THE TREATMENT OF KNEE OSTEOARTHRITIS WITH ARTHROSCOPIC DEBRIDEMENT AND INTRAARTICULAR HYALURONIC ACID INJECTIONS
Nurzat ELMALI, Muharrem İNAN, Kadir ERTEM, İrfan ESENKAYA, İrfan AYAN, Mustafa KARAKAPLAN
İnönü Üniversitesi Tıp Fakültesi, Turgut Özal Tıp Merkezi, Ortopedi ve Travmatoloji Anabilim Dalı
Keywords: Knee, Osteoarthritis, Arthroscopy, Debridement, Hyaluronic Acid.
Introduction: Adjunctive therapies such as nonsteroidal anti-inflammatory drugs (NSAIDs), physiotherapy and intra-articular steroid injections are incorporated into an arthroscopic debridement treatment for knee osteoarthritis. Additionally, intraarticular injections of hyaluronic acid have been shown to provide relief of pain and improved function in patients with osteoarthritis of the knee. In this study, we aimed to evaluate the results of arthroscopic debridement and intraarticular hyaluronic acid injections in patients with knee osteoarthritis. Materials and
Methods: Between April 1998 and December 1999, 29 knees in 23 patients with knee osteoarthritis were treated with knee debridement followed by three intraarticular sodium hyaluronate (30 mg/2ml) injections weekly over a 2-week period. The mean age of patients was 53.8 (39-63). There were 14 women and 9 men. Nineteen right, 10 left knees were treated. Patients were evaluated with the Hospital for Special Surgery (HSS) knee score and the Knee Society (KS) clinical rating system for pain and function before treatment, at the end of first year and up to mean 20.3 months (12-32 months). Chondral lesions were evaluated according to Outerbridge criteria during arthroscopic examination.
Results: Overall, 23 knees of 19 patients (79.3%) had a good or excellent result in 1 year and 20 knees of 17 patients (69%) had a good or excellent result in 20.3 months. In the last evaluation of the patients whom grade I-III chondral lesions were arthroscopically diagnosed clinical improvement was continuing, and the patients with grade IV chondral lesion showed no improvement as compared to pretreatment.
Conclusion: Although arthroscopic debridement followed by intraarticular sodium hyaluronate injections can provide pain relief and improvement in function for short term, further well-controlled, long-term, large clinical studies are needed to compare this treatment to debridement or hyaluronic acid injections alone.