Department of Orthopaedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Siriraj Hospital 2 Prannok Road Bangkoknoi, Bangkok, 10700, Thailand,
Knee Surg Sports Traumatol Arthrosc. 2014 Jun;22(6):1415-23. doi: 10.1007/s00167-013-2735-1. Epub 2013 Oct 27.
High tibial osteotomy (HTO) is a surgical procedure used to correct abnormal mechanical loading of the knee joint; additionally, intra-articular hyaluronic acid injections have been shown to restore the viscoelastic properties of synovial fluid and balance abnormal biochemical processes. It was hypothesized that combining HTO with intra-articular hyaluronic acid injections would have benefit to improve the cartilage volume of knee joints.
Forty patients with medial compartment knee osteoarthritis (OA) were randomly placed into 1 of 2 groups. The study group (n = 20) received 2 cycles (at 6-month intervals) of 5 weekly intra-articular hyaluronic acid injections after HTO operation. The control group (n = 20) did not receive any intra-articular injections after HTO surgery. Cartilage volume (primary outcome) was assessed by magnetic resonance imaging (MRI) pre-operatively and 1 year post-operatively. Treatment efficacy (secondary outcomes) was evaluated with the Western Ontario and McMaster Universities OA Index (WOMAC) and by the comparison of the total rescue medication (paracetamol/diclofenac) used (weeks 6, 12, 24, 48).
MRI studies showed a significant increase in total cartilage volume (p = 0.033), lateral femoral cartilage volume (p = 0.044) and lateral tibial cartilage volume (p = 0.027) in the study group. Cartilage volume loss was detected at the lateral tibial plateau in the control group. There were significant improvements after surgery in both groups for all subscales of WOMAC scores (p < 0.001) compared to the baseline. However, no difference was found between the two groups. The study group had significantly lower amounts of diclofenac consumption (p = 0.017).
Based on the findings of the present study, intra-articular hyaluronic acid injections may be beneficial for increasing total cartilage volume and preventing the loss of lateral tibiofemoral joint cartilage after HTO.
Therapeutic study, Level I.
胫骨高位截骨术（HTO）是一种用于纠正膝关节异常力学负荷的手术方法；此外，关节内透明质酸注射已被证明可以恢复滑液的粘弹性特性并平衡异常的生化过程。有人假设，将 HTO 与关节内透明质酸注射相结合将有助于改善膝关节的软骨体积。
40 例内侧间室膝关节骨关节炎（OA）患者被随机分为 2 组。研究组（n = 20）在 HTO 手术后接受 2 个周期（间隔 6 个月）的每周 5 次关节内透明质酸注射。对照组（n = 20）在 HTO 手术后未接受任何关节内注射。通过磁共振成像（MRI）在术前和术后 1 年评估软骨体积（主要结局）。采用 Western Ontario 和 McMaster 大学骨关节炎指数（WOMAC）评估治疗效果（次要结局），并通过比较使用的总解救药物（对乙酰氨基酚/双氯芬酸）（第 6、12、24、48 周）来评估。
MRI 研究显示，研究组的总软骨体积（p = 0.033）、外侧股骨软骨体积（p = 0.044）和外侧胫骨软骨体积（p = 0.027）均显著增加。对照组在外侧胫骨平台检测到软骨体积丢失。与基线相比，两组术后所有 WOMAC 评分子量表均有显著改善（p < 0.001）。然而，两组之间没有差异。研究组的双氯芬酸消耗明显减少（p = 0.017）。
根据本研究的结果，关节内透明质酸注射可能有益于增加总软骨体积并防止 HTO 后外侧胫骨股骨关节软骨的丢失。
治疗研究，I 级。
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