted IL-1 release into mice joints. Both compounds induced IL-6 and CXCL-1 release. Conclusion: Intra-articular injection of HY or GM promote acute transient synovitis whilst not provoking detectable significant joint damage. Local administration of these polysaccharides induces acute intra-articular release of inflammatory cytokines, which may account for joint flares following viscosupplementation.(AU)


Subject(s)
Animals , Mice , Osteoarthritis/physiopathology , Polysaccharides/administration & dosage , Viscosupplementation/instrumentation , Hyaluronic Acid/administration & dosage
11.
Acta ortop. bras ; 27(4): 230-236, July-Aug. 2019.
Article in English | LILACS-Express | LILACS | ID: biblio-1010968

ABSTRACT

ABSTRACT Objective: The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. Methods: A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. Results: The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. Conclusion: This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.


RESUMO Objetivo: O Consenso Brasileiro de Viscossuplementação visa gerar uma fonte referencial e consensual, a partir de levantamentos bibliográficos relevantes, do conhecimento teórico e da experiência clínica de especialistas de áreas afins para tratamento de viscossuplementação na osteoartrite do joelho, mitigando pontos críticos desse procedimento, como via de aplicação, indicação, eficácia e tolerabilidade. Métodos: Um painel multidisciplinar foi formado com dois médicos do esporte, seis ortopedistas, quatro fisiatras e dois reumatologistas, com base nas experiências clínica e acadêmica no uso da viscossuplementação. Foram elaboradas, discutidas e votadas 16 afirmativas. Cada membro do painel deu um valor entre zero e 10, em uma escala tipo Likert, especificando seu nível de concordância com a afirmação. Resultados: O painel chegou a um consenso sobre diversos aspectos da viscossuplementação, com destaque para as seguintes afirmativas: a melhor indicação é para artrose de joelhos leve a moderada; o uso prévio ou concomitante de hexacetonido de triancinolona intra-articular pode otimizar o efeito do ácido hialurônico; a viscossuplementação não deve ser realizada como procedimento isolado no tratamento da OA, mas em conjunto com outras medidas reabilitadoras e farmacológicas; promove efeito analgésico; anti-inflamatório; condroprotetor; e é custo-efetiva. Conclusão: Este consenso traz informações claras e servirá, como guia tanto para médicos quanto para as fontes pagadoras. Nível de evidência V, Consenso de especialistas.

12.
Acta ortop. mex ; 33(3): 166-168, may.-jun. 2019.
Article in Spanish | LILACS | ID: biblio-1248656

ABSTRACT

Resumen: Introducción: La osteoartrosis es actualmente la quinta causa de discapacidad en el adulto. Su prevalencia aumenta a partir de los 40 años. La viscosuplementación es un tratamiento para las etapas iniciales de la osteoartrosis de rodilla. Objetivo: Comparar la eficacia y la calidad de vida en pacientes con gonartrosis sintomática tratados con ácido hialurónico de alto y mediano peso molecular. Material y métodos: Estudio analítico, retrospectivo, transversal, observacional de expedientes clínicos de pacientes con diagnóstico de gonartrosis grado II y grado III, de Octubre de 2017 a Junio de 2018, tratados con viscosuplementación con ácido hialurónico de alto o de mediano peso molecular; se analizó la calidad de vida y la escala de WOMAC de manera previa a la primera aplicación y con seguimiento a los dos, cuatro y seis meses. Resultados: 194 pacientes, con edades entre 30 y 87 años (promedio 61.85; DE = 11.3); 134 mujeres (69.1%) y 60 hombres (30.9%). En ambos grupos la evolución fue hacia la mejoría, con disminución en el puntaje WOMAC, sin diferencia significativa entre grupos. El puntaje de WOMAC tuvo un aumento mínimo pasados seis meses de la aplicación en ambos grupos, lo que se interpreta como disminución del efecto terapéutico. Dos pacientes tuvieron reacciones adversas mínimas localizadas, las cuales se resolvieron con medidas generales. Conclusión: El ácido hialurónico en ambas presentaciones, de alto y de bajo peso molecular, es efectivo en el tratamiento de la gonartrosis sintomática sin diferencia con el peso molecular.


