Effectiveness of Five Intraarticular Strategies on Knee Osteoarthritis

NCT ID: NCT03783455

Last Updated: 2018-12-21

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2015-09-01

Study Completion Date

2016-06-01

Brief Summary

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BACKGROUND: Current medical treatment strategies for knee osteoarthritis (OA) are aimed at pain reduction and symptom control. The Non-Arthroscopic Joint Lavage (NAJL) is included inside the therapeutic algorithm of knee OA when other therapies are contraindicated or have lost effectiveness. The large variety of potentially invasive interventions available (joint lavage included) has raised the need to assess their efficacy. The objective of this study is to compare the short-term effectiveness of five treatment strategies in patients with knee osteoarthritis (OA).

METHODS: It was conducted a randomized prospective study involving 150 patients of whom 76.7% were females. The age range was 40-81 years. All patients had knee OA according to the American College of Rheumatology criteria, with Kellgren-Lawrence radiographic grades II and III. Patients were assigned to five groups, 1) non-arthroscopic joint lavage (NAJL) (n= 30), 2) NAJL plus hyaluronic acid (HA) (n= 32), 3) NAJL plus corticosteroid (CS) (n= 32), 4) HA (n= 31), 5) CS (n= 25). Evaluations took place at baseline, one and three months after enrollment. Demographic variables, Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Lequesne scores were recorded. Statistical analysis included mixed analysis of variance, post-hoc comparisons with Sidak's adjustment, and multiple linear regression using as outcome WOMAC total at 3 months.

TRIAL REGISTRATION: The protocol of the study was approved by the "Hospital Universitario Reina Sofía" Ethics Committee, under the number 1996, in the Minutes 208 of 29 May 2012.

Detailed Description

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Conditions

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Osteo Arthritis Knee

Keywords

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Corticosteroid Hyaluronic acid Joint Lavage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Open, controlled, randomized and prospective study.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Non arthroscopic joint lavage (NAJL)

Establishment of sterile areas and cleaning of the skin around the knee with a povidone-iodine solution, followed by an injection of local anesthetic (5 mL of 2% mepivacaine hydrochloride) into the outer mediopatellar zone. The anesthetic was allowed to act, and an access way was then opened with a No. 16 abocat. Any effusion in the joint was drained. Then, approximately 100 mL of cold saline was instilled through the outer access way. Once the knee was distended, a further 5 mL of local anesthetic was injected into the inner mediopatellar zone, and a new abocat guide was used to establish the inner drainage way. The lavage proper involved instillation of 4 L of cold (8ºC) saline at a constant flow-rate using a dropper line connected to the entry way; the inner zone was also connected to another, free-fall dropper.

Group Type ACTIVE_COMPARATOR

Non arthroscopic joint lavage

Intervention Type PROCEDURE

Instillation of 4 litters of cold physiological serum

Non arthroscopic joint lavage plus corticosteroid

Establishment of sterile areas and cleaning of the skin around the knee with a povidone-iodine solution, followed by an injection of local anesthetic (5 mL of 2% mepivacaine hydrochloride) into the outer mediopatellar zone. The anesthetic was allowed to act, and an access way was then opened with a No. 16 abocat. Any effusion in the joint was drained. Then, approximately 100 mL of cold saline was instilled through the outer access way. Once the knee was distended, a further 5 mL of local anesthetic was injected into the inner mediopatellar zone, and a new abocat guide was used to establish the inner drainage way. The lavage proper involved instillation of 4 L of cold (8ºC) saline at a constant flow-rate using a dropper line connected to the entry way; the inner zone was also connected to another, free-fall dropper. Following administration of the joint lavage, the NAJL plus corticosteroid group was given an intra-articular injection containing 40 mg of triamcinolone acetonide.

Group Type ACTIVE_COMPARATOR

Non arthroscopic joint lavage plus corticosteroid

Intervention Type PROCEDURE

Instillation of 4 litters of cold physiological serum followed by intraarticular injection of triamcinolone

Non arthroscopic joint lavage plus hyaluronic acid

Establishment of sterile areas and cleaning of the skin around the knee with a povidone-iodine solution, followed by an injection of local anesthetic (5 mL of 2% mepivacaine hydrochloride) into the outer mediopatellar zone. The anesthetic was allowed to act, and an access way was then opened with a No. 16 abocat. Any effusion in the joint was drained. Then, approximately 100 mL of cold saline was instilled through the outer access way. Once the knee was distended, a further 5 mL of local anesthetic was injected into the inner mediopatellar zone, and a new abocat guide was used to establish the inner drainage way. The lavage proper involved instillation of 4 L of cold (8ºC) saline at a constant flow-rate using a dropper line connected to the entry way; the inner zone was also connected to another, free-fall dropper. Following administration of the joint lavage, the patients were given an intra-articular injection containing 4 ml of a bioengineered hyaluronic acid.

