Skip to main content
Log in

Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The aim of this study was to investigate the effects of intra-articular hyaluronic acid (HA) on symptoms, functional outcome, and changes in articular cartilage assessed by magnetic resonance imaging (MRI) in patients with knee osteoarthritis. Thirty patients were randomly assigned to treatment with HA (hylan G-F 20, Synvisc) or saline. The treatment group consisted of 20 patients receiving three weekly injections of HA into one or both knees (30 knees). The control group consisted of ten patients receiving three intra-articular injections of 2 ml saline at the same intervals (ten knees). To determine the effectiveness of the HA therapy, all patients were assessed prior to the injections (baseline) and after the 1st, 2nd, 3rd, and 8th weeks. Assessment comprised the following: pain at rest, at night, and on walking using a visual analogue scale (VAS); Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores; 15-m walking time; need for analgesics; and evaluation of treatment by the patients. MRI of patellofemoral (PF) articular cartilage was also examined before and after the course of injections at the 8th week. When compared to placebo, a significant statistical difference was found in all clinical parameters. On MRI, although the difference in the PF joint cartilage quality in the HA group before and after the treatment was statistically significant (p<0.05), this significance was not detected between the groups after the treatment (p>0.05). After the HA injections, a significant analgesic effect was seen as early as the 3rd week continuing up to the 8th week and functional improvement was seen at the 8th week. In conclusion, intra-articular injections of HA is an effective choice of treatment in patients with knee osteoarthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 43:1905–1925

    Google Scholar 

  2. Scott JC, Lethbridge C, Hochberg MC (1999) Epidemiology and economic consequences of osteoarthritis. Osteoarthritis clinical and experimental aspects. Springer, Berlin Heidelberg New York, pp 20–38

  3. Pelletier JP, Pelletier MJ (1993) The pathophysiology of osteoarthritis and the implication of the use of hyaluronan and hylan as therapeutic agents in viscosupplementation. J Rheumatol Suppl 39:19–24

    CAS  PubMed  Google Scholar 

  4. Goorman SD, Watanabe TK, Miller EH, Perry C (2000) Functional outcome in knee osteoarthritis after treatment with hylan G-F 20: a prospective study. Arch Phys Med Rehab 81:479–483

    CAS  Google Scholar 

  5. Kirwan J (2001) Is there a place for intra-articular hyaluronate in osteoarthritis of the knee? Knee 8:93–101

    CAS  PubMed  Google Scholar 

  6. Simon LS (1999) Viscosupplementation therapy with intraarticular hyaluronic acid. Fact or fantasy? Rheum Dis Clin North Am 25:345–357

    CAS  PubMed  Google Scholar 

  7. Weiss C, Band P (1999) Basic principles underlying the development of viscosupplementation for the treatment of osteoarthritis. J Clin Rheumatol 5:2–11

    Google Scholar 

  8. Wobig M (1999) Hylan G-F 20 (Synvisc) for the treatment of osteoarthritis of the knee. Clinical studies and practical considerations. J Clin Rheumatol 5:12–17

    Google Scholar 

  9. Peyron JG (1993) Intraarticular hyaluronan injections in the treatment of osteoarthritis: state-of-the-art review. J Rheumatol Suppl 39:10–15

    CAS  Google Scholar 

  10. Altman R, Asch E, Bloch D et al (1986) Development of criteria for the classification and reporting of osteoarthritis of the knee. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum 29:1039–1049

    CAS  PubMed  Google Scholar 

  11. Kellgren HJ, Lawrence SJ (1967) Radiological assessment of osteoarthritis. Ann Rheum Dis 16:494–501

    Google Scholar 

  12. Chan WP, Lang P, Stevens MP, Sack K, Majumdar S, Basch C, Genant HK (1991) Osteoarthritis of the knee: comparison of radiography, CT and MR imaging to assess extent and severity. AJR Am J Roentgenol 157:799–806

    CAS  PubMed  Google Scholar 

  13. Recht MP, Kramer J, Marcelis S, Pathria MN, Trudel D, Haghighi P, Sartoris DJ, Resnick D (1993) Abnormalities of articular cartilage in the knee: analysis of available MR techniques. Radiology 187:473–478

    CAS  PubMed  Google Scholar 

  14. Bellamy N, Buchanan WW, Goldsmith C, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15:1833–1840

    CAS  PubMed  Google Scholar 

  15. Watterson JR, Esdaile JM (2000) Viscosupplementation: therapeutic mechanisms and clinical potential in osteoarthritis of the knee. J Am Acad Orthop Surg 8:277–284

