Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options

Duymuş, Tahir Mutlu; Mutlu, Serhat; Dernek, Bahar; Kömür, Baran; Aydoğmuş, Suavi; Kesiktaş, Fatma Nur

doi:10.1007/s00167-016-4110-5

Cited by 221 publications

(252 citation statements)

References 32 publications

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“…This data seems to suggest a prolonged efficacy after the end of the treatment protocol of HA, unlike in O 2 O 3 . Taken together, our results provide further credence to those obtained by Duymus et al with a similar protocol of IA O 2 O 3 compared to a single IA HA administration [22]. Regarding the other secondary outcome variables (OKQ, MCS and PCS), the O 2 O 3 treatment showed comparable scores to HA improvements without any statistically significant difference between the two groups.…”

Section: Discussionsupporting

confidence: 89%

“…Specifically, in the O 2 O 3 group, adverse events consisted in self-limiting pain and encumbering sensation resuming spontaneously a few minutes after treatment, while in HA group, swelling and joint heaviness/encumbering sensation were observed immediately after treatment. These results constitute the proof-ofprinciple of the similar safety of one-month weekly IA O 2 O 3 injection for knee OA, compared to HA, confirming previous reports [21,22]. Importantly, the IA O 2 O 3 treatment determined a statistically significant reduction of pain measured with VAS scale at any evaluation.…”

Section: Discussionsupporting

confidence: 88%

“…Furthermore, Al-Jaziri et al treated 220 patients with spine or joints osteoarthritis with an IA or intramuscular paravertebral O 2 O 3 , observing a significant pain reduction after 12 sessions [21]. More recently, a RCT comparing IA injection of platelet-rich plasma (PRP), HA, and O 2 O 3 in knee OA patients, showed comparable effects on pain reduction among the three approaches after 1 month of treatment [22]. Despite these charming data, the conundrum of the efficacy and safety of IA O 2 O 3 compared to IA HA therapy remains unsolved.…”

Section: Introductionmentioning

confidence: 99%

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Safety of Intra-Articular Oxygen-Ozone Therapy Compared to Intra-Articular Sodium Hyaluronate in Knee Osteoarthritis: A Randomized Single Blind Pilot Study

Invernizzi¹,

Stagno²,

Carda³

et al. 2017

Int J Phys Med Rehabil

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Objective: Osteoarthritis (OA) is a chronic degenerative musculoskeletal disease and one of the leading causes of chronic musculoskeletal pain, often affecting the knee. Despite intra-articular (IA) injectable hyaluronan (HA) preparations are widely used in the treatment of this debilitating condition, only a few data about their efficacy have been reported so far. Therefore, the use of HA in OA management is not universally recommend in clinical practice. Oxygen-ozone (O 2 O 3 ) therapy can be employed in several pain-related conditions and diseases. However, both its efficacy and safety for IA therapy in knee OA have never been explored. Here, we evaluated the reliability of knee IA therapy with O 2 O 3 compared to IA HA in chronic knee OA.Methods: A total of 42 consecutive chronic OA patients with radiological diagnosis of knee OA were prospectively enrolled in this single-blind, controlled study. After randomization, all patients underwent IA therapy with O 2 O 3 or HA (q1wk) for 4 weeks, with additional 4 weeks of follow-up. Examination of the adverse events occurred during the whole study was performed. To measure knee function and pain, visual analogue scale (VAS), Oxford knee questionnaire (OKQ), and 12-item short form survey (SF-12) were administered. EuroQol five dimensions questionnaire (EQ-5D) was used to assess patients' quality of life.Results: No significant difference in adverse events occurrence was observed. Knee IA treatment with O 2 O 3 showed shorter reduction of pain compared to IA HA. VAS score decreased in both groups during the treatment period (p<0.001), while OKQ score significantly increased (p<0.001). SF-12 and EQ-5D scores were comparable between the two groups of patients.Conclusions: Despite IA administration of O 2 O 3 and hyaluronan are comparable treatments in knee OA both in terms of safety and quality of life improvement, the latter shows longer times of pain reduction.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Safety of Intra-Articular Oxygen-Ozone Therapy Compared to Intra-Articular Sodium Hyaluronate in Knee Osteoarthritis: A Randomized Single Blind Pilot Study

Invernizzi¹,

Stagno²,

Carda³

et al. 2017

Int J Phys Med Rehabil

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“…However, Duymus et al used a similar protocol (3 PRP infiltrations and 4 Ozone infiltrations) in the management of knee Osteoarthritis; then this was the only experimental study which compared both treatment options [45]. From his observations, it was established that PRP was more effective than Ozone in pain relief and function recovery.…”