Abstract: Introduction: OA is currently the fifth leading cause of adult disability, its prevalence increases from age 40. Viscosupplementation is a treatment for the early stages of knee OA. Objective: To compare efficacy and quality of life in patients with symptomatic gonartrosis, treated with high and low molecular weight hyaluronic acid. Material and methods: Analytical, retrospective, cross-sectional, observational study of clinical records of patients diagnosed with grade II and grade III gonarthrosis, October 2017 to June 2018, treated with viscosupplementation with high molecular weight hyaluronic acid or low molecular weight; WOMAC quality of life and scale were analyzed prior to the first application and tracked at two, four and six months. Results: 194 patients, aged between 30 to 87 years (promedio 61.85; SD = 11.3); 134 women (69.1%), 60 men (30.9%). In both groups the evolution was towards improvement, with a decrease in the WOMAC score, with no significant difference between groups. The WOMAC score had a minimum increase after 6 months of application in both groups, which is interpreted as decreasing the therapeutic effect. Two patients had localized minimal adverse reactions which were resolved with general measures. Conclusion: Hyaluronic acid in both presentations, high and low molecular weight, are effective in the treatment of symptomatic goonarthrosis without difference to molecular weight.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Osteoarthritis, Knee/therapy , Viscosupplementation , Quality of Life , Cross-Sectional Studies , Retrospective Studies , Treatment Outcome , Hyaluronic Acid , Injections, Intra-Articular , Middle Aged , Molecular Weight
13.
Cad. Saúde Pública (Online) ; 35(10): e00098618, 2019. tab
Article in Portuguese | LILACS | ID: biblio-1039384

ABSTRACT

Resumo: A osteoartrite de joelho afeta cerca de 3,8% da população mundial e se manifesta por dor, edema, rigidez e redução da função articular, impactando na qualidade de vida do paciente. O tratamento consiste na modalidade farmacológica, não farmacológica e cirúrgica. A viscossuplementação (ácido hialurônico intra-articular) se propõe a oferecer alívio dos sintomas e a possibilidade de adiamento da cirurgia. Este estudo estimou o impacto orçamentário entre a associação desse medicamento e o tratamento não cirúrgico (tratamento padrão), sob a perspectiva do Sistema Único de Saúde. Com base no pressuposto de que 5% dos portadores da doença seguem para tratamento e nos custos diretos das modalidades: farmacológica e não farmacológica foram calculados os cenários de referência e alternativos que compararam as diferentes opções de tratamento para um horizonte temporal de três anos. A análise principal estimou um impacto orçamentário incremental de aproximadamente R$ 126 milhões (1 ampola anual) e R$ 252 milhões (2 ampolas anuais). Já a diacereína, um condroprotetor oral, avaliada como uma opção alternativa, mostrou um impacto de R$ 334 milhões no orçamento em relação ao tratamento padrão, o que proporciona um aumento de 24% no custo em relação ao uso de 2 ampolas anuais de ácido hialurônico, tornando-a economicamente menos vantajosa. A viscossuplementação pode proporcionar maior qualidade de vida ao paciente, redução de custos para o sistema e otimização do fluxo de atendimento nas unidades de saúde. As estimativas apresentadas neste estudo podem auxiliar o gestor quanto à melhor utilização dos recursos financeiros e consequente tomada de decisão quanto à incorporação da tecnologia.


Abstract: Knee osteoarthritis affects 3.8% of the world population and manifests as pain, edema, stiffness, and reduced joint function, impacting the patient's quality of life. Treatment consists of the pharmacological, non-pharmacological, and surgical modalities. Viscosupplementation (intraarticular hyaluronate) has been proposed to relieve symptoms and potentially postpone surgery. This study estimated the budget impact of the association of this drug and non-surgical treatment (standard treatment) from the perspective of the Brazilian Unified National Health System. Based on the assumption that 5% of patients proceed to treatment and on the direct costs of the pharmacological and non-pharmacological modalities, the authors calculated the reference and alternative scenarios that compared the different treatment options in a three-year timeline. The principal analysis estimated an incremental budget impact of approximately BRL 126 million (U$ 32 million) for one vial of hyaluronate a year and BRL 252 million (USD 64 million) for two vials a year. Diacerein, an oral chondroprotector, assessed as an alternative, showed a budget impact of BRL 334 million (USD 86 million) in relation to standard treatment, representing a 24% cost increase compared to two vials a year of hyaluronate, making it less economically advantageous. Viscosupplementation can provide better quality of life for patients, reduce costs for the health system, and optimize the flow of care in health services. The estimates presented in this study can assist administrators in the best use of resources and thus in decision-making on the technology's incorporation.