Group Type ACTIVE_COMPARATOR

Non arthroscopic joint lavage plus hyaluronic acid

Intervention Type PROCEDURE

Instillation of 4 litters of cold physiological serum followed by intraarticular injection of hyaluronic acid

Intraarticular injection of hyaluronic acid

Establishment of sterile areas and cleaning of the skin around the knee with a povidone-iodine solution. This was followed by an intraarticular injection containing 4 mL of a bioengineered hyaluronic acid.

Group Type ACTIVE_COMPARATOR

Intraarticular injection of hyaluronic acid

Intervention Type PROCEDURE

Intraarticular injection containing 4 mL of a bioengineered hyaluronic acid.

Intraarticular injection of corticosteroid

Establishment of sterile areas and cleaning of the skin around the knee with a povidone-iodine solution. This was followed by an intraarticular injection containing 40 mg of triamcinolone acetonide.

Group Type ACTIVE_COMPARATOR

Intraarticular injection of corticosteroid

Intervention Type PROCEDURE

Intraarticular injection containing 40 mg of triamcinolone acetonide.

Interventions

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Non arthroscopic joint lavage

Instillation of 4 litters of cold physiological serum

Intervention Type PROCEDURE

Non arthroscopic joint lavage plus corticosteroid

Instillation of 4 litters of cold physiological serum followed by intraarticular injection of triamcinolone

Intervention Type PROCEDURE

Non arthroscopic joint lavage plus hyaluronic acid

Instillation of 4 litters of cold physiological serum followed by intraarticular injection of hyaluronic acid

Intervention Type PROCEDURE

Intraarticular injection of corticosteroid

Intraarticular injection containing 40 mg of triamcinolone acetonide.

Intervention Type PROCEDURE

Intraarticular injection of hyaluronic acid

Intraarticular injection containing 4 mL of a bioengineered hyaluronic acid.

Intervention Type PROCEDURE

Other Intervention Names

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NAJL

Eligibility Criteria

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Inclusion Criteria

* Meeting American College of Rheumatology (ACR) criteria for knee OA, symptoms for at least three months despite conservative medical treatment, knee OA grade II or III on the radiological Kellgren-Lawrence scale, and voluntary collaboration.

Exclusion Criteria

* ankylosis of joint;
* total arthroplasty or previous osteotomy
* infected injury;
* treatment with dicumarinic drugs or alterations in blood coagulation,
* venous insufficiency or episode of venous thrombosis;
* administration of hyaluronic acid (HA) in the previous year, and/or corticosteroid (CS) infiltration or NAJL in the previous three months.
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Maimónides Biomedical Research Institute of Córdoba

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Lourdes Ladehesa, MD

Role: PRINCIPAL_INVESTIGATOR

Hospital Universitario Reina Sofía

References

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Cope PJ, Ourradi K, Li Y, Sharif M. Models of osteoarthritis: the good, the bad and the promising. Osteoarthritis Cartilage. 2019 Feb;27(2):230-239. doi: 10.1016/j.joca.2018.09.016. Epub 2018 Oct 25.

Reference Type BACKGROUND
PMID: 30391394 (View on PubMed)

Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, Towheed T, Welch V, Wells G, Tugwell P; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012 Apr;64(4):465-74. doi: 10.1002/acr.21596.

Reference Type BACKGROUND
PMID: 22563589 (View on PubMed)

Cooper C, Rannou F, Richette P, Bruyere O, Al-Daghri N, Altman RD, Brandi ML, Collaud Basset S, Herrero-Beaumont G, Migliore A, Pavelka K, Uebelhart D, Reginster JY. Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice. Arthritis Care Res (Hoboken). 2017 Sep;69(9):1287-1296. doi: 10.1002/acr.23204. Epub 2017 Aug 8. No abstract available.

Reference Type BACKGROUND
PMID: 28118523 (View on PubMed)

Escobar A, Quintana JM, Bilbao A, Azkarate J, Guenaga JI. Validation of the Spanish version of the WOMAC questionnaire for patients with hip or knee osteoarthritis. Western Ontario and McMaster Universities Osteoarthritis Index. Clin Rheumatol. 2002 Nov;21(6):466-71. doi: 10.1007/s100670200117.

Reference Type BACKGROUND
PMID: 12447629 (View on PubMed)

Other Identifiers

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NAJL

Identifier Type: -

Identifier Source: org_study_id