Efficacy of viscosupplementation in knee osteoarthritis : a clinical trial of three agents

Abstract EN

Background : In 2008, Osteoarthritis Research Society International (OARSI) cited intra-articular (IA) injection of hyaluronic acid (HA) as a useful therapeutic modality, which relieves pain and functional score and delays progress of Osteoarthritis.

Currently, there are more than five HA formulations in the market approved commonly used for intra-articular (IA) injection.

Objective : To compare the efficacy of the three commonly used injections in a cohort population.

Design : A Prospective Randomized Study.

Setting : King Fahd Hospital of the University, Al Khobar.

Method : Two hundred twenty-seven patients with grade 1, 2 and 3 OA were included in the study.

Three different intra-articular injections of HA were used after double blinding: Osteonil (Sodium hyaluronate, TRB Chemedica UK ltd), Durolane (stabilized form of hyaluronic acid, Bioventus) and Synvisc (hylan GF-20, Sanofi Biosurgery).

The data were analyzed using Stata SE/v.12.

Analysis of variance followed by a post hoc t-test (LSD) was used for inferential statistical analysis.

Result : Group A had 78 patients, group B 74 patients and group C 75 patients.

Analysis of variance showed that the efficacy of the treatment differed significantly (F = 53.34, df1 = 2, df2 = 207, p-Value < 0.001).

The result of the post-hoc tests showed Synvisc Injection was the most effective showing significant improvement than both Osteonil Injection (mean diff = 7.68, p < 0.001, CI = 4.73, 10.64) and Durolane Injection (mean diff = 15.61, p < 0.001, CI = 12.63, 18.59).

Osteonil Injection was found to be superior to Durolane Injection (mean diff = 7.93, p < 0.001, CI = 10.89725, 4.957825).

Conclusion : Viscosupplement (VS) agents provide significant though temporary symptomatic relief in grade 2 and 3 OA.

The efficacy of all three agents was similar with marginal superiority of one over the other.

Considering excellent tolerability, viscosupplementation may be included in the armamentarium of OA.