RESUMO
Osteoarthritisis a highly prevalent musculoskeletal disorder characterized by degradation of cartilage and synovial fluid (SF). Platelet derivatives as platelet-rich plasma (PRP) and platelet lysate have great potential in the treatment of osteoarthritis because they contain biologically active substances including growth factors (GFs). Rapid release of GFs and their short biological half-life are factors that can limit the therapeutic impact of PRP therapy. Herein, the first work that describes hydrogels based on polyaldehyde derivative of hyaluronic acid (HA-OX) as carriers of platelet derivatives for in situ applications is presented, which can be a possible solution to the problem. HA-OX hydrogels containing 50% (w/w) of PRP or platelet lysate can be injected using a syringe due to low viscosity(<10 Pa s) and injection force (<20 N), and reach elastic modulus up to 2000 Pa. Insulin-like GF-1 and Platelet-derived GF-AB release from HA-OX hydrogels (mesh size 297-406 nm) by Fickian and non-Fickian diffusion respectively. The released PRP GFs maintain their ability to induce cell proliferation (87%-92%). Based on the obtained results, the unique concept of a new material that can restore viscoelastic properties of SF and at the same time gradually deliver GFs from platelet derivatives is designed.
Assuntos
Plasma Rico em Plaquetas , Viscossuplementação , Ácido Hialurônico/farmacologia , Viscossuplementação/métodos , Líquido Sinovial , Hidrogéis/farmacologia , Cartilagem , Peptídeos e Proteínas de Sinalização IntercelularRESUMO
BACKGROUND: Advanced radiological stage of knee osteoarthritis (OA) is predictive of poor response to viscosupplementation (VS). To date, the impact of x-ray features on the duration of effectiveness (DE) of VS has not been investigated. OBJECTIVES: To investigate the radiological features associated with DE of VS in patients with knee OA. METHODS: Cross-sectional study in patients with knee OA treated with 1 injection of cross-linked hyaluronic acid (HA). The primary outcome was DE, self-assessed by the patients in weeks of effectiveness. Radiological features (joint space narrowing-JSN topography and Kellgren-Lawrence [K-L] grade) associated with DE were studied. RESULTS: Fifty-one patients-33 females (76 knees)-were analyzed. The average DE was 52.0 (24.7) weeks (range, 13-155 weeks). In the bivariate analysis, DE was 14 weeks longer in those with K-L grades 1 and 2 (62.6 ± 36.4 weeks) than in those with K-L 3 and 4 (48.9 ± 18.6) (P = 0.03). DE was not significantly different according to the involved compartment(s). It was significantly longer in men than in women (60 ± 31.4 vs. 47 ± 16 weeks; P = 0.035). In multivariate analysis, K-L grade (1-2 vs. 3-4) (P = 0.007), male gender (0.02), and older age (0.04) were independently associated with a longer DE. CONCLUSION: DE of a single injection of extended-release HA is longer in K-L 1-2 than in K-L 3-4 OA knees, regardless of the JSN topography. However, even the patients with more advanced OA benefited from HANOX-M-XL injection for an average duration barely less than 1 year.
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Feminino , Humanos , Masculino , Estudos Transversais , Ácido Hialurônico , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/tratamento farmacológico , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the effectiveness and safety of viscosupplementation for pain and function in patients with knee osteoarthritis. DESIGN: Systematic review and meta-analysis of randomised trials. DATA SOURCES: Searches were conducted of Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to 11 September 2021. Unpublished trials were identified from the grey literature and trial registries. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Randomised trials comparing viscosupplementation with placebo or no intervention for knee osteoarthritis treatment. MAIN OUTCOME MEASURES: The prespecified primary outcome was pain intensity. Secondary outcomes were function and serious adverse events. Pain and function were analysed as standardised mean differences (SMDs). The prespecified minimal clinically important between group difference was -0.37 SMD. Serious adverse events were analysed as relative risks. METHODS: Two reviewers independently extracted relevant data and assessed the risk of bias of trials using the Cochrane risk of bias tool. The predefined main analysis was based only on large, placebo controlled trials with ≥100 participants per group. Summary results were obtained through a random effects meta-analysis model. Cumulative meta-analysis and trial sequential analysis under a random effects model were also performed. RESULTS: 169 trials provided data on 21 163 randomised participants. Evidence of small study effects and publication biases was observed for pain and function (Egger's tests with P<0.001 and asymmetric funnel plots). Twenty four large, placebo controlled trials (8997 randomised participants) included in the main analysis of pain indicated that viscosupplementation was associated with a small reduction in pain intensity compared with placebo (SMD -0.08, 95% confidence interval -0.15 to -0.02), with the lower bound of the 95% confidence interval excluding the minimal clinically important between group difference. This effect corresponds to a difference in pain scores of -2.0 mm (95% confidence interval -3.8 to -0.5 mm) on a 100 mm visual analogue scale. Trial sequential analysis for pain indicated that since 2009 there has been conclusive evidence of clinical equivalence between viscosupplementation and placebo. Similar conclusions were obtained for function. Based on 15 large, placebo controlled trials on 6462 randomised participants, viscosupplementation was associated with a statistically significant higher risk of serious adverse events than placebo (relative risk 1.49, 95% confidence interval 1.12 to 1.98). CONCLUSION: Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference. Strong conclusive evidence indicates that viscosupplementation is also associated with an increased risk of serious adverse events compared with placebo. The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42021236894.