Section: Discussionmentioning

confidence: 99%

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Fernández-Cuadros¹,

Albaladejo-Florín²,

Algarra-López³

et al. 2017

Divers Equal Health Care

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Objective: 1) to determine the efficiency of PRP compared to Ozone Infiltrations on pain, function and quality of life (QoL) in patients with Patellofemoral Pain Syndrome (PFPS) and Chondromalacia. Material and methods:Prospective non-randomized controlled-trial, comparing two treatment protocols in parallel design, on 48 patients (24 in each group), with PFPS and Chondromalacia , who were treated at Santa Cristina's University Hospital, from January 2014 to May 2017. The PRP-protocol consisted of 3 sessions (1 session/week) of platelet-rich plasma (PRP), by an intra-articular infiltration of 3 ml. To obtain PRP, a kit device from EXACTECH (Accelerate Concentration System Device and Drucker Centrifuge was used.The Ozone-protocol consisted of 4 sessions (1 per week) of a medical mixture of Oxygen-Ozone (95%-5%) 20 ml, at a 20 ug/ml concentration, infiltrated intra-articularly. Pain, function, stiffness and Quality of Life were measured by Western Ontario and Mc Master Universities Index for Osteoarthritis (WOMAC) and Visual Analogical Scale (VAS) at baseline/end of treatment.Results: At baseline, age, sex, ratio male to female, clinical chondromalacia grades and symptom severity such as pain, stiffness and function were similar between groups of treatment. In both groups, the most common grade of chondromalacia was 2º grade (41.8% in PRP, 50% in Ozone), followed by 3º (37.6% in PRP, 33.4% in Ozone) and 4º (16.6% in both PRP and Ozone). When treatment protocols are analyzed separately, both PRP and Ozone were capable to produce pain relief (measured by VAS and WOMAC pain subscale), and improvement in function and rigidity (measured by WOMAC subscales), with a significant statistical level (p<0.05). In the case of pain, Ozone is even more effective than PRP (1.46 points on VAS scale and 2.95 points on WOMAC pain subscale) (p<0.05).Conclusion: PRP and ozone produce pain relief, function recovery and quality of life improvement in PFPS and chondromalacia, measured by WOMAC and VAS scores. In the case of pain severity, ozone produces even greater pain relief. PRP and Ozone are safe and effective modalities for the management of PFPS and chondromalacia.

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“…Si bien todos fueron efectivos, el efecto benéfico para el ozono fue de 3 meses, mientras el PRP fue de hasta 12 meses (37). En los primeros 6 meses no hubo una diferencia clínicamente significativa entre el AH y PRP, pero posterior a los 6 meses el efecto de AH desapareció y el del PRP perduró hasta los 12 meses (37).…”

Section: Discussionunclassified

Terapias intervencionistas para manejo de dolor en Osteoartrosis de rodilla sintomática

Orozco-Arango¹

2016

Rev. Soc. Esp. Dolor.

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Introduction: Osteoarthritis (OA) of knee is the most common type of OA. It is a multifactorial disorder where pain is the most important clinical feature. Analgesic treatment in knee OA usually begins with acetaminophen and NSAIDs. Nonsurgical interventional indicated on nonsurgical symptomatic knee OA unresponsive to analgesic and anti-inflammatory oral and topical treatment, as well as knee osteoarthritis in surgery, when surgery is contraindicated or inadvisable.Objectives: A critical review of the current evidence for the following therapies intraarticular (IA): corticosteroids, hyaluronic acid (HA), ozone, platelet-rich plasma (PRP), botulinum toxin and RF geniculate nerves.Methodology: A search and no systematic review of individual articles, systematic reviews, meta-analysis was performed.Results and conclusions: IA steroids are effective, especially in those with greater radiographic commitment, with a level of evidence 1B. The PRP and AH, are useful in patients with mild to moderate knee osteoarthritis but not in severe knee osteoarthritis, with a longer duration of effect for the PRP. In severe degrees of gonarthrosis (Grades III-IV), the most suitable therapy is the RF geniculate nerves. Botulinum toxin, is superior to IA steroids with adequate response in different degrees of arthrosis, even when other therapies have not achieved adequate response. All therapies have been revised effective pain relief in knee osteoarthritis. However, there is great controversy over the degree of recommendation

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Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options

Abstract: Therapeutic study, Level I.

Cited by 221 publications

References 32 publications

Safety of Intra-Articular Oxygen-Ozone Therapy Compared to Intra-Articular Sodium Hyaluronate in Knee Osteoarthritis: A Randomized Single Blind Pilot Study

Safety of Intra-Articular Oxygen-Ozone Therapy Compared to Intra-Articular Sodium Hyaluronate in Knee Osteoarthritis: A Randomized Single Blind Pilot Study

Efficiency of Platelet-rich Plasma (PRP) Compared to Ozone Infiltrations on Patellofemoral Pain Syndrome and Chondromalacia: A Non- Randomized Parallel Controlled Trial

Terapias intervencionistas para manejo de dolor en Osteoartrosis de rodilla sintomática

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