Knee Osteoarthritis: Condroprotector Action and Symptomatic Effect of Ozone on Pain, Function, Quality of Life, Minimal Joint Space and Knee Arthroplasty Delay

Abstract

Objectives: To evaluate the effect of Ozone on pain, function, quality of life, minimal joint space and knee arthroplasty delay in a case series of patients with knee osteoarthritis (OA). Methods:Prospective quasi-experimental before-after study on 52 out of 120 patients with knee osteoarthritis (OA) Kellgren-Lawrence (K-L) grade 2 or more, who attended Santa Cristina's University Hospital, from January 2012 to June 2016. The Ozone protocol consisted of four sessions (1 session/week) of an intra-articular infiltration of a medical mixture of oxygen-ozone (95% -5%) at a 20 µg/mL concentration. Pain and quality of life (QoL) were measured by visual analogical scale (VAS) and western ontario and Mc master universities index for osteoarthritis (WOMAC), and minimal internal/external joint space width were measured by plain posterior-anterior weight-bearing knee radiographies at the beginning / end of treatment.Results: Mean age 70.36 years. Women 80.8% (n = 42), men 19.2% (n = 10). The severity of OA according to Kellgren-Lawrence scale was 3°(n = 36; 69.2%). Pain measured by VAS significantly decreased (P < 0.0001) from 8.1 to 2.5. The WOMAC-pain, WOMAC-stiffness and WOMAC-function subscales decreased significantly (P < 0.0001) from 16.5 to 4.9 points, 3.2 to 2 and 48 to 17.6, respectively. With respect to minimal joint space, the internal compartment measured 4.17 mm and increased significantly to 4.44 mm (P = 0.0003); while the external compartment was 6.02 mm and improved significantly to 6.26 mm (P = 0.0032) after the treatment protocol. After a mean of 10 months follow-up to a maximum of 28 months, none of knee OA patients underwent knee arthroplasty replacement. Conclusions:Ozone treatment is capable of producing pain relief, recovery of function and radiological improvement on minimal joint space in knee OA patients. Based on the results of our study, it is assumed that Ozone could slow/revert OA progression, due to the increase in the minimal internal and external joint space width. Ozone treatment delays the need for total knee arthroplasty.

Symptomatic (Pain and Inflammation) and Disease-Modifying Effect (Minimal Joint Space) of Intra-articular Ozone (O2-O3) in Osteoarthritis of the Knee: a Clinical Case

“…After 1 year of follow-up and two treatment cycles, ozone (O2-O3) has been able to increase the minimum joint space of the medial compartment of both knees, as has been observed radiologically (from 2.9 to 4.6 mm in the right knee and from 3.4 to 4 mm in the left knee), reversing knee osteoarthritis in our patient. This finding confirms the disease-modifying effect of ozone (O2-O3) on osteoarthritis of the knee, findings that coincide with what was recently reported by Fernández-Cuadros et al [9]. For the first time, this case report shows that ozone (O2-O3) is a drug capable of producing structural (anabolic) changes in knee osteoarthritis.…”

Ozone (O2 - O3) Has SYSADOA (Symptomatic Slow Acting Drug for Osteoarthritis) and DMDOA (Disease Modifying Drug for Osteoarthritis) Effect in Knee Osteoarthritis Patients

“…Finally, Fernandez-Cuadros et al demonstrated that in the long-term follow-up period of 10 to 28 months that ozone was capable of increasing medial and lateral minimal joint space at the knee in 52 OA patients (10). Ozone was also capable of delaying knee arthroplasty replacement to an extent that none of the patients went to definitive surgical procedure (10).…”

“…The arguments of this article are based on three previous quasi-experimental before-and-after studies published by the study group and with a level of evidence 2b (6,9,10). Scientists are encouraged to replicate the current promising findings for the management of knee OA.…”

Does glucosamine/chondroitin sulfate have a long‐term effect on the progression of structural changes in knee osteoarthritis? Comment on the article by Raynauld et al

“…The lower the JSW, the greater the knee OA severity (5). That correlation is only valid for the medial compartment, because for the lateral compartment, the greater the JSW, the greater the OA severity (6). The JSW usually narrows in the weightbearing compartment (mainly medial), and it widens in the contralateral compartment (frequently lateral) (7-9), phenomena known as the yawn sign (2).…”