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Humanos , Viscossuplementação/efeitos adversos , Osteoartrite do Joelho/tratamento farmacológico , Medição da Dor , Dor/tratamento farmacológicoRESUMO
Viscosupplementation (VS) of the temporomandibular joint (TMJ) aims to treat temporomandibular dysfunction (TMD) by stimulating synovial cells to improve intracapsular lubrication. The purpose of the present study was to assess a VS protocol planned with the aid of cone-beam computed tomography (CBCT) and checked by ultrasonography (US). The study was carried out in 3 stages. The first was to check the correspondence between the proposed facial reference points and the osseous components of the joint by means of CBCT. In the second stage, the upper and lower compartments of 20 TMJs of fresh frozen cadavers were injected with coloured liquids, and the accuracy of the technique was confirmed by dissecting the anatomical specimens. The third stage consisted of VS in 10 patients (20 TMJs), with real-time verification of the location of the needle tip by means of ultrasonography. CBCT confirmed the correct locations of the marked points used in the proposed VS protocol. The dissections showed that 13 of the 14 injections effectively reached the upper and lower compartments. The location of the needle tip was effectively verified by ultrasonography, confirming the correct access to both compartments. The proposed protocol was effective for accessing the upper and lower compartments of the TMJ. The evaluated protocol proved to be accurate, safe and clinically reproducible means of VS in the upper and lower compartments of the TMJ.
Assuntos
Transtornos da Articulação Temporomandibular , Viscossuplementação , Humanos , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Articulação Temporomandibular/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , UltrassonografiaRESUMO
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.
Assuntos
Osteoartrite , Alocação de Custos , ViscossuplementaçãoRESUMO
Polymer-based formulations present an attractive strategy in intraarticular drug-delivery to refrain biologicals from early leakage from the joint. In this study, co-formulations of hyaluronic acid and polyvinylpyrrolidone were investigated for their potential as viscosupplements and their influence on the transsynovial loss of adalimumab. For this purpose, polymer mixtures were evaluated for their viscosity and elasticity behavior while their influence on the permeation of adalimumab across a porcine ex-vivo synovial membrane was determined. Hyaluronic acid showed strong shear thinning behavior and exhibited high viscosity and elasticity at low motions, while combinations with polyvinylpyrrolidone provided absorption and stiffness at high mechanical stress, so that they can potentially restore the rheological properties of the synovial fluid over the range of joint motion. In addition, the formulations showed significant influence on transsynovial permeation kinetics of adalimumab and hyaluronic acid, which could be decelerated up to 5- and 3-fold, respectively. Besides viscosity effects, adalimumab was retained primarily by an electrostatic interaction with hyaluronic acid, as detected by isothermal calibration calorimetry. Furthermore, polymer-mediated stabilization of the antibody activity was detected. In summary, hyaluronic acid - polyvinylpyrrolidone combinations can be efficiently used to prolong the residence of adalimumab in the joint cavity while simultaneously supplying viscosupplementation.
