Is intraarticular enjections effective on pain management in patients with late stage primer gonarthrosis during COVID-19 pandemic? A single centre experience

Year 2022, , 944 - 948, 30.11.2022

Mete Gedikbaş , Yusuf Bayram

https://doi.org/10.16899/jcm.1143442

Abstract

Background: Primary gonarthrosis is a progressive disease that increases with age and leads to limitations in activities of daily living. Until surgery is performed, nonsteroidal anti-inflammatory drugs, intraarticular injections, and physical therapy methods are used.
Purpose: This study aims to compare the clinical outcomes of intra- articular corticosteroid (CCS) and hyaluro nic acid (HA) injections for pain relief in primary gonartrhosis in COVID -19 pandemic period.
Study Design: Retrospective Cohort Study.
Methods: In this study, 88 patients who underwent intra-articular CCS and HA injection between August 2020 and March 2021 due to Kellgren-Lawrence stage 2 and higher gonarthrosis were investigated. Patients were divided into two groups. Group I represents the patients who received HA injections, and group II represents the patients who received CCS injection. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Knee Society Score (KSS) scores were used for the preoperative and postoperative functional evaluations of the patients.
Results: Group I included 40 patients and group II included 48 patients. The mean age was 59.4 ± 7.3 years, and the average follow-up period was 12 ± 2,6 months. The pre-intervention WOMAC scores were 13,5 in Group I and 13.6 in Group II, KSS scores were 26,5 in Group I and 25,2 in Group II. While there was a significant change in the control at month 1 in both groups, no difference was found between the groups. At the 6th month control, the improvement in group 1 continued at a significant level compared to the pre-injection period, while group 2 returned to the pre-injection level. (p<0,01). After the injection, three patients in group 1 were hospitalized for one day because of sudden onset of pain and then discharged. Apart from this situation, no patient had septic arthritis or hemarthrosis.
Conclusion: Our study shows that both injections have a similar effect in the first month, but the palliative effect of IAHA may be beneficial for a longer period of time.

Keywords

Corticosteroid injection, COVID-19 pandemic, hyaluronic acid, gonarthrosis, pain relief

COVID-19 pandemisi sürecinde ileri evre gonartrozu olan hastalarda eklem içi enjeksiyonlar ağrı yönetiminde etkili midir? Tek merkez deneyimi.

Abstract

Giriş: Primer gonartroz, yaşla birlikte artan ve günlük yaşam aktivitelerinde kısıtlamalara yol açan ilerleyici bir hastalıktır. Ameliyat yapılana kadar nonsteroid antiinflamatuar ilaçlar, eklem içi enjeksiyonlar ve fizik tedavi yöntemleri kullanılır.
Amaç: Bu çalışma, COVID-19 pandemi döneminde primer gonartrozda ağrının giderilmesi için eklem içi kortikosteroid (CCS) ve hyalüronik asit (HA) enjeksiyonlarının klinik sonuçlarını karşılaştırmayı amaçlamaktadır.
Çalışma Tasarımı: Retrospektif Kohort Çalışması.
Yöntemler: Bu çalışmada Kellgren-Lawrence sınıflamasına göre evre 2 ve üzeri gonartrozu olan ve Ağustos 2020 ile Mart 2021 tarihleri ​​arasında eklem içi CCS ve HA enjeksiyonu yapılan 88 hasta incelendi. Hastalar iki gruba ayrıldı. Grup I, HA enjeksiyonu yapılan hastaları, grup II ise CCS enjeksiyonu yapılan hastaları içermektedir. Hastaların ameliyat öncesi ve ameliyat sonrası fonksiyonel değerlendirmelerinde Western Ontario ve McMaster Universities Arthritis Index (WOMAC) ve Knee Society Score (KSS) skorları kullanıldı.
Bulgular: Grup I'de 40 hasta ve grup II'de 48 hasta yer aldı. Ortalama yaş 59.4 ± 7.3 yıl, ortalama takip süresi 12 ± 2,6 ay idi. Enjeksiyon öncesi WOMAC skorları Grup I'de 13,5 ve Grup II'de 13.6, KSS skorları Grup I'de 26,5 ve Grup II'de 25,2 idi. Her iki grupta 1. ayda kontrolde anlamlı bir değişiklik varken, gruplar arasında fark bulunmadı. 6. ay kontrolünde, grup 1'deki iyileşme enjeksiyon öncesi döneme göre anlamlı düzeyde devam ederken, grup 2 enjeksiyon öncesi seviyeye döndü. (p<0,01). Enjeksiyondan sonra grup 1'deki üç hasta ani başlayan ağrı nedeniyle bir gün hastanede yatırılarak taburcu edildi. Bu durum dışında hiçbir hastada septik artrit veya hemartroz görülmedi.
Sonuç: Çalışmamız, her iki enjeksiyonun ilk ay içerisinde benzer etkisinin olduğunu ancak IAHA'nın palyatif etkisinin daha uzun süre faydalı olabileceğini göstermektedir

Keywords

kortikosteroid enjeksiyonu,, COVID-19 pandemisi, hyaluronik asit, gonartroz, ağrı kesici

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