B. ATEŞ, F. SEYFETTİNOĞLU, Z. ATEŞ, F. DUYGUN, T. UCA

Dejeneratif diz osteoartritinde artroskopik debridman sonrası eklem içi hiyalüronik asid ve oral glukozamin sülfat ile tedavi sonuçlarının karşılaştırılması

Amaç: Bu çalışmada dejeneratif diz osteoartriti tanısıyla artroskopik debridman yapılan hastalara eklem içi hiyalüronik asit veya oral glukozamin sülfat verilip erken dönem klinik sonuçlarının karşılaştırılması amaçlandı. Gereç ve Yöntem: Ocak 2005 ile Aralık 2009 tarihleri arasında Artroskopik debridman yapılan 89 hastadan Outerbridge evre 1 ve evre 2 kıkırdak hasarı saptanan, varus/valgus deformitesi olmayan ve daha önce diz cerrahisi geçirmemiş 64 hasta bu çalışmaya alındı. Hastaların hepsi kadındı ve ortalama yaşları 55.8 idi. Hastalar artroskopi sonrası 32’şer kişilik iki gruba ayrıldı. Birinci gruptaki 32 dize debridmandan 21 gün sonra eklem içine birer hafta ara ile 30 mg/2 ml sodyum hiyalüronat üç doz uygulandı. İkinci gruptaki 32 dize ise debridmandan 21 gün sonrası 1500mg/gün oral glukozamin sülfat üç ay süre ile verildi. Hastalar; ameliyat öncesi görsel ağrı skalası (GAS) skoru, ameliyat sonrası 21. gün GAS skoru ve tedavi sonrası 12 ay GAS skorları ile değerlendirildiler. Bulgular: Grup 1’deki 32 hastanın ameliyat öncesi ortalama GAS skoru 8.56 iken ameliyat sonrası üçüncü haftada 3.28 idi. Aradaki fark istatistiksel olarak anlamlı bulundu (p0.05).Grup 2’deki 32 hastanın ameliyat öncesi ortalama GAS skoru 8.50 iken, ameliyat sonrası üçüncü haftada 3.22 idi. Aradaki fark istatistiksel olarak anlamlı bulundu (p

Comparison of the results of intra-articular hyaluronic acid and oral glucozaminosulfate treatment after arthroscopic debridement in patients with degenerative knee osteoarthritis

Objective: In this study we compare the early clinical results of the intra-articular hyaluronic acid and oral glucosaminosulfate treatment after arthroscopic debridement in patients with degenerative knee osteoarthritis. Materails and Methods: Studies were conducted between January 2005-2009 on 89 patients who had arthroscopic debridement, 64 patients who have Outerbridge grade 1 and grade 2 cartilage damage on the medial femoral condyle, who do not have varus or valgus deformity and have had not applied for a knee operation. All the patients are female and their average age is 55.8 years. After arthroscopy, patients were divided into two groups containing 32 patients each. In the first group, 21 days after the debridement, we applied once a week intra-articular 30 mg/2 ml sodium hyaluronate three times. In the second group, 21 days after the debridement, a daily dose of 1500 mg/day oral glucozaminosulfate was administered for three months. Patients were evaluated before the operation, on the 21st day after operation and 12 months after the treatment with visual analog scale (VAS). Results: In the first group, before the operation, the average VAS score of the 32 patients was 8.56 and in the third week after the operation the average VAS score was 3.28. The difference was found to be statistically significant (p<0.05). In this group, the average VAS score after hyaluronate treatment was 2.22. The difference between the average VAS scores after operation and after treatment was not significant (p>0.05). In the second group, before the operation, the average VAS score of the 32 patients was 8.56 and in the third week after the operation the average VAS skore was 3.22. The difference was found to be statistically significant (p<0.05). In this group, the average VAS score after oral glucozamin treatment for three months was 2.38. The difference between the average VAS scores after operation and after treatment was not significant (p>0.05). Conclusion: This study shows that arthroscopic debridement is significantly useful to reduce the pain in the early and intermediate period in patients with outerbridge type 1- 2 cartilage damage but after arthroscopic procedure. sodium hyaluronate and glucozamine treatments did not provide significant additional contributions.