Assuntos
Viscossuplementação , Adalimumab , Animais , Ácido Hialurônico/química , Injeções Intra-Articulares , Povidona , Suínos , Viscossuplementos/químicaRESUMO
Osteoarthritis (OA) is one of the most common musculoskeletal disorders in the world. OA is often associated with the loss of viscoelastic and tribological properties of synovial fluid (SF) due to degradation of hyaluronic acid (HA) by reactive oxygen species (ROS) and hyaluronidases. Viscosupplementation is one of the ways how to effectively restore SF functions. However, current viscosupplementation products provide only temporal therapeutic effect because of short biological half-life. In this article we describe a novel device for viscosupplementation (NV) based on the cross-linked tyramine derivative of HA, chondroitin sulfate (CS), and high molecular weight HA by online determination of viscoelastic properties loss during degradation by ROS and hyaluronidase. Rheological and tribological properties of developed viscosupplement were compared with HA solutions with different molecular weights in the range 500-2000 kDa, which are currently commonly used as medical devices for viscosupplementation treatment. Moreover, based on clinical practice and scientific literature all samples were also diluted by model OA SF in the ratio 1:1 (vol/vol) to better predict final properties after injection to the joint. The observed results confirmed that NV exhibits appropriate rheological properties (viscosity, elastic, and viscous moduli) comparable with healthy SF and maintain them during degradation for a significantly longer time than HA solutions with molecular weight in the range 500-2000 kDa and cross-linked material without CS.
Assuntos
Osteoartrite do Joelho , Osteoartrite , Viscossuplementação , Sulfatos de Condroitina/farmacologia , Humanos , Ácido Hialurônico/farmacologia , Hialuronoglucosaminidase/uso terapêutico , Injeções Intra-Articulares , Osteoartrite/tratamento farmacológico , Espécies Reativas de Oxigênio , Tiramina/uso terapêutico , Viscossuplementação/métodos , Viscossuplementos/uso terapêuticoRESUMO
BACKGROUND: This study aimed to evaluate the efficacy of viscosupplementation after arthroscopic partial meniscectomy. METHOD: A randomized controlled trial of 47 patients who underwent arthroscopic partial meniscectomy was conducted between March 2020 and March 2021. Patients were randomized into two groups: a viscosupplementation group (n = 23) and a control group (n = 24). A single-dose intraarticular hyaluronic acid injection was used as viscosupplementation. The 100 mm visual analogue scale (VAS) for pain assessment was measured at baseline and at 1 day, 2 weeks, 6 weeks, and 3 months post-surgery. The International Knee Documentation Committee (IKDC), Tegner, Lysholm, and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) scores and range of motion (ROM) of the knee were measured at baseline, 2 weeks, 6 weeks, and 3 months. RESULTS: The 100 mm VAS score for pain was significantly lower in the viscosupplementation group at 2 weeks post-surgery (27.5 mm vs. 40.7 mm, P = 0.047). ROM was significantly greater in the viscosupplementation group than in the control group at 2 weeks (131.5° vs. 121.0°, P = 0.044) post-surgery. No significant differences were observed in the IKDC or in the Tegner, Lysholm, and WOMAC scores between the two groups. CONCLUSIONS: Viscosupplementation after arthroscopic partial meniscectomy significantly reduced pain at 2 weeks post-surgery and improved ROM of the knee at 2 weeks post-surgery. There might be some benefits in terms of pain and functional recovery of viscosupplementation after arthroscopic surgery. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. TRIAL REGISTRATION: This randomized controlled trial was registered at cris.nih.go.kr # KCT0004921 .