Resumen: La osteoartritis de rodilla afecta a cerca de un 3,8% de la población mundial y se manifiesta por dolor, edema, rigidez y reducción de la función articular, impactando en la calidad de vida del paciente. El tratamiento consiste en la modalidad farmacológica, no farmacológica y quirúrgica. La viscosuplementación (ácido hialurónico intraarticular) se propone ofrecer un alivio de los síntomas y la posibilidad de un aplazamiento de la cirugía. Este estudio estimó el impacto presupuestario entre la asociación de este medicamento y el tratamiento no quirúrgico (tratamiento estándar), desde la perspectiva del Sistema Único de Salud. Basándonos en el supuesto de que un 5% de los portadores de la enfermedad siguen el tratamiento y en los costos directos de las modalidades tanto farmacológica, como no farmacológica, se calcularon los escenarios de referencia y alternativos que compararon las diferentes opciones de tratamiento para un horizonte temporal de tres años. El análisis principal estimó un impacto presupuestario incremental de aproximadamente BRL 126 millones (1 ampolla anual) y BRL 252 millones (2 ampollas anuales). En el caso de la diacereína, un condroprotector oral, evaluado como una opción alternativa, mostró un impacto de BRL 334 millones en el presupuesto, respecto al tratamiento estándar, lo que proporciona un aumento de un 24% en el costo, en relación con el uso de 2 ampollas anuales de ácido hialurónico, haciéndola económicamente menos ventajosa. La viscosuplementación puede proporcionar mayor calidad de vida al paciente, reducción de costes para el sistema y la optimización del flujo de atención en las unidades de salud. Las estimaciones presentadas en este estudio pueden ayudar al gestor en lo referente a una mejor utilización de los recursos financieros y, consecuentemente, en la toma de decisiones respecto a la incorporación de tecnología.


Subject(s)
Humans , Osteoarthritis, Knee/drug therapy , Viscosupplements/therapeutic use , Viscosupplementation/economics , Hyaluronic Acid/therapeutic use , Brazil/epidemiology , Budgets , Prevalence , Osteoarthritis, Knee/epidemiology , National Health Programs
14.
Acta ortop. mex ; 32(2): 70-75, mar.-abr. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1019333

ABSTRACT

Resumen: Objetivo: Nuestro objetivo fue evaluar la efectividad de las infiltraciones subacromiales de ácido hialurónico en el tratamiento del dolor crónico de hombro como alternativa a los tratamientos quirúrgicos y no quirúrgicos actualmente disponibles. Material y métodos: Estudio prospectivo de 80 pacientes consecutivos con dolor crónico de hombro seguidos durante 12 meses. Se realizaron cinco infiltraciones subacromiales con ácido hialurónico durante cinco semanas consecutivas y se analizaron los resultados clínicos obtenidos. Resultados: La puntuación en la escala de Constant mejoró en 7.7 puntos, el cuestionario DASH disminuyó en cinco puntos y la puntuación en la escala visual analógica para el dolor disminuyó 1.6 puntos por término medio. Los pacientes que presentaban dolor de menos de 24 meses de evolución respondieron mejor al tratamiento. Las mujeres respondieron mejor. Los pacientes con disminución del espacio subacromial o lesión del manguito rotador según la resonancia magnética mejoraron, pero los pacientes que mostraron signos de artrosis acromioclavicular en la resonancia empeoraron en todas las escalas evaluadas. Discusión: Las infiltraciones subacromiales de ácido hialurónico son especialmente efectivas en el tratamiento del dolor crónico de hombro de menos de 24 meses de evolución, con disminución del espacio subacromial o lesión parcial o total del manguito rotador, pero en nuestra experiencia, su resultado no es bueno en pacientes con artrosis acromioclavicular.


Abstract: Objective: Our purpose was to assess the effectiveness of hyaluronic acid infiltrations for chronic shoulder pain as an alternative to the non-surgical and surgical treatments that are currently available. Material and methods: This is a prospective study of 80 consecutive patients suffering from chronic shoulder pain followed for twelve months. Five subacromial hyaluronic acid injections on five consecutive weeks were administrated to all patients. Results: A significant improvement within the whole group after six months was observed. Constant score improved by 7.7 points, DASH questionnaire decreased by 5 points and Visual Analog Scale for pain decreased by 1.6 points. Patients with history of less than 24 months of pain responded better to treatment. Females responded better. Patients with decreased subacromial space or cuff tear in the MRI improved but patients diagnosed by the MRI of acromioclavicular osteoarthritis worsened in all scales assessed. Discussion: Subacromial hyaluronic acid injections are specially effective in patients with history of less than 24 months of pain, a decreased subacromial space or partial or total cuff tear but, in our experience, its result is not good in patients with acromioclavicular osteoarthritis.