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1. Bostan B, Şen U, Güneş T ve ark. Diz osteoartritinde eklem içi hiyalüronik asit uygulaması ile tıbbi çamur tedavisinin kısa dönem sonuçlarının karşılaştırılması. Acta Orthop Traumatol Turc 2010;44(1):42-47.
2. Diaz-Gallego L, Prieto JG, Coronel P, Gamazo LE, Gimeno M, Alvarez AI. Apoptosis nitric oxide in an experimental model osteoarthritis in rabbits after hyaluronic acid treatment. J Orthop Res 2005;23:1370-1376.
3. Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg 2004;86:538-545.
4. Ulucay C, Altintas F, Ugutmen E, Beksac B. The use of arthroscopic debridement and viscosupplementation in knee osteoarthritis. Acta Orthop Traumatol Turc 2007;41:337-342.
5. Kelly MA. Role of Arthroscopic debridement in the arthritic knee. J Arthroplasty 2006;21(4 Suppl 1): 9-10.
6. Akman S, Sen C, Gogus A, Demirhan M, Kilicoglu O. The efficacy of intraarticular sodium hyaluronate injection following arthroscopic debridement in the treatment of gonarthrosis. Acta Orthop Traumatol Turc 2001;35:107-110.
7. Jones RE. Knee arthritis: The role of arthroscopic debridement. Seminars in Arthroplasty 2009;20(1):2-5.
8. Dervin GF, Stiel IG, Rody K, Grabowski J. Effect of arthroscopic debridement for osteoarthritis of the knee on health-related quality of life. J Bone Joint Surg 2003;85(1):10-19.
9. Ahlbacks S. Osteoarthritis of the knee: A radiographic investigation. Acta Radiol (Suppl) 1968;277:7.
10. Outerbridge RE. The etiology of chondromalacia patella. J Bone Joint Surg 1963;43-B:752.
11. Elmalı N, İnan M, Ertem K, Esenkauya İ, Ayan İ, Karakaplan M. Diz osteoartitinin artroskopik debridman ve intraartiküler hiyalüronik asit ile tedavisi. Eklem Hast Cerr Derg 2002;13(3):131-135.
12. Heybeli N, Doral MN, Atay ÖA, Leblebicioğlu G, Üzücügil A. Diz osteoartriti tedavisinde artroskopik debridman sonrası eklem içi sodyum hiyalüronat enjeksiyonu: Prospektif, randomize, kontrollü çalışma. Acta Orthop Traumatol Turc 2008;42(4):221-227.
13. Forster MC, Straw R. A prospective randomised trial comparing intra-articular hyalgan injection and arthroscopic washout for knee osteoarthritis. The Knee 2003; 10: 291-293.
14. Müezzinoğlu S, Buluç L. Kıkırdak lezyonlarının konservatif tedavisinde nonsteroid antienflamatuvar ilaclar, oral preparatlar ve viskosuplemantasyonun rolü. Acta Orthop Traumatol Turc 2007;41(Suppl):2:48-53.
15. Wobig M, Dickhut A, Maier R. Viscosupplementation with hylan G-F 20: A 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 1998;20:410-423.
16. Lohmander LS, Dalen N, Englund G, et al. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: A randomised, double-blind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. Ann Rheum Dis 1996;55:424-431.
17. Fond J, Rodin D, Ahmad S, Nirschl RP. Arthroscopic debridement for the treatment of osteoarthritis of the knee: 2- and 5-year results. Arthroscopy 2002;18:829-834.
18. Anderson JW, Nicolosi RJ, Borzelleca JF. Glucosamine effects in humans: A review of effects on glucose metabolism, side effects, safety considerations and efficacy. Food Chem Toxicol 2005;43:187-201.
19. McAlindon TE, LaValley MP, Gulin JP, Felson DT. Glucosamine and chondroitin for treatment of osteoarthritis: A systematic quality assessment and meta-analysis. JAMA 2000;283:1469-1475.
20. Cibere J, Kopec JA, Thorne A, et al. Randomized, double-blind, placebo-controlled glucosamine discontinuation trial in knee osteoarthritis Arthritis Rheum 2004;51:738-745.
21. Thie NM, Prasad NG, Major PW. Evaluation of glucosamine sulfate compared to ibuprofen for the treatment of temporomandibular joint osteoarthritis: A randomized double blind controlled 3 month clinical trial. J Rheumatol 2001;28:1347-1355.
22. Reginster JY, Dereoisy R, Rovati LC, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: A randomized, placebo-controlled clinical trial. Lancet 2001;357(9252):251-256.
23. Pavelka K, Gatterova J, Olejarova M, et al. Glucosamine sulfate use anda delay of progression of kne osteoarthtis: A 3 year, randomized, placebo-controlled, double-blind study. Arch Intern Med 2002;162(18):2113-2123.
24. Cole BJ, Harner CD. Degenerative arthritis of the knee in active patients: Evaluation and management. J am Acad Othop Surg 1999;7(6):389-402.
25. Reddy AS, Gambardella RA. Arthroscopic treatment of degenerative joint disease of the knee. In: Harner CD, Vince KG, Fu FH (eds). Tecniques in Knee Surgery, Lippincott, Williams and Wilkins 2001:159-164.