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Artroscopia , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Meniscectomia/efeitos adversos , Osteoartrite do Joelho/tratamento farmacológico , Osteoartrite do Joelho/cirurgia , Resultado do TratamentoRESUMO
MANDAT: L'Institut national d'excellence en santé et en services sociaux (INESSS) a reçu le mandat du Bureau de l'innovation de produire un avis sur la pertinence d'inclure les produits SynviscMD et Synvisc-OneMD au sein de la couverture du régime public pour les patients atteints d'arthrose du genou. DÉMARCHE D'ÉVALUATION: Une revue des données issues de la littérature et de celles fournies par le fabricant a été réalisée afin de documenter l'efficacité, l'innocuité et l'efficience des produits SynviscMD et Synvisc-OneMD. Des données expérientielles et contextuelles issues de la consultation d'experts sont aussi présentées. De plus, la perspective de patients atteints d'arthrose du genou a été obtenue au moyen d'un questionnaire élaboré par l'INESSS et diffusé par la Société de l'arthrite. BESOIN DE SANTÉ: La prévalence de l'arthrose du genou s'établit à environ 4,0 % dans la population québécoise âgée de plus de 20 ans. La nature évolutive de cette maladie a des répercussions grandissantes sur la qualité de vie des patients, leur fonctionnalité et leur autonomie. Il n'existe actuellement pas de traitement curatif pour l'arthrose. La prise en charge vise à soulager les symptômes et à maintenir une certaine fonctionnalité et consiste en l'utilisation concomitante de divers modes d'intervention. Toutefois, celle-ci ne permet de combler que partiellement les besoins de santé et une minorité de traitements sont accessibles ou couverts par le système de santé publique. Certains enjeux d'équité d'accès se posent dans la mesure où des patients n'ayant pas de moyens financiers ou d'assurances privées ont accès à moins d'options de traitements et de services. Certains patients peuvent donc se retrouver dans une impasse thérapeutique pendant plusieurs années, ce qui peut grandement affecter leur qualité de vie. PRODUITS EN ÉVALUATION: Les produits SynviscMD et Synvisc-OneMD sont des agents de viscosupplémentation identiques qui se distinguent par leur régime d'administration, soit par injection intraarticulaire à raison de 3 injections de 2 ml à intervalle d'une semaine pour SynviscMD ou d'une seule injection de 6 ml pour Synvisc-OneMD. SynviscMD et Synvisc-OneMD sont des options de traitement de l'arthrose depuis 22 et 12 ans respectivement, et disponibles au Québec pour plusieurs indications, y compris l'arthrose du genou, la coxarthrose, l'arthrose de la cheville et de l'épaule. Les experts mentionnent que le Synvisc-OneMD serait majoritairement utilisé par rapport au SynviscMD, notamment pour limiter le nombre d'injections. La viscosupplémentation pour le traitement de l'arthrose du genou avait déjà fait l'objet d'une évaluation en 2007 par l'Agence d'évaluation des technologies et des modes d'intervention en santé (AETMIS). L'agence avait conclu que, compte tenu de l'efficacité modeste de cette modalité thérapeutique par rapport au placébo, de son coût relativement élevé et des ressources professionnelles additionnelles nécessaires pour l'administrer, il n'était pas alors justifié d'envisager le financement public de la viscosuppléance pour l'ensemble des patients souffrant de gonarthrose au Québec.
Assuntos
Humanos , Osteoartrite do Joelho/tratamento farmacológico , Viscossuplementação/instrumentação , Avaliação em Saúde , Análise Custo-BenefícioRESUMO
PURPOSE: The purpose of this double-blind randomized controlled trial (RCT) was to compare clinical improvement and radiographic findings up to 2 years of follow-up of a single intra-articular injection of bone marrow aspirate concentrate (BMAC) versus hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA). The hypothesis was that BMAC injection could lead to better clinical and radiographic results compared to viscosupplementation. METHODS: Patients with bilateral knee OA were randomized to one intra-articular injection of tibial-derived BMAC in one knee and one HA injection in the contralateral knee. Sixty patients were enrolled, and 56 were studied up to the final follow-up (35 men, 21 women, mean age 57.8 ± 8.9 years), for a total of 112 knees. Patients were evaluated before the injection and at 1, 3, 6, 12, and 24 months with the IKDC subjective score, VAS for pain, and the KOOS score. Minimal clinically important difference (MCID), patient treatment judgement, and adverse events were documented, as well as bilateral X-Rays (Rosenberg view) before and after treatment. RESULTS: No severe adverse events nor differences were reported in terms of mild adverse events (7.1% vs 5.4%, p = ns) and treatment failures (10.7% vs 12.5%, p = ns) in BMAC and HA groups, respectively. The IKDC subjective score improved from baseline to all follow-ups for BMAC (p < 0.0005), while it improved up to 12 months (p < 0.0005) and then decreased at 24 months (p = 0.030) for HA. Compared to HA, BMAC showed a higher improvement for VAS pain at 12 (2.2 ± 2.6 vs 1.7 ± 2.5, p = 0.041) and 24 months (2.2 ± 2.6 vs 1.4 ± 2.8, p = 0.002). The analysis based on OA severity confirmed this difference only in Kellgren-Lawrence 1-2 knees, while comparable results were observed in moderate/severe OA. Radiographic evaluation did not show knee OA deterioration for both treatment groups, without intergroup differences. CONCLUSION: BMAC did not demonstrate a clinically significant superiority at short-term compared to viscosupplementation, reporting overall comparable results in terms of clinical scores, failures, adverse events, radiographic evaluation, MCID achievement, and patient treatment judgment. However, while HA results decreased over time, BMAC presented more durable results in mild OA knees. LEVEL OF EVIDENCE: Level I.
