Effect of Sodium Hyaluronate on Recovery after Arthroscopic Knee Surgery

Abstract

The aim of this study was to evaluate the effect of a single immediate postoperative instillation of 10 mL of sodium hyaluronate (Viscoseal) into the knee following arthroscopy. A single-center, prospective, randomized, controlled study was undertaken. Consenting knee arthroscopy patients were randomized into two groups following surgery: the study group received 10 mL of sodium hyaluronate intra-articularly, while the control group received an intra-articular instillation of 10 mL of Bupivacaine. Pre- and postoperative visual analogue scale scores for pain and Western Ontario and McMaster Universities (WOMAC) scores for knee function were obtained. Overall, 48 patients under the care of a single surgeon were randomized into two groups of 24. There were no statistically significant demographic differences at baseline. Three patients were lost to follow-up. There was a statistically significant difference in pain scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p < 0.05), and a statistically significant difference in WOMAC scores favoring the study group compared with the control group at 3 and 6 weeks postoperatively (p = 0.01). Synovial fluid replacement with sodium hyaluronate following arthroscopic knee surgery conferred statistically significant improvements in pain and function scores compared with Bupivacaine in the short term (3–6 weeks).

Keywords

knee arthroscopy - sodium hyaluronate - randomized trial

• References

• 1 DeLee JC ; Committee on Complications of Arthroscopy Association of North America. Complications of arthroscopy and arthroscopic surgery: results of a national survey. Arthroscopy 1985; 1 (4) 214-220
• 2 Small NC ; Committee on Complications of the Arthroscopy Association of North America. Complications in arthroscopy: the knee and other joints. Arthroscopy 1986; 2 (4) 253-258
• 3 Small NC. Complications in arthroscopic surgery performed by experienced arthroscopists. Arthroscopy 1988; 4 (3) 215-221
• 4 Reagan BF, McInerny VK, Treadwell BV, Zarins B, Mankin HJ. Irrigating solutions for arthroscopy. A metabolic study. J Bone Joint Surg Am 1983; 65 (5) 629-631
• 5 Bulstra SK, Kuijer R, Eerdmans P, van der Linden AJ. The effect in vitro of irrigating solutions on intact rat articular cartilage. J Bone Joint Surg Br 1994; 76 (3) 468-470
• 6 Straehley D, Hellar A, Solomons C , et al. The effect of arthroscopic irrigating solutions on cartilage and synovium. Trans Orthop Res Soc 1985; 10: 260
• 7 Bulstra SK, Douw C, Kuijer R. Normal saline irrigation of the rat knee inhibits cartilage metabolism; hyaluronan restores this disturbed metabolism to normal. Presentation at: the 45th Annual Meeting of the Orthopaedic Research Society; 1–4 February, 1999; Anaheim, CA
• 8 Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 1998; 20 (3) 410-423
• 9 Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006; (2) CD005321
• 10 Kobayashi K, Matsuzaka S, Yoshida Y, Miyauchi S, Wada Y, Moriya H. The effects of intraarticularly injected sodium hyaluronate on levels of intact aggrecan and nitric oxide in the joint fluid of patients with knee osteoarthritis. Osteoarthritis Cartilage 2004; 12 (7) 536-542
• 11 Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: are the effects molecular weight dependent?. Semin Arthritis Rheum 2002; 32 (1) 10-37
• 12 Theiler R, Brühlmann P. Overall tolerability and analgesic activity of intra-articular sodium hyaluronate in the treatment of knee osteoarthritis. Curr Med Res Opin 2005; 21 (11) 1727-1733
• 13 Listrat V, Ayral X, Patarnello F , et al. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthritis Cartilage 1997; 5 (3) 153-160
• 14 Dougados M, Nguyen M, Listrat V, Amor B. High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. Osteoarthritis Cartilage 1993; 1 (2) 97-103
• 15 Karatay S, Kiziltunc A, Yildirim K, Karanfil RC, Senel K. Effects of different hyaluronic acid products on synovial fluid levels of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1 in knee osteoarthritis. Ann Clin Lab Sci 2004; 34 (3) 330-335
• 16 Miyamoto H, Sakashita H, Miyata M , et al. Arthroscopic management of temporomandibular closed lock. Aust Dent J 1998; 43 (5) 301-304
• 17 McCain JP, Balazs EA, de la Rua H. Preliminary studies on the use of a viscoelastic solution in arthroscopic surgery of the temporomandibular joint. J Oral Maxillofac Surg 1989; 47 (11) 1161-1168
• 18 Mathies B. Effects of Viscoseal, a synovial fluid substitute, on recovery after arthroscopic partial menisectomy and joint lavage. Knee Surg Sports Traumatol Arthrosc 2006; 14 (1) 32-39
• 19 Cubukçu D, Ardiç F, Karabulut N, Topuz O. Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment. Clin Rheumatol 2005; 24 (4) 336-341
• 20 Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc 2007; 15 (5) 537-546
• 21 Thein R, Haviv B, Kidron A, Bronak S. Intra-articular injection of hyaluronic acid following arthroscopic partial meniscectomy of the knee. Orthopedics 2010; 33 (10) 724
• 22 Forster MC, Straw R. A prospective randomised trial comparing intra-articular Hyalgan injection and arthroscopic washout for knee osteoarthritis. Knee 2003; 10 (3) 291-293
• 23 Gotoh S, Onaya J, Abe M , et al. Effects of the molecular weight of hyaluronic acid and its action mechanisms on experimental joint pain in rats. Ann Rheum Dis 1993; 52 (11) 817-822
• 24 Frizziero L, Govoni E, Bacchini P. Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: clinical and morphological study. Clin Exp Rheumatol 1998; 16 (4) 441-449
• 25 Waddell DD, Bert JM. The use of hyaluronan after arthroscopic surgery of the knee. Arthroscopy 2010; 26 (1) 105-111
• 26 Sun QB, Liu SD, Meng QJ, Qu HZ, Zhang Z. Single administration of intra-articular bupivacaine in arthroscopic knee surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2015; 16: 21
• 27 Wei J, Yang HB, Qin JB, Kong FJ, Yang TB. Single-dose intra-articular bupivacaine after knee arthroscopic surgery: a meta-analysis of randomized placebo-controlled studies. Knee Surg Sports Traumatol Arthrosc 2014; 22 (7) 1517-1528
• 28 Chu CR, Coyle CH, Chu CT , et al. In vivo effects of single intra-articular injection of 0.5% bupivacaine on articular cartilage. J Bone Joint Surg Am 2010; 92 (3) 599-608
• 29 Lo IK, Sciore P, Chung M , et al. Local anesthetics induce chondrocyte death in bovine articular cartilage disks in a dose- and duration-dependent manner. Arthroscopy 2009; 25 (7) 707-715
• 30 Piper SL, Kramer JD, Kim HT, Feeley BT. Effects of local anesthetics on articular cartilage. Am J Sports Med 2011; 39 (10) 2245-2253
• 31 Lubowitz JH, Appleby D. Cost-effectiveness analysis of the most common orthopaedic surgery procedures: knee arthroscopy and knee anterior cruciate ligament reconstruction. Arthroscopy 2011; 27 (10) 1317-1322
• 32 Marcheggiani Muccioli GM, Wykes P, Hundle B, Grassi A, Roatti G, Funk L. Effects of a synovial fluid substitute on early recovery after arthroscopic subacromial decompression of the shoulder. Musculoskelet Surg 2015; 99 (2) 121-126