Indian Journal of Physical Medicine and Rehabilitation

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VOLUME 26 , ISSUE 1 ( March, 2015 ) > List of Articles


Clinical and Imaging Evaluation of Efficacy of Viscosupplementation in Degenerative Osteo-arthritis Knee – A Prospective Interventional Study

Rohini Gupta, SY Kothari, Jaydeep Nandi, Diganta Borah, BB Thukral

Citation Information : Gupta R, Kothari S, Nandi J, Borah D, Thukral B. Clinical and Imaging Evaluation of Efficacy of Viscosupplementation in Degenerative Osteo-arthritis Knee – A Prospective Interventional Study. Indian J Phy Med Rehab 2015; 26 (1):6-10.

DOI: 10.5005/ijopmr-26-1-6

Published Online: 01-03-2015

Copyright Statement:  Copyright © 2015; The Author(s).


In this study 30 patients with osteo-arthritis (OA) knee (total 55 knees) were given weekly injections of high molecular weight (HMW) hyaluronic acid (HA) for 3 weeks. The subjective parameter was Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) score which improved from 97.67±21.4 at baseline to 61.03±24.8 at six months follow-up (p=0.0001). Also the mean range of motion (ROM) of the involved knees was 125.73± 10.8 degrees at baseline and it increased to 132.64±5.2 degrees after six months (p=0.0001) of injection treatment. The objective parameter of disease modification was MRI based semi-quantitive Whole-organ Magnetic Resonence Imaging Score (WORMS) score. The mean of total WORMS score in medial femorotibial joint (MFTJ) and patellofemoral joint (PFJ) improved from baseline (28.382±10.446; 22.64±5.969) to final follow up (27.46±10.32; 21.76± 6.182) which was quite significant (p=0.0321; p=0.0294) and implies a reduced rate of cartilage destruction after injection HA though there is no regrowth of cartilage as such.

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  1. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 1986;29:1039-10.
  2. Burden of Major Musculoskeletal Conditions. Policy and Practice. Special Theme-Bone and Joint Decade 2000-2010. Bull of the World Health Organ 2003;81:646-656.
  3. A critical appraisal of guidelines for the management of knee osteoarthritis using Appraisal of Guidelines Research and Evaluation criteria. Arthritis Res Ther 2007;9:126-34.
  4. Visco-supplementation for osteoarthritis: current status, unresolved issues and future directions. J Rheumatol 1998;25:2056-8.
  5. Lancet 2011;377:2115-26.
  6. Intra-articular injection of hyaluronan as treatment for knee osteoarthritis. What is the evidence? Arthritis Rheum 2000;43:1192-203.
  7. Visco-supplementation for the treatment of osteoarthritis of the knee. Cochrane Database of Systematic Reviews 2006;Issue 2:
  8. OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthritis Cartilage 2010;18:476-99.
  9. Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group. Osteoarthritis Cartilage 2011;19:606-10.
  10. Predictors of clinical response to intraarticular hylan injections -a prospective study using synovial fluid measures, clinical outcomes, and magnetic resonance imaging. J Rheumatol 2008;35:4685-90.
  11. Effects of hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskeletal Disorde 2011;12:195.
  12. Preliminary evaluation of potential disease modification by hylan G-F 20 (Synvisc®) using dGEMRIC. J Mol Imag Dynamic 2012;2:104.
  13. Determination of cartilage volume using MRI in patients with knee osteoarthritis: efficacy study of 25 milligrams of sodium hyaluronate (2.5 Ml) versus placebo. Clin Exp Pharmacol 2012;112. doi:10.4172/2161-1459.1000112
  14. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004;12:177-90.
  15. Defining osteoarthritis for epidemiological purpose. In: Buckwalter Joseph A, Goldberg Victor M, editors. Osteoarthritis: Diagnosis and Medical/Surgical Management. 4th ed. London: Lippincot & Williams, 2007:35-9.
  16. Osteoarthritis and disk degeneration in an urban population. Ann of Rheum 1958;17:388-97.
  17. Pain assessment in osteoarthritis: Experience with the WOMAC osteoarthritis index. Semin Arthritis Rheum 1989;18:14-7.
  18. Intra articular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. J Rheumatol 1998;25:2203-12 [Published erratum appears in J Rheumatol 1999;26:1216].
  19. The effectiveness and safety of intra-articular injection of sodium hyaluronate (500-730 Kda) in the Ttreatment of patients with painful knee osteoarthritis. J Med Assoc Thai 2009;92:1287-94.
  20. Open label multi centre trial on safety and efficacy of intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee–a prospective study. JIACM 2005;6:232-5.
  21. Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee–a long term study. Eur Rheum Inflamm 1995;15:57-62.
  22. Intra-articular sodium hyaluronate (Hyalgan) in gonarthritis. Clin Trials J 1987;24:341-350.
  23. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cart 1997;5:153-60.
  24. Visco-supplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol 1996;23:1579-85.
  25. Ethnicity and OPRM variant independently predict pain perception and patient-controlled analgesia usage for post operative pain. Mol Pain 2009;5:32.
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