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Viscossuplementação/métodos , Osteoartrite do Joelho/tratamento farmacológico , Seguimentos , Medula Óssea , Resultado do Tratamento , Injeções Intra-Articulares , Ácido Hialurônico/uso terapêutico , Dor/tratamento farmacológicoRESUMO
Objetivos: La osteoartrosis (OA) es una artropatía incurable mono o poliarticular. En la rodilla es la enfermedad degenerativa más común, con gran incidencia de los factores mecánicos. El arsenal terapéutico para el manejo de la OA de rodilla (OAR) comprende medidas no farmacológicas, farmacológicas, medicación de técnicas intraarticulares y cirugía. Los objetivos de este trabajo fueron evaluar la eficacia en términos de dolor, función articular y calidad de vida de los pacientes infiltrados con ácido hialurónico (AH) de alto peso molecular (PM), doblemente reticulado (Cientific Synovial®, en adelante: CS) así como la seguridad de su uso. Adicionalmente se intentó objetivar el tiempo libre de prótesis en pacientes con esta indicación. Materiales y métodos: Se efectuó un diseño pre y post (un solo grupo) para pacientes con gonartrosis. Se analizó una muestra de cuarenta y seis pacientes (n = 46) a quienes se dividió en dos grupos según clasificación de Kellgren-Lawrence (KL). Un grupo KL 12 fue infiltrado con AH 40 mg (CS40), y otro grupo KL 34 fue infiltrado con AH 60 mg (CS60). A todos los pacientes se les suministró el cuestionario KOOS-12 (Knee injury and Osteoarthritis Outcome Score) pre y postinfiltración y se efectuó estadística descriptiva e inferencial apropiada. Conclusiones: el AH de alto PM y doblemente reticulado (Cientific Synovial®) mejoró estadística y clínicamente todos los parámetros de eficacia analizados por medio del cuestionario KOOS-12. El preparado se mostró seguro y sin aparición de efectos adversos de relevancia. Tanto en los pacientes con indicación previa de reemplazo total de rodilla (RTR) rechazada (n = 12) como en el resto de los pacientes de la muestra se verificó la supervivencia libre de prótesis hasta el final del estudio
Objectives: Osteoarthrosis (OA) is an incurable mono or polyarticular arthropathy and in the knee it is the most common degenerative disease with a high incidence of mechanical factors. The therapeutic arsenal for the management of knee OA (OAR) includes non-pharmacological and pharmacological measures, medication and intra-articular techniques, and surgery. The objectives of this study were to evaluate the efficacy in terms of pain, joint function and quality of life of patients infiltrated with double cross-linked high molecular weight (MW) hyaluronic acid (HA) (Cientific Synovial®, CS) as well as the safety of its use. Additionally, we tried to objectify the prosthesis-free time in patients with this indication. Materials and methods: a pre - post design (single group) was carried out for patients with knee osteoarthritis. A sample of fortysix patients (n = 46) was analyzed who were divided into two groups according to the Kellgren-Lawrence (KL) classification. A group KL 12 was infiltrated with HA 40 mg (CS40) and another group KL 34 was infiltrated with HA 60 mg (CS60). All patients filled out the KOOS-12 questionnaire (Knee injury and Osteoarthritis Outcome Score) pre and post infiltration and appropriate descriptive and inferential statistics were performed. Conclusions: The double-crosslinked, high-MW HA (Cientific Synovial®) improved statistically and clinically all the efficacy parameters analyzed using the KOOS-12 questionnaire. The preparation was shown to be safe and without the appearance of significant adverse effects. Both in the patients with a previous indication for total knee replacement (TKR) rejected (n = 12), as in the rest of the patients in the sample, prosthesis-free survival was verified until the end of the study
Assuntos
Resultado do Tratamento , Osteoartrite do Joelho/terapia , Viscossuplementação , Ácido Hialurônico/uso terapêuticoRESUMO
