Treatment of Osteoarthritis of the Ankle by Intra-articular Injections of Hyaluronic Acid

2010 ◽  
Vol 100 (2) ◽  
pp. 93-100 ◽  
Author(s):  
Omer Mei-Dan ◽  
Beni Kish ◽  
Shai Shabat ◽  
Sabri Masarawa ◽  
Avi Shteren ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Conservative Treatment ◽  
Global Assessment ◽  
Symptomatic Relief ◽  
Sodium Hyaluronate ◽  
Signs And Symptoms ◽  
Ankle Osteoarthritis ◽  
Large Joint ◽  
Kellgren And Lawrence

Background: Treatment of osteoarthritis of the ankle is similar to that of any other large joint and includes conservative and surgical options. Surgical treatment in severe cases is fusion or joint replacement, whereas conservative treatment is limited and includes mainly ankle supports and physiotherapy. Hyaluronic acid was discovered by Meyer and Palmer in 1934 and has recently been widely used in the treatment of knee osteoarthritis. We evaluated the efficacy of an intra-articular preparation containing sodium hyaluronate in the treatment of osteoarthritis of the ankle. Methods: We studied 16 patients aged 31 to 79 years (mean age, 43 years) with symptomatic ankle osteoarthritis of 9 months' to 27 years' duration. The radiographic severity of the ankle osteoarthritis was graded II, III, or IV according to Kellgren and Lawrence. Arthritic ankles underwent intra-articular injections of 25 mg of sodium hyaluronate for 5 consecutive weeks. Follow-up visits were performed 4, 8, 11, 17, and 32 weeks after treatment and included clinical evaluation and objective scoring. Results: Global assessment showed improvement in 13 of 15 patients who completed the study. There was improvement by 20% in range of motion and a significant reduction in pain assessed by visual analog scale and ankle-hindfoot scores, all statistically significant. Seven months after treatment, no decrease in efficacy was shown. Two patients did not show any significant improvement in global assessment after treatment. One patient was dropped from follow-up owing to concurrent back surgery. Conclusions: Symptomatic relief of signs and symptoms of osteoarthritis of the ankle was achieved by injection of an intra-articular preparation containing sodium hyaluronate. There were significant improvements, in objective and subjective parameters, that lasted for more than 7 months. Ankle intra-articular injection of sodium hyaluronate is a valid conservative treatment for ankle osteoarthritis. (J Am Podiatr Med Assoc 100(2): 93–100, 2010)

scholarly journals Effect of Hyaluronic Acid/Trehalose in Two Different Formulations on Signs and Symptoms in Patients with Moderate to Severe Dry Eye Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Klemens Fondi ◽  
Piotr A. Wozniak ◽  
Doreen Schmidl ◽  
Ahmed M. Bata ◽  
Katarzyna J. Witkowska ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Dry Eye ◽  
Sodium Hyaluronate ◽  
Signs And Symptoms ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
Quality Of Sleep ◽  
Pro Re Nata ◽  
Breakup Time

Purpose. This randomized, observer-masked, crossover study investigated the effect of two hyaluronic acid/trehalose-based containing formulations, with different physical properties, on the signs and symptoms in patients with moderate to severe dry eye disease (DED). Methods. In one group, patients received a mixture of sodium hyaluronate and trehalose (HT, Thealoz Duo®) for use during the day. In the other group, patients received a more viscous formulation consisting of hyaluronic acid, trehalose, and carbomer (HTC-gel, Thealoz Duo Gel) to use pro re nata. Both groups used HTC-gel before going to bed. Clinical standard tests for DED were performed at the beginning and end of each one-week period. Further, patient satisfaction including quality of sleep was assessed using a visual analogue scale. Results. Corneal fluorescein and conjunctival lissamine green staining scores decreased, and tear breakup time (BUT) increased for both groups (p<0.001 each). Mean instillation frequency was 3.1 ± 2.6 drops/day when using HT and 1.9 ± 2.2 drops/day when using HTC-gel (p=0.02). A significant improvement in the quality of sleep was observed with both treatments (p=0.01). Conclusions. Our results show improvement in signs and symptoms of DED in both groups. While instillation of HTC-gel resulted in a lower instillation frequency, both formulations of trehalose showed good clinical efficacy. This trial is registered with NCT02980913.

