EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

Abstract

Objectives The 3 aims of the work were to identify population subgroups that can benefit the most from viscosupplementation (VS), to provide recommendations on injection techniques, and to discuss VS appropriateness in clinical situations that are commonplace in daily practice. Methods The task force members voted on their degree of agreement on 27 statements, 36 recommendations, and 22 clinical scenarios using a 9-point scale. The strength of agreement/appropriateness/recommendation (SOA/SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained. Results Among the assumed predictors for VS failure, obesity, radiographic severity, large synovial fluid effusion, severe patellofemoral involvement, major malalignment, and gross joint instability received a large majority of agreements. The lateral mid-patellar approach was recommended for knee injection. Imaging guidance was unanimously recommended for hip and ankle. Agreement was achieved to strictly respect the dosing regimen proven by controlled trials. There was agreement for treating with VS patients with mild to moderate knee and hip OA, with normal weight or moderate overweight, insufficiently improved by first-line therapies, or who do not wish get oral treatment or who have contraindications to pain killers. The group considered the patient's wishes as a key element in therapeutic decision making. Conclusion Based on literature data and clinical experience, the EUROVISCO group proposed a set of recommendations for optimizing the results of VS, aimed to help practitioners, especially in some cases in which the patients' specificities make the therapeutic decision difficult.

Injectable Amniotic Membrane/Umbilical Cord Particulate for Knee Osteoarthritis: A Prospective, Single-Center Pilot Study

“…However, by 24 weeks, all WOMAC subscale scores regressed, suggesting that the treatment might not have a lasting effect in obese patients (Figure 3). Collectively, this result resembled what has been reported in obese patients with symptomatic knee OA who tend to present failure in the treatment of viscosupplementation [43, 44]. It should be noted, however, that use of a second injection for patients not showing relief introduced a potential bias that may give a negative case a second chance to be positive.…”

Bone Marrow Aspirate Concentrate Is More Effective Than Hyaluronic Acid and Autologous Conditioned Serum in the Treatment of Knee Osteoarthritis: A Retrospective Study of 505 Consecutive Patients

“…The inclusion criteria were as follows: (1) KL classification of knee OA grades I-III, diagnosed on radiograph and MRI imaging; (2) pain in the knee joint (VAS ≥ 1); and…”

“…(3) the patient age between 18 and 80 years. The exclusion criteria were as follows: (1) grade IV degenerative changes as determined by the KL classification, (2) if the grade of arthritis could not be determined from the medical records, (3) inflammatory arthropathies such as rheumatoid arthritis and connective tissue diseases, (4) the presence of another source of significant pain or dysfunction affecting the ability to isolate symptoms of the affected knee when evaluating the effectiveness of the treatment and (5) if the patients had already received a similar type of injection or surgical intervention within 12 months prior to treatment.…”

“…Osteoarthritis (OA) is a multifactorial joint disease that can lead to pain, dysfunction and a decreased quality of life [1]. It is the most common joint disorder, affecting millions of people worldwide [2,3]; knee OA is one of the main reasons for physical disability [4]. Unfortunately, there is no disease-modifying medical intervention to prevent or cure this disease.…”

Injection therapy in hip osteoarthritis: one year in review

“…The recommendations of the European Viscosupplementation Consensus Group (EUROVISCO) 18 is to treat with viscosupplementation patients with mild to moderate knee and hip OA, with normal weight or moderate overweight, who did not improve sufficiently with first-line therapies (analgesics, nonsteroidal anti-inflammatory drugs and nonpharmacological therapies), or do not wish to take an oral treatment or have contraindications to analgesics. The group considered the patient's wishes as a key element in therapeutic decision making.…”