Subject(s)
Humans , Male , Female , Shoulder Pain/drug therapy , Viscosupplements/administration & dosage , Hyaluronic Acid/administration & dosage , Prospective Studies , Treatment Outcome , Injections
15.
Acta ortop. mex ; 31(6): 319-327, nov.-dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-949788

ABSTRACT

Resumen: En la degradación del cartílago articular, la limitación funcional y el dolor se asocian a la alteración cuantitativa y cualitativa del ácido hialurónico en un proceso fisiopatológico sobre el que influye una amplia variedad de factores cuyo impacto agrava la enfermedad y disminuye la calidad de vida del paciente. El manejo farmacológico convencional para la osteoartritis es a menudo insuficiente. Por fortuna, en el mundo actual se cuenta con viscosuplementos capaces de mejorar, restituir y promover la producción endógena del ácido hialurónico degradado en los cuadros de osteoartritis. El uso de estos compuestos exige el apego a un conjunto de técnicas específicas, diseñadas para la correcta infiltración intraarticular del viscosuplemento sin necesidad de infligir una carga traumática adicional al paciente; estas técnicas -con referencia especial al paciente afectado por la osteoartritis de rodilla (gonartritis)- se describen en el presente artículo, en el que además se destacan los criterios para la elección del viscosuplemento idóneo, el más semejante al ácido hialurónico nativo de personas jóvenes y sanas y aquel cuyo uso terapéutico reporta mayores beneficios clínicos a corto y a largo plazo.


Abstract: In the degradation of articular cartilage, functional limitation and pain -cardinal signs of osteoarthritis- underlies, as a central factor, the quantitative and qualitative alteration of hyaluronic acid, the main component of synovial fluid and cartilage, in a pathophysiological process influenced by a wide variety of risk factors whose impact complicates the disease and radically reduces the quality of life of the patient. Conventional pharmacological management for osteoarthritis is often insufficient. Fortunately, in our days, there are viscosupplements capable of improving, replacing and promoting the endogenous production of degraded hyaluronic acid in osteoarthritis. The use of these compounds requires the adherence to a set of specific techniques, designed for the correct intra-articular infiltration of the viscosupplement without the need to inflict an additional traumatic load on the patient; these techniques -with special reference to the patient affected by knee osteoarthritis (gonarthritis)- are described in this article, which also highlights the criteria for choosing the ideal viscosupplement, the one most similar to hyaluronic acid native in healthy young people, and one whose therapeutic use reports greater clinical benefits in the short and long term.


Subject(s)
Humans , Synovial Fluid , Osteoarthritis, Knee/therapy , Osteoarthritis, Knee , Injections, Intra-Articular
16.
Int. j. morphol ; 35(3): 870-876, Sept. 2017. ilus
Article in English | LILACS | ID: biblio-893066

ABSTRACT

The aim of this study was to perform a literature review regarding the role of hyaluronic acid (HA) in the homeostasis and therapeutics of temporomandibular joint (TMJ) osteoarthritis (OA). The TMJ has characteristics that give it special adaptation and recovery abilities, where HA plays a fundamental role in helping to maintain joint homeostasis, which is affected in pathological processes like OA. OA is a chronic degenerative multi-factor disease that can affect all the components of the synovial joints, causing degradation of the articular cartilage, extracellular matrix and breakage in the HA molecules. HA is a non-branched linear polysaccharide with viscosupplementation, anti-inflammatory, lubrication and pain relief effects; it also activates the intrinsic repair processes of the cartilage and normalizes the endogenous production of HA by the synoviocytes. In recent years, the therapeutic use of HA has shown evidence that supports its application in TMJ OA, improving viscosupplementation capacity, acting at the cellular and molecular levels, reducing various inflammatory mediators and improving the reparative characteristics. Its use has been studied in animal models and in humans. However, no consensus has been reached in terms of concentrations, dose, application frequency or molecular weight to be used.


