Prospective Open Case Control Comparative Study of Intraarticular Injection of Low and High Molecular Weight Viscosupplement in Osteoarthritis of Knee when given with and without Steroid and to assess the Use of C-arm in Target Delivery of Viscosupplement

Nested Prospective Open Case Control Comparative Study of Intraarticular Injection of Low and High Molecular Weight Viscosupplement With and Without Steroid In Osteoarthritis of Knee and Look For The Frequency of Requirement For Repeat Dose of Hyaluronic Acid and To Assess The Use of C-Arm In Target Delivery Viscosupplement Into Joint Cavity as Against The Routine Practice of Giving Viscosupplement Through Sub-Patellar Route. Samikrishnan Perumal, 1 Maruthu Thurai Sambandam, 2 Senthakrishna Thangaraj.3 AIM To study the role of viscosupplement in osteoarthritis of knee joint from KL grade-2, 3 and 4. To compare the efficacy between low with high molecular weight viscosupplements. To assess the frequency of its use when it was given with and without Steroid. To study the role of C-arm in intra-articular viscosupplementation of OA knee, OBJECTIVE OF THE STUDY Indians become affluent and most of them are obese and fortunately, their life expectancy has been increased, only to welcome the early onset of osteoarthritis, and in particular OA knee. Unfortunately, it never even leave the poor, OA affect them, just because of their hard work. Sadly, whether they are rich or poor, they vehemently oppose or reluctant to accept for the surgical replacement of joints. Thus, to study the effect of intra-articualr injection of low molecular and high molecualr weight (20, 000 and 60, 000 daltons) viscosupplement in OA knee with and without steroid and look for the frequency of requirement for repeat dose of HA and to assess the use of C-arm in delivering viscosupplement into joint cavity as against routine practice of giving HA through sub-patellar route. MATERIAL AND METHODS We have enrolled 358 patients (104 males and 254 females) of osteoarthritis of knee with radiological Kellgren and Lawrence (K& L) grades 2 to 4 based on X-rays of knee taken in AP in standing view. Pain was evaluated by VAS, and performance was assessed by 50 foot walk time. We categorized the patients into KL grade 2 (M 24& F 82), KL grade 3 (M 41& F 112) and KL grade 4 (M 39& F 60). We have randomly picked up and formed into group-A& B.178 cases are kept in group-A with KL grade-2 (M22& F37), KL grade-3 (M27& F52) and KL grade-4 (M21& F19). In group- B, we have selected 180 cases from KL grade-2 (M24& F44), KL grade-3 (M29& F40) and KL grade-4 (M 19& F 24). In group- A (n-178), 85 cases allotted for low (M32& F53) and 93 cases for high (M40& F53) molecular weight viscosupplement without steroid and it was kept as control for Group-B. In group-B (n-180), 86 cases have been selected for low (M32& F54& and 94 cases for high (M40& F54) molecular weight viscosupplement with steroid. The low molecular weight HA was given as weekly once for five weeks and high molecular weight viscosupplement was given as single dose. From group- A and B, we randomly selected 211 (60.75 %) cases (37& 52 from group- A and 40& 82 from group- B) for assessing the role of C- arm in delivering viscosupplements into knee joint cavity, because knee joint cavity is well away from sub-patella and in KL grade 3 and 4, joint cavity is narrow or asymmetrically present with valgus and varus deformity and thus, viscosupplement was given under the guidance of C-arm for appropriate target delivery. We asked them stay in bed for 8 to 24 hours for the even distribution and allow the HA to get complete percolation in the fissured cartilages and for the remaining cases, viscosupplement was given into knee joint as the routine sub-patellar route on lateral approach. RESULTS Mean age of patients 52.4 years (range 39-74 years), with male female ratio of 12.44. Early feel good response in group-A and group-B were assessed by VAS from 0 to 100. Before and after the viscosupplementation, visual analogue scale was compared with both group. In group-A, before viscosupplement, 100 % pain was noted in 82 patients, and 50 % pain was seen in 61 cases, whereas after viscosupplementation, more than 50 % pain relief was noted in 92 cases (31 in LMW HA and 61 cases in HMW HA). In group-B, as per VAS, 100 % pain in 85 patients and 50 % pain in 70 patients are have been noted, whereas after HA, more than 50 % pain relief and early feel good response was noted in 152 patients (68 in LMW HA and 84 patients in HMW HA). Pre and Post procedures, the performance was assessed by 50 foot walk time. In group-A, in low molecular weight HA category, before viscosupplement, they take 76 seconds to finish 50 foot walk and whereas after the procedure, they able to complete 50 foot walk in 68 seconds, and in HMW HA category, before visco, they need 68 seconds, and after the visco, only 42 seconds are required to complete the target. In group-B, in low molecular weight category, before the procedure, patients took 72 seconds for 50 foot walk and whereas after the procedure, only they needed 36 seconds and in HMW HA category, before visco, it was 81 seconds and after visco, they quickly complete 50 foot