    Google Scholar 

  16. Shah R, Ericksen J, Lacerte M (2003) New frontiers: invasive nonsurgical interventions. Arch Phys Med Rehabil 84:39–44

    Article  Google Scholar 

  17. Grecomoro G, Martorana U, Di Marco C (1987) Intra-articular treatment with sodium hyaluronate in gonarthrosis: a controlled clinical trial versus placebo. Pharmatherapeutica 5:137–141

    CAS  PubMed  Google Scholar 

  18. Wobig M, Bach G, Beks P, Dickhut A, Runzheimer J, Schwieger G et al (1999) The role of elastoviscosity in the efficacy of viscosupplementation for osteoarthritis of the knee: a comparison of hylan G-F 20 and a lower-molecular-weight hyaluronan. Clin Ther 21:1549–1562

    CAS  PubMed  Google Scholar 

  19. Lussier A, Alfred A, Charles A (1996) Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol 23:1579–1585

    CAS  PubMed  Google Scholar 

  20. Namiki O, Koyoshima H, Morisaki N (1982) Therapeutic effect of intraarticular injection of high molecular weight hyaluronic acid on osteoarthritis of the knee. Int J Clin Pharmacol Ther Toxicol 20:501–507

    CAS  PubMed  Google Scholar 

  21. Carabba M, Paresce E, Angelini M et al (1992) The intra-articular treatment of osteoarthritis of the knee. A comparative study between hyaluronic acid (Hyalgan®) and orgotein. Eur J Rheumatol Inflamm 12:47–57

    Google Scholar 

  22. George E (1998) Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis 57:637–640

    CAS  PubMed  Google Scholar 

  23. Pietrogrande V, Melanotte P, D’Agnolo B (1991) Hyaluronic acid versus methylprednisolone intraarticularly injected for treatment of osteoarthritis of the knee. Curr Ther Res 50:691–701

    Google Scholar 

  24. Leardini G, Mattara L, Fracechini M, Perbelli A (1991) Intra-articular treatment of knee osteoarthritis: acomparative study between hyaluronic acid and 6-methyl prednisolone acetate. Clin Exp Rheumatol 9:375–381

    CAS  PubMed  Google Scholar 

  25. Adams E, Atkinson MH, Lussier A, Schulz JI, Siminovitch A, Wade JP, Zummer M (1995) The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee. Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthritis Cartilage 3:213–226

    CAS  PubMed  Google Scholar 

  26. Kolarz G, Kotz R, Bröll H (1995) Hyaluronic acid in the comparative clinical study. Eur J Rheumatol Inflamm 15:39–45

    Google Scholar 

  27. Carabba M, Paresce E, Angelini M (1995) The safety and efficacy of different dose schedules of hyaluronic acid in the treatment of painful osteoarthritis of the knee with joint effusion. Eur J Rheumatol Inflamm 15:25–31

    Google Scholar 

  28. Creamer P, Sharif M, George E, Meadows K, Cushnaghan J (1994) Intra-articular hyaluronic acid in osteoarthritis of the knee: an investigation into mechanisms of action. Osteoarthritis Cartilage 2:133–140

    CAS  PubMed  Google Scholar 

  29. Guermazi A, Zaim S, Taouli B, Miaux Y, Peterfy CG, Genant HK (2003) MR findings in knee osteoarthritis. Eur Radiol 13:1370–1386

    Article  PubMed  Google Scholar 

  30. Gandy SJ, Dieppe PA, Keen MC, Maciewicz RA (2002) No loss of cartilage volume over three years in patients with knee osteoarthritis as assessed by magnetic resonance imaging. Osteoarthritis Cartilage 10:929–937

    CAS  PubMed  Google Scholar 

  31. Gold GE, McCauley TR, Gray ML, Disler DG (2003) What’s new in cartilage? Radiographics 23:1227–1242

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to F. Ardıç.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Çubukçu, D., Ardıç, F., Karabulut, N. et al. Hylan G-F 20 efficacy on articular cartilage quality in patients with knee osteoarthritis: clinical and MRI assessment. Clin Rheumatol 24, 336–341 (2005). https://doi.org/10.1007/s10067-004-1043-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-004-1043-z

Keywords

Navigation