El objetivo de este estudio fue realizar una revisión de la literatura respecto del rol del ácido hialurónico (AH) en la homeostasis y terapéutica de la osteoartritis (OA) de la articulación temporomandibular (ATM). La ATM presenta características que le confieren propiedades de adaptación y recuperación especiales, donde el AH juega un rol fundamental ayudando a mantener la homeostasis articular, la cual se ve afectada en procesos patológicos como la OA. La OA es una enfermedad multifactorial crónica degenerativa que puede afectar a todos los componentes de las articulaciones sinoviales, generando degradación del cartílago articular, matriz extracelular y quiebre de las moléculas de AH. El AH es un polisacárido lineal no ramificado que presenta efectos de viscosuplementación, antiinflamatorios, lubricantes, en el alivio del dolor, permite además, activar procesos intrínsecos de reparación del cartílago y normalizar la producción endógena de AH por parte de los sinoviositos. En los últimos años el uso terapéutico del AH ha presentado evidencia que sustenta su aplicación en OA de ATM mejorando la capacidad de viscosuplementación, actuando a nivel celular y molecular, disminuyendo diversos mediadores inflamatorios y mejorando las características reparativas. Su uso se ha estudiado en modelos animales y en humanos, sin embargo no existe consenso en cuanto a concentraciones, dosis, frecuencias de aplicación y peso molecular a utilizar.


Subject(s)
Osteoarthritis/drug therapy , Temporomandibular Joint Disorders/drug therapy , Viscosupplementation/methods , Hyaluronic Acid/administration & dosage , Temporomandibular Joint/drug effects , Homeostasis/drug effects
17.
Acta fisiátrica ; 24(3): 127-132, set. 2017. tab
Article in English | LILACS | ID: biblio-968422

ABSTRACT

The viscosupplementation and strength training are interventions accepted in the treatment of knee osteoarthritis. Objective: The study describes the effect of two interventions in quality of life and functional capacity. Method: Thirty women diagnosed with bilateral knee osteoarthritis of grade II and III by radiological criteria of Kellgren & Lawrence, were randomized into three groups with ten patients each: VSTF group submitted to viscosupplementation and strength training, TF group submitted only to strength training and VS group submitted only to viscossuplementation. Moments of the study were defined as pre-procedure (PRE), after 48 hours of VS (POS-VS) after 12 weeks of training (POS T) and after eight weeks of detraining (POS D). Quality of life was assessed by the SF-36 BRAZIL, functional capacity by Lequesne index. Intraarticular infiltrations were carried out with a single dose of 6 ml / 48 mg with 6,000,000 kDa Hylan GF-20 and strength training sessions were held for twelve weeks. Results: Strength training and viscosupplementation were effective in the treatment of knee osteoarthritis. Both interventions promoted improvements in quality of life and in functional capacity (p < 0.001), with advantage to the groups that trained force. Conclusion: Strength training is a possible replacement of viscosupplementation in the treatment of osteoarthritis of women's knees. However, the beneficial effect of viscosupplementation in pain reduction suggests better efficiency in the strength training execution which may be an advantage of the association of both


Subject(s)
Quality of Life , Osteoarthritis, Knee/therapy , Viscosupplementation/instrumentation , Resistance Training/methods , Double-Blind Method
18.
Article in English | WPRIM | ID: wpr-759265

ABSTRACT

PURPOSE: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. RESULTS: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. CONCLUSIONS: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.


Subject(s)
Humans , Arthroplasty , Follow-Up Studies , Hyaluronic Acid , Injections, Intra-Articular , Knee , Molecular Weight , Osteoarthritis , Osteoarthritis, Knee , Patient Selection , Retrospective Studies , Survival Rate , Treatment Outcome , Viscosupplementation , Viscosupplements
19.
Rev. bras. med. esporte ; 22(6): 465-470, nov.-dez. 2016. tab, graf
Article in Portuguese | LILACS | ID: biblio-829960

ABSTRACT

RESUMO Introdução: A artrite pós-traumática é uma complicação frequente nas fraturas intra-articulares de joelho, que ocasiona dor e limitação funcional. Uma opção terapêutica que tem mostrado resultados promissores é a infusão intra-articular do ácido hialurônico (viscossuplementação), associada ou não a exercícios e dieta para perder peso. Objetivo: Verificar a resposta ao tratamento de artrite pós-traumática de joelho com uso de viscossuplementação associada ou não a exercícios físicos. Métodos: Avaliaram-se o arco de movimento articular, ângulo de retração poplíteo, a escala visual de dor, o escore de Lysholm e a circunferência da coxa em pacientes submetidos à correção cirúrgica de fratura do platô tibial em nossa instituição, os quais, depois de alta cirúrgica e fisioterápica, foram tratados com viscossuplementação em infusão única associada ou não a exercícios físicos programados, durante seguimento de 12 meses. Resultados: Houve diferença significativa a favor do grupo submetido à viscossuplementação associada a exercícios para o ângulo de retração poplíteo (p = 0,012) e espessura da coxa 10 cm acima da patela (p = 0,047). Em todas as demais variáveis estudadas, os resultados nesse grupo também foram superiores, porém sem alcançar significância estatística correspondente. Todos os pacientes estariam dispostos a repetir a infusão após 12 meses. Conclusão: A viscossuplementação trouxe melhora da dor e função aos pacientes com artrite pós-traumática de joelho e a melhora é maior quando os exercícios são associados em seguimentos de 12 meses.