Does Meniscectomy Have Any Advantage Over Conservative Treatment of Degenerative Medial Meniscus Posterior Root Tear?

2021 ◽  
Author(s):  
Nam-Hun Lee ◽  
Hyoung-Yeon Seo ◽  
Myung-Jin Sung ◽  
Bo-Ram Na ◽  
Eun-Kyoo Song ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Clinical Outcomes ◽  
Symptomatic Relief ◽  
Slope Angle ◽  
Joint Space ◽  
Conservative Group ◽  
Arthroscopic Meniscectomy ◽  
Activity Scale ◽  
Tegner Activity Scale

Abstract Background: This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT.Methods: From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis according to the K-L classification. We compared the hip-knee-ankle angle, medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method. Results: Although all clinical outcomes had significantly improved in both groups after treatment, the VAS score (p=0.07), IKDC subjective score (p=0.18), Tegner activity scale score (p=0.08), and Lysholm knee score (p=0.53) showed no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p=0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87% and 88%, respectively. Conclusions: This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression.

High-grade vesicoureteral reflux in infants: Our experience with endoscopic subureteric injections

2020 ◽  
pp. 039156032096618
Author(s):  
Saeed Al Hindi ◽  
Mohamed Mubarak ◽  
Husain Al Aradi
Keyword(s):  
Hyaluronic Acid ◽  
Vesicoureteral Reflux ◽  
Clinical Laboratory ◽  
Symptomatic Relief ◽  
Treatment Success ◽  
High Grade ◽  
Management Options ◽  
Endoscopic Injection ◽  
Acid Copolymer

Background: Vesicoureteral reflux (VUR) is the most common urological anomaly in pediatric patients. Management options for VUR vary from continuous antibiotic prophylaxis (CAP) to surgery via either endoscopic subureteric injection of a bulking agent or open anti-reflux surgery. In this study, we assess the efficacy of subureteric injections of Dextranomer/Hyaluronic acid Copolymer (Deflux) in managing primary VUR in infant patients with high-grade VUR. Methods: From 2010 to 2015, children less than 1-year-old with primary high-grade VUR were observed prospectively following the administration of endoscopic subureteric injections of Dextranomer/Hyaluronic Acid Copolymer (Deflux). The diagnosis of VUR was based on MCUG, and all patients underwent a holistic clinical, laboratory, and radiological assessment before and after the intervention. Complete success was defined as the resolution of VUR on follow up 1 year post-operatively. Results: A total of 30 infants (50 renal units) with high-grade VUR (grades IV and V) were included in the study. The mean age at surgery was 6.3 ± 2.5 months. Most of the patients presented with a urinary tract infection (90%). Complete symptomatic relief was achieved in 27 patients (90%) at the first post-operative follow-up. Forty-four renal units received one injection, while six required a second injection as they did not meet our treatment success criteria. No patients required a third injection or referral for open surgery. Conclusion: Endoscopic injection of Dextranomer/Hyaluronic acid Copolymer (Deflux) at the vesicoureteral junction is an effective minimally invasive intervention to treat high grades VUR (IV–V) infants.

scholarly journals CONSERVATIVE MANAGEMENT OF ACUTE LUMBAR DISC HERNIATION WITH ASSOCIATED RADICULOPATHY: A STUDY

2021 ◽  
pp. 57-59
Author(s):  
RAPPAI TJ ◽  
SURENDER ◽  
NEERAV PORWAL ◽  
ASHOK KUMAR ◽  
SAPNA CHAUHAN
Keyword(s):  
Conservative Treatment ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Clinical Signs ◽  
Indirect Costs ◽  
Poor Response ◽  
Signs And Symptoms ◽  
Disability Score ◽  
Clinical Signs And Symptoms

Objective: Acute disc herniation (DH) is a common cause of low back pain (LBP). It ranks fifth in the category of diseases in terms of cost of hospital care. It has higher indirect costs due to absenteeism from work and disability than any other disease. The present study was performed to assess the clinical outcomes of non-surgically treated LBP patients after 6 months of follow-up. Methods: The present study was prospective study which was performed on 450 lumbar radicular patients visiting the neurosurgery outpatient department having clinical signs and symptoms of acute lumbar DH of less than 3 month duration. Their diagnosis was confirmed by magnetic resonance imaging. The patients were treated conservatively during 6 months. Pain and disability were assessed by visual analog scale (VAS) and Oswestry disability questionnaire, respectively. Results: About 135 (30%) female and 315 (70%) male participated in the study. During the follow-up period, 27 (06%) patients (21 male and 6 female) showed poor response to conservative treatment and motor weakness and underwent surgical intervention. A significant improvement in the VAS Score was seen after 6 months of conservative treatment than initial evaluation of patients (3.12±1.84, 7.1±1.43, p=0.00). Furthermore, significant improvement in disability score of patients was seen in follow-up period (25.82±16.92, 53.66±17.66; p=0.00). Conclusion: Results of our study showed that conservative treatment in patients of acute lumbar DH have significant improvement in pain relief and disability without any notable side effect.

scholarly journals Appendicectomy for Uncomplicated Simple Appendicitis: Is It Always Required?

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ibrahim Falih Noori Alsubsiee ◽  
Ahmed Falih Noori Alsubsiee
Keyword(s):  
Conservative Treatment ◽  
Acute Appendicitis ◽  
Medical Treatment ◽  
Clinical Improvement ◽  
Antibiotic Treatment ◽  
Standard Treatment ◽  
Signs And Symptoms ◽  
Oral Antibiotics ◽  
Uncomplicated Appendicitis

Background. Although appendicectomy is still the classical and standard treatment for acute appendicitis, initial conservative antibiotic only treatment for simple uncomplicated cases has been proposed and tried as a feasible and effective approach. The objective of this study was to evaluate the efficacy and outcomes of antibiotics treatment for acute simple uncomplicated appendicitis. Methods. This is a prospective controlled nonrandomized study in which a total of 156 patients whose ages range from 16 to 54 years presenting with clinical diagnosis of acute uncomplicated appendicitis were assigned for conservative antibiotics treatment, which consists of ceftriaxone I gram twice daily and metronidazole infusions, 500 mg in 100 ml, 3 times daily for 48 to 72 hours to be converted on oral antibiotics after clinical improvement for 5 to 7 days. Patients who failed to initial conservative treatment and those who had recurring symptoms of appendicitis were presented for appendectomy. Results. Antibiotic treatment was successful and feasible in 138 (88.5%) patients. Progression of the signs and symptoms despite full medical treatment was observed in 11 (7%) patients during the same admission. Further 7 (4.5%) patients showed recurrence of the symptoms during follow-up period of 6–12 months after successful initial conservative treatment and also proceeded for appendicectomy. Conclusion. Nonoperative antibiotic treatment of acute simple appendicitis is safe, feasible, and effective for properly selected cases, thus avoiding unnecessary surgery with its possible complications.

scholarly journals TREATMENT FOR CONJUNCTIVOCHALASIS: A COMBINED APPROACH UTILIZING RADIOFREQUENCY CAUTERIZATION AND THERMALIDTM PROCEDURE

2021 ◽  
Vol 4 (1) ◽  
pp. e1-e10
Author(s):  
Liem Nguyen ◽  
Edward Jaccoma
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Symptomatic Relief ◽  
Retrospective Chart Review ◽  
Signs And Symptoms ◽  
Meibomian Gland ◽  
Significant Clinical Improvement ◽  
Pre Treatment ◽  
Tear Meniscus Height