Introducción: La viscosuplementación ecoguiada con ácido hialurónico en la coxartrosis sintomática se ha extendido como tratamiento seguro con eficacia demostrada, aunque con falta de consenso en su uso como práctica habitual. Pocos estudios han comparado la eficacia de dos productos de inyección única. Objetivo: Evaluar la eficacia en pacientes infiltrados con dos ácidos hialurónicos de inyección única comparando Adant One® (A) a seis meses con Hyalone® (H) anual.Material y método: Estudio observacional retrospectivo sobre cohorte de pacientes con coxartrosis sintomática, tratados mediante viscosuplementación intrarticular ecoguiada de cadera con dos tipos de inyección única de ácido hialurónico. Su eficacia fue evaluada de acuerdo con las escalas WOMAC y EVA a los 6 y 12 meses. Resultados: Fueron tratados 144 pacientes con una dosis única de A y 84 con H. A los 6 meses aquellos tratados con A mostraron mejoras en relación con disminución del dolor en la EVA (p < 0,001) y en el WOMAC dolor (p = 0,003), así como en WOMAC global (p = 0,027). No hubo cambios en WOMAC rigidez y función. A los 12 meses los tratados con H mostraron mejorías en los parámetros EVA (p < 0,001) y WOMAC global (p = 0,010) y en todas sus dimensiones de manera significativa. Conclusiones: Una inyección única de H anual fue más efectiva para mejorar el dolor y la funcionalidad de la cadera con artrosis a 1 año comparado con A semestral. Es posible establecer protocolos anuales de viscosuplementación para la artrosis de cadera con ácido hialurónico usando H.(AU)
Introduction: Ultrasound-guided viscosupplementation with hyaluronic acid in symptomatic hip osteoarthritis is widely used as a safe treatment with proven efficacy, although there is a lack of consensus on its use as routine practice. Few studies have compared the efficacy of two single injection products. Objetive: To evaluate the efficacy in infiltrated patients with two single injection hyaluronic acids comparing Adant One® (A) at six months with annual Hyalone® (H).Material and method: Restrospective observational study on a cohort of patients with symptomatic hip osteoarthritis, treated by ultrasound-guided intra-articular viscossuplementation with two types of single injection of hyaluronic acid. Its efficacy was evaluated according to the WOMAC and VAS scales at 6 and 12 months. Results: 144 patients were treated with a single dose of A and 84 with H. At 6 months, those treated with A showed improvements in relation to pain reduction in the VAS (p < 0.001) and in the WOMAC pain (p = 0.003), as well as in global WOMAC (p = 0.027). There were no changes in WOMAC stiffness and function. At 12 months, those treated with H showed significant improvements in the VAS (p < 0.001) and global WOMAC (p = 0.010) parameters and in all their dimensions. Conclusions: A single injection of annual H was more effective in improving pain and function of the hip with osteoarthritis at 1 year compared to A at 6 months. It is possible to establish annual viscossuplementation protocols for hip osteoarthritis with hyaluronic acid using H.(AU)
Assuntos
Humanos , Ácido Hialurônico , Osteoartrite do Quadril , Viscossuplementação , Pacientes , Eficácia , Infiltração-Percolação , Estudos Retrospectivos , Estudos de CoortesRESUMO
OBJECTIVES: This work studied if and how current clinical practice agrees with European Viscosupplementation Consensus Group (EUROVISCO) recommendations and how this agreement might be different according to physician's specialization. In addition, this work aimed to identify key decision factors that practitioners consider in their decision to retreat or not a patient with hyaluronic acid viscosupplementation. METHODS: Practitioners have been invited by e-mail to participate in an online exercise on viscosupplementation retreatment. They received a fictional patient case at random among a set of predefined fictional cases. The platform asked the practitioner if he/she would retreat the patient with viscosupplementation or not. To take a decision, the practitioner could select questions among a list of predefined questions. Among them, some were related to criteria used in the EUROVISCO decision tree and others served as confounding factors. RESULTS: A total of 506 practitioners participated to the exercise, of which 399 gave their decision about the case assigned to them by the platform. The observed agreement between practitioner decisions and EUROVISCO recommendations was 58.89 ± 4.95% (95% confidence interval [CI]). Overall, the decision to retreat was taken in 47.87% of the cases, while the EUROVISCO guidelines follow-up would have led to 55.89% retreatment for the same cases (P = 0.03). CONCLUSIONS: In current practice, physicians tended to reinject their patients less than recommended, although EUROVISCO guidelines for viscosupplementation retreatment consider decision criteria that clearly correspond to those of practitioners in real life. These include the patients' willingness to be treated or the patients' perception of the effectiveness of the treatment.
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Consenso , Feminino , Humanos , Ácido Hialurônico/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Retratamento , Viscossuplementos/uso terapêuticoRESUMO
The discovery of unique properties of the hyaluronic acid and learning about the role of this aid in pathophysiology of extracellular matrices resulted in using this substance in pharmacological support in cases of tissue dysfunction due to numerous disease units. Therefore, the products containing this substance are now widely used in medicine including dermatology and aesthetic medicine, ophthalmology, facial-mandibular surgery and orthopedics, being among the most effective products used in the treatment of numerous cases of function impairment and deformation of tissues and organs. There are applied in both post-traumatic and post-inflammatory conditions as well as in symptoms due to chronic conditions. Their therapeutic effects result from joint surface moisturizing, reduction of the coefficient of friction (COF) and good bio-tolerance and biocompatibility confirmed by a low percentage of side effects and biocompatibility. The introduction of hyaluronic acid hybrid complexes with high and low molecular mass (H/L-HA) has increased the clinical usefulness of hyaluronic acid products thanks to their increased viscoelasticity, increased anti-inflammatory and chondroprotective properties and thermodynamic stabilization of the product guaranteeing its half-life. Thanks to the above mentioned pro-perties it becomes more effective in the non-surgical treatment of osteoarthritis.
Assuntos
Osteoartrite , Viscossuplementação , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Osteoartrite/tratamento farmacológico , Viscossuplementos/uso terapêuticoRESUMO
BACKGROUND: This study aimed to compare the efficacy and safety of intra-articular hyaluronic acid (HA) injection with different molecular weights (MWs) for treating hip osteoarthritis (OA). METHODS: A systematic literature search for relevant studies was conducted in 3 electronic databases, including PubMed, BMJ Journals, and Cochrane Library, from inception to April 2020. Extracted outcomes included visual analogue scale (VAS) (1, 3, and 6 months), Lequesne index (3 and 6 months), and adverse effects. HAs were classified into low-molecular-weight (LMW), moderate-molecular-weight (MMW), high-molecular-weight (HMW), and ultra-high-molecular-weight (UHMW) groups. Meta-analysis was performed using Review Manager 5.3. RESULTS: A total of 15 studies with 614 patients were included. Our meta-analysis showed that the HMW HA group had the best improvement in VAS and Lequesne index compared with other HA groups for all the follow-up visits. Moreover, the HMW group demonstrated significantly better improvement than the other groups in VAS at 6-month follow-up and in Lequesne index at 3- and 6-month follow-ups. Analysis for adverse effects revealed low rates of systemic adverse effects (≤0.6%) in all groups and similar rate of local adverse effects (around 10%) among the groups except for UHMW HA group (37.5%). CONCLUSION: Among different MWs of HA for treating hip OA, HMW HA injection demonstrated the best efficacy for up to 6 months after treatment without increased risk of adverse effects. Further studies with more comprehensive data and a higher level of evidence are required to prove our results.
Assuntos
Ácido Hialurônico/efeitos adversos , Osteoartrite do Quadril/tratamento farmacológico , Viscossuplementação/efeitos adversos , Idoso , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Masculino , Pessoa de Meia-Idade , Peso Molecular , Resultado do TratamentoRESUMO
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.
Assuntos
Luxações Articulares , Viscossuplementação , Artrocentese , Estudos Transversais , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Disco da Articulação Temporomandibular , Resultado do TratamentoRESUMO
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.
Assuntos
Humanos , Osteoartrite/tratamento farmacológico , Transtornos da Articulação Temporomandibular/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Dor Facial , Viscossuplementação , ArtrocenteseRESUMO
PURPOSE OF REVIEW: After removing the native vitreous during vitreoretinal surgery, an adequate substitute is required to ensure homeostasis of the eye. Current clinically used endotamponades (silicone oil, gases, semifluorinated alkanes) are effective in promoting retinal reattachment, but lead to complications such as emulsification, prolonged inflammation, blurred vision, raised intraocular pressure, cataract formation or the need for revision surgery. The aim of this review is to provide an update on novel vitreous substitutes with a focus on polymer-based systems. RECENT FINDINGS: Polymeric hydrogels provide favourable properties such as high water content, optical transparency, suitable refractive indices and densities, adjustable rheological properties, injectability, biocompatibility and their ability to tamponade the retina via viscosity and swelling pressure, comparable to the native human vitreous body. Here, vitreous replacement strategies can be divided into chemically or physically crosslinked hydrogel systems that are applied as preformed or in-situ gelling matrices. SUMMARY: Several hydrogel-based vitreous substitutes have already been positively evaluated in preclinical tests and have the potential to enter the clinical phase soon.
