Suganthi, S (2017) Comparison of the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Osteoarthritis (OA) of the knee is characterized by chronic pain, cartilage matrix degradation, deterioration of the mechanical properties of the synovial fluid, bony osteophyte formation, and episodic inflammation. Compared to healthy joints, the synovial fluid in joints affected by OA can be characterized by both diminished molecular weight and concentration of its primary functional constituent, hyaluronan. Hyaluronan is a polysaccharide consisting of repeating linear dimers of N-acetylglucosamine and glucuronic acid. It is physiologically ubiquitous in the animal kingdom, in particular existing as a large molecular weight substance in bony joints where small quantities serve as both a lubricant and a transport medium for nutrients, proteins, and degradation products related to joint tissue metabolism. Lower molecular weight hyaluronan found in osteoarthritic joints fails to retain its viscoelasticity and ability to withstand shear forces, both small (normal joint movement) and large (high impact forces). As a result, joint surfaces can become progressively damaged when endogenous hyaluronan production is reduced by disease. Corticosteroids may work through influencing levels of collagenase and aggrecan, as well as matrix metalloproteinases and proinflammatory cytokines. No single cause of OA found no far. Multiple factors that might cause OA includes, genetic predisposition, age, injury prior to adulthood, microtrauma, body weight, stress on the joint, occupational task i.e., repetitive knee bending, heavy lifting and previous surgery of joint. AIMS AND OBJECTIVES: To compare the functional outcome and pain relief of Intra articular Hylan GF-20 Vs. Methyl Prednisolone Acetate for Grade II Osteo Arthritis – Knee. Study Centre: Government Institute of Rehabilitation Medicine, KK Nagar, Chennai-600 083. Duration of study: 18 months (March-2015 to August-2016). Study design: Prospective Single blinded Cohort study. - Subjects will be randomized by systematic random sampling, according to registration number of the study - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. METHODOLOGY: - Patients will be given test dose of 0.5ml of Lignocaine 2%. - They will be taken to Operation theatre and parts will be cleaned with Betadine and drapped with sterile towel. - Under aseptic precautions, Lignocaine 2% will be injected to anesthetise the injection site. - By following randomization procedure, either Hylan-GF20 (48mg)/methyl prednisolone acetate(40mg) will then be infiltrated into the knee joint space after confirmation by aspiration technique by infero lateral approach. - After infiltration the subjects will be observed for 15 minutes for adverse reactions. - Subjects will be asked to report immediately in case of adverse reactions like post injection flare (increased pain, swelling)/hypersensitivity reactions etc., - Also they will be given 3 days of analgesics and antibiotics. Inclusion criteria: 1. Age > 45 years, 2. Grade II osteoarthritis knee by Kellgren-Lawrence grading, 3. Knee pain with failed conservative treatment for 1 month, 4. Stiffness:< 30mts, 5. Crepitus, 6. Bony tenderness, 7. Bony enlargement, 8. No palpable warmth. Exclusion criteria: 1. Post Operative cases, 2. Cellulitis / Infections, 3. Any implants inside, 4. Associated with DVT calf muscles, 5. Non co-operative patient, 6. Low I.Q Patients /psychiatric patient, 7. Trauma, 8. Meniscal injury, 9. Anterior/Posterior cruciate ligament injury, 10. Medial/Lateral collateral ligament injury, 11. Bursitis, 12. Rheumatoid arthritis, 13. Pseudogout, 14. Other grades of osteo arthritis knee. Sample size: Approx 30+30. Product/Investigation details: Investigations: FBS, PPBS, X-ray knee-AP and Lateral. Product details: Methylprednisolone acetate – 80mg, Hylan-GF 20 – 48mg. Data collection and Methods: - Subjects will be randomized according to registration number of the study. - Odd numbers (Group A) will be treated with Hylan GF-20. - Even numbers (Group B) will be treated with Methyl Prednisolone Acetate. - Case History age, sex, duration of pain will be collected. Anthropometric measurements height and weight of the patient will be collected. - They will be assessed with pre procedural and post procedural. o pain score using Visual Analog Score (VAS). o WOMAC-C score. o Range of Movements of Knee. - The assessment will be analysed using SPSS software (version 21). RESULTS: There were 23 males and 37 females enrolled in the study, among which 14 males (60.9% of total males) and 16 females (43.2% of total females) were enrolled in Hylan group and 9 males (29.1% of total males) and 21 females (56.8% of total females) were enrolled in the steroid group. 49 patients had pain along anterior aspect of knee joint and 11 patients had pain along medial joint line. Among hylan group, 25 patients had pain along anterior aspect and 5 had pain along medial joint line. In steroid group, 24 had pain along anterior aspect and 6 had pain along medial joint line. Pain was assessed using Visual Analog Scoring (VAS) in this study. It showed significant pain relief with hylan group over due course of time. In steroid group, there was initial pain response till 8 weeks after the treatment, but later the pain score started to show upward trend in later weeks. In conclusion, pain relief was better in hylan group than steroid group with p value < 0.05 in all the follow up period except 8th week. Functional assessment after the treatment was done using WOMAC score (The Western Ontario and McMaster Universities Arthritis Index) and improvement in range of movements of the knee in this study. It showed significant functional improvement with hylan group over due course of time. In steroid group, there was initial better response till 8 weeks, but later the functional ability started to reduce in later weeks. In conclusion, functional improvement as per WOMAC score was better in hylan group than steroid group with p value <0.05. Functional assessment after the treatment was also done using range of movements (ROM). It showed significant improvement in ROM with hylan group over due course of time and remained stable in 12th and 26th weeks. In steroid group, there was initial better response around 4th and 8th weeks, but later ROM got reduced and did not show any further change in later weeks. In conclusion, functional improvement as per ROM was better in hylan group than steroid group with p value < 0.05. CONCLUSIONS: Intra articular Hylan GF-20 shows statistically significant improvement in Pain in analyzing the patients with Visual Analog Score (VAS). • Similarly, there is improvement in range of movements and WOMAC score (C domain) in hylan group. • For steroid group, there is initial statistical improvement upto 8 weeks in pain and other functional components, but after 8 weeks, there is no clinical improvement. • Hence Hylan GF-20 can be considered as an important therapeutic measure in the management of OA knee.
| Item Type: | Thesis (Masters) |
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| Additional Information: | Reg.No:201429001 |
| Uncontrolled Keywords: | functional outcome, pain relief, Intra articular Hylan GF-20, Methyl Prednisolone Acetate, Grade II Osteo Arthritis, Knee. |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Feb 2020 02:13 |
| Last Modified: | 23 Feb 2020 02:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/11981 |
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