ABSTRACT Introduction: Post-traumatic arthritis is a frequent complication of intra-articular fractures of the knee, which causes pain and functional limitation. A therapeutic option that has shown promising results is the intra-articular infusion of hyaluronic acid (viscosupplementation), with or without exercise and diet to lose weight. Objective: To assess the response to treatment of post-traumatic arthritis of the knee with use of viscosupplementation with or without exercise. Methods: We evaluated the arc of joint motion, popliteal retraction angle, visual pain scale, Lysholm score, and thigh circumference in patients undergoing surgical correction of the tibial plateau fracture at our institution, which, after surgical and physical therapy discharge, were treated with viscosupplementation in a single infusion with or without programmed exercise during follow-up of 12 months. Results: There was significant difference in favor of the group subjected to viscosupplementation associated with exercises for the retraction popliteal angle (p=0.012) and thickness of the thigh 10 cm above the patella (p=0.047). In all the other variables, the results in this group were also higher, but did not reach the corresponding statistical significance. All patients would be willing to repeat the infusion after 12 months. Conclusion: The viscosupplementation brought improvement in pain and function to patients with post-traumatic arthritis of the knee and the improvement is greater when exercises are associated in follow-ups of 12 months.


RESUMEN Introducción: La artritis postraumática es una complicación frecuente en las fracturas intraarticulares de rodilla, que ocasiona dolor y limitación funcional. Una opción terapéutica que ha mostrado resultados promisorios es la infusión intraarticular del ácido hialurónico (viscosuplementación), asociada o no a ejercicios y dieta para perder peso. Objetivo: Verificar la respuesta al tratamiento de artritis postraumática de rodilla con uso de viscosuplementación asociada o no a ejercicios físicos. Métodos: Se evaluaron el arco de movimiento articular, ángulo de retracción poplíteo, la escala visual de dolor, el score de Lysholm y la circunferencia del muslo en pacientes sometidos a corrección quirúrgica de fractura del platillo tibial en nuestra institución, los que después de alta quirúrgica y fisioterápica, fueron tratados con viscosuplementación en infusión única asociada o no a ejercicios físicos programados, durante seguimiento de 12 meses. Resultados: Hubo diferencia significativa a favor del grupo sometido a viscosuplementación asociada a ejercicios para el ángulo de retracción poplíteo (p = 0,012) y espesor del muslo 10 cm por encima de la rótula (p = 0,047). En todas las demás variables estudiadas, los resultados en ese grupo también fueron superiores, aunque sin alcanzar significancia estadística correspondiente. Todos los pacientes estarían dispuestos a repetir la infusión después de 12 meses. Conclusión: La viscosuplementación trajo mejora del dolor y función a los pacientes con artritis postraumática de rodilla y la mejora es mayor cuando los ejercicios son asociados en seguimientos de 12 meses.

20.
Acta ortop. bras ; 24(1): 52-54, Jan.-Feb. 2016. tab, graf
Article in English | LILACS | ID: lil-771864

ABSTRACT

ABSTRACT To evaluate the efficacy of viscosupplementation in patients with osteoarthritis of the ankle. A systematic review to evaluate the evidence in the literature on the use of viscosupplementation for osteoarthritis of the ankle. For this review, we considered blind randomized prospective studies involving the use of viscosupplementation for osteoarthritis of the ankle. A total of 1,961 articles were identified in various databases. After examining each of the articles, five articles were included in this review. Treatment with intraarticular hyaluronic acid is a safe treatment modality that significantly improves functional scores of patients, with no evidence of superiority in relation to other conservative treatments. Further clinical trials with larger numbers of patients are needed so that we can recommend its use and address unanswered questions . Systematic Review of Randomized Clinical Trials.

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