Assuntos
Hidrogéis/química , Viscossuplementos/química , Cirurgia Vitreorretiniana , Corpo Vítreo , Materiais Biocompatíveis/análise , Tamponamento Interno , Humanos , Polímeros/química , ViscossuplementaçãoRESUMO
OBJECTIVE: To evaluate the influence of viscosupplementation on osteoarthritic knee arthrokinematics analyzed by VAG. It is considered that intra-articular hyaluronic acid injection may improve the function of synovial joints by recovery of friction-reducing properties of articular environment. DESIGN: Thirty-five patients with knee osteoarthritis (grade II according to the Kellgren-Lawrence system) and 50 asymptomatic subjects were enrolled in the study. Patients were analyzed at 3 time points: 1 day before and 2 weeks and 4 weeks after single injection of 1.5% cross-linked hyaluronate. Control subjects were tested once. The vibroarthrographic signals were collected during knee flexion/extension motion using an accelerator and described by variation of mean square (VMS), mean range (R5), and power spectral density for frequency of 50 to 250 Hz (P1), and 250 to 450 Hz (P2). RESULTS: Patients before viscosupplementation were characterized by about 2-fold higher values of vibroarthrographic parameters than controls. Two weeks after the procedure, the values of R5, P1, and P2 significantly decreased, in comparison to pre-injection. At 4 weeks post-injection, we noted a significant increase in R5, P1, and P2 values, when compared to 2 weeks post-injection. Finally, at 4 weeks post-injection, the level of VMS, R5, and P2 parameters did not differ from values obtained at pre-injection. CONCLUSIONS: We showed that viscosupplementation may be effective in providing arthrokinematics improvement, but with a relatively short period of duration. This phenomenon is observed as decreased vibroacoustic emission, which reflects a more smooth movement in the joint.
Assuntos
Osteoartrite do Joelho , Viscossuplementação , Humanos , Ácido Hialurônico/uso terapêutico , Injeções Intra-Articulares , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/tratamento farmacológicoRESUMO
OBJECTIVE: Lubrication and free radical scavenging are key features of biomaterials used for viscosupplementation (VS) of joints affected by osteoarthritis (OA). The objective of this study was to describe the non-clinical performance characterization of KiOmedine® CM-Chitosan, a non-animal carboxymethyl chitosan, in order to assess its intended action in VS and to compare it to existing viscosupplements based on crosslinked hyaluronan (HA) formulations. METHOD: The lubrication capacity of the tested viscosupplements (VS) was evaluated in-vitro and ex-vivo. In-vitro, the coefficient of friction (COF) was measured using a novel tribological system. Meanwhile, an ex-vivo biomechanical model in ovine hindlimbs was developed to assess the recovery of join mobility after an intra-articular (IA) injection. Free radical scavenging capacity of HA and KiOmedine® CM-Chitosan formulations was evaluated using the Trolox Equivalent Antioxidant Capacity (TEAC) assay. RESULTS: In the in-vitro tribological model, KiOmedine® CM-Chitosan showed high lubrication capacity with a significant COF reduction than crosslinked HA formulations. In the ex-vivo model, the lubrication effect of KiOmedine® CM-Chitosan following an IA injection in the injured knee was proven again by a COF reduction. The recovery of joint motion was optimal with an IA injection of 3 ml of KiOmedine® CM-Chitosan, which was significantly better than the crosslinked HA formulation at the same volume. In the in-vitro TEAC assay, KiOmedine® CM-Chitosan showed a significantly higher free radical scavenging capacity than HA formulations. CONCLUSION: Overall, the results provide a first insight into the mechanism of action in terms of lubrication and free radical scavenging for the use of KiOmedine® CM-Chitosan as a VS treatment of OA. KiOmedine® CM-Chitosan demonstrated a higher capacity to scavenge free radicals, and it showed a higher recovery of mobility after a knee lesion than crosslinked HA formulations. This difference could be explained by the difference in chemical structure between KiOmedine® CM-Chitosan and HA and their formulations.
