NURETTİN HEYBELİ, Mahmut Nedim DORAL, Özgür Ahmet ATAY, Gürsel LEBLEBİCİOĞLU, AKIN ÜZÜMCÜGİL

Diz osteoartriti tedavisinde artroskopik debridman sonrası eklemiçi sodyum hiyalüronat enjeksiyonu: Prospektif, randomize, kontrollü çalışma

Amaç: Hafif ve orta derece diz osteoartriti olan hastalarda artroskopik debridman sonrası eklemiçi hiyalüronik asit (HA) enjeksiyonlarının ağrı ve fonksiyon parametreleri üzerindeki etkisi araştırıldı. Çalışma planı: Kellgren-Lawrence sınıflandırmasına göre evre II-III primer diz osteoartriti olan 67 hasta (21 erkek, 46 kadın; ort. yaş 56; dağılım 40-65) standart yöntemlerle artroskopik debridman sonrası HA enjeksiyonu (n=33) ve sadece takip (kontrol, n=34) gruplarına rastgele ayrıldı. Artroskopik girişimden üç hafta sonra başlanan sodyum hiyalüronat (Orthovisc) enjeksiyonu birer hafta arayla üç kez tekrarlandı. İki grup, artroskopi öncesi ve artroskopi sonrası 6, 12 ve 24. haftalarda WOMAC osteoartrit indeksinin ağrı ve fiziksel fonksiyon altskalalarıyla değerlendirildi. Sonuçlar: Altıncı haftada ağrı skorundaki düzelme iki grup arasında anlamlı farklılık göstermezken (HA %21, kontrol %16; p=0.478), fonksiyon skorundaki düzelme enjeksiyon grubunda anlamlı derecede fazla idi (HA %23, kontrol %9.2; p=0.018). Sonraki değerlendirmelerde, her iki grupta ağrı ve fonksiyon parametrelerinde süren belirgin düzelme gruplar arasında anlamlı farklılık göstermedi. Fonksiyon skorunda başlangıca göre en az %30 ve %40 düzelme gösteren hastaların oranı, sadece altıncı haftada enjeksiyon grubunda anlamlı derecede yüksek bulundu (sırasıyla p=0.025 ve p=0.038). Çıkarımlar: Artroskopik debridman sonrası eklemiçi HA tedavisinin erken dönemde ek yararı olsa da, bu tedavi kombinasyonunun önerilebilmesi için daha uzun takip süresi olan daha geniş kontrollü çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Ağrı ölçümü, Ağrı, Osteoartrit, diz, Viskosuplementler, Hiyalüronik asit, Enjeksiyon, eklem içi, Hastalık ciddiyet indeksi, İleriye dönük çalışma, Debridman, Artroskopi, Tedavi sonucu

Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: A prospective, randomized, controlled study

Objectives: The purpose of this study was to evaluate the effect of intra-articular hyaluronic acid (HA) injections after arthroscopic debridement on pain and functional parameters in patients with mild-to-moderate knee osteoarthritis. Methods: Sixty-seven patients (21 men, 46 women; mean age 56 years; range 40 to 65 years) who underwent standard arthroscopic debridement for primary knee osteoarthritis of Kellgren-Lawrence grade II-III were randomly assigned to HA injections (n=33) or to only follow-up as controls (n=34). Intra-articular sodium hyaluronate injections (Orthovisc) were started three weeks after arthroscopic debridement, totaling three injections interspersed with a week. The two groups were evaluated with the pain and physical function subscales of the WOMAC osteoarthritis index before and after 6, 12, and 24 weeks of arthroscopic debridement. Results: Improvement in pain scores at 6 weeks did not differ between the two groups (HA 21%, control 16%; p=0.478), whereas improvement in function scores was significantly higher in the HA group (23% vs 9.2%; p=0.018). The rates of improvement in pain and function scores increased in subsequent evaluations, but these did not differ significantly between the two groups. The percentages of patients who exhibited at least 30% and 40% improvement from baseline function scores were significantly greater in the HA group only at six weeks (p=0.025 and p=0.038, respectively). Conclusion: Intra-articular HA injections after arthroscopic debridement provide additional short-term benefits, but this combination therapy should be justified by further controlled studies with longer follow-up and larger patient groups.

Keywords:

Pain Measurement, Pain, Osteoarthritis, Knee, Viscosupplements, Hyaluronic Acid, Injections, Intra-Articular, Severity of Illness Index, Prospective Studies, Debridement, Arthroscopy, Treatment Outcome,

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