BackgroundDry Eye Disease (DED) and related ocular surface diseases have multiple etiologies, but two of the most prevalent are Meibomian Gland Dysfunction (MGD) and Conjunctivochalasis (CCH). This study examines a customizable two-step approach utilizing radiofrequency to treat these two commonly coexisting condi-tions and provide patients with relief from DED signs and symptoms. Study DesignAn IRB approved retrospective chart review of 25 consecutively treated patients was conducted. Patients were included if they presented with DED symptoms and were treated with a combination treatment approach to improve both MGD and CCH, with pre- and post-treatment dry eye metrics outlined below. Follow-up visit information was compared to pre-treatment baseline to evaluate the efficacy and safety of treatment. ResultsStatistically significant results were observed in a decrease in symptoms as evaluated by the primary endpoints of the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire and an increase in the number of Meibomian Glands Yielding Liquid Secretion (MGYLS). Tear Meniscus Height also saw statistically significant improvement while Non-invasive Tear Break-Up Time (NTBUT) and Schirmer’s saw minor progress. Clinical evaluation and ocular surface photographs showed marked improvement in CCH with minimal observed side effects during post-operative follow-up visits. ConclusionA two-step approach utilizing a radiofrequency device to treat dry eye symptoms provides significant clinical improvement and symptomatic relief for a broad spectrum of patients who had received a variety of prior treatments for DED.

scholarly journals Efficacy of arthrocentesis with injection of hyaluronic acid in the treatment of inflammatory-degenerative disease of temporomandibular joint

2021 ◽  
Vol 33 (1) ◽  
pp. 1-5
Author(s):  
Enas A Abdulmaged ◽  
Thair Abdul Lateef
Keyword(s):  
Hyaluronic Acid ◽  
Life Quality ◽  
Mouth Opening ◽  
Sodium Hyaluronate ◽  
Degenerative Disease ◽  
Therapeutic Benefits ◽  
Masticatory Efficiency ◽  
Pain Symptoms

Background:Temporomandibular joint (TMJ) problems refer to a group of heterogeneous pain and dysfunction conditions involving the mastication, reducing life quality of the patients. Arthrocentesis is a simple and less invasive surgical method for the treatment of inflammatory-degenerative disease than other conservative procedures and better than arthroscope. This clinical study aimed at evaluating the benefit of arthrocentesis with injection of hyaluronic acid in the management of inflammatory-degenerative disease of the TMJ. Material and methods: Eighty consecutive patients were enrolled in this study with pain symptoms of TMJ, insufficient masticatory efficiency during function and limitation of mouth opening; they were assessed with clinical examination and approved with computed tomography scan. Arthrocentesis was done by inserting 18 gauge needles in the upper joint compartment, lavage by normal saline solution and at the end of the procedure 1ml of hyaluronic acid (HA) was injected. Intensity of the TMJ pain and masticatory efficiency was analyzed by visual analog scale (VAS), maximum mouth opening (MMO) was assessed by a ruler. All the assessed parameters were measured before the procedure then 1 and 4 months later. Results: During 5 months follow-up, comparison of the obtained results showed reduction in pain at chewing and rest 87.5%, improvement in mouth opening 100% and significant improvement in masticatory efficiency 87.5% of patients. Conclusion: The procedure of arthrocentesis with Sodium Hyaluronate injection, used in patients who suffered from inflammatory-degenerative disease (IDD), showed therapeutic benefits, simplicity, safety, patient satisfaction, lack of significant side effects and complications.  

scholarly journals Quantitative Evaluation of Meniscal Healing Process of Degenerative Meniscus Lesions Treated with Hyaluronic Acid: A Clinical and MRI Study

2020 ◽  
Vol 9 (7) ◽  
pp. 2280
Author(s):  
Alessandra Berton ◽  
Umile Giuseppe Longo ◽  
Vincenzo Candela ◽  
Federico Greco ◽  
Francesca Maria Martina ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Hyaluronic Acid ◽  
Global Assessment ◽  
Resonance Imaging ◽  
White Zone ◽  
Sf 36 ◽  
Meniscus Lesions ◽  
Significant Difference ◽  
One Year

Purpose: We aimed to evaluate clinical efficacy and healing effects of conservative management of degenerative meniscus lesions (DMLs) with a hyaluronic acid (HA) hydrogel. Methods: Patients were subjected to two HA injections two weeks apart. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Patient’s Global Assessment (PtGA) and Clinical Observer Global Assessment (CoGA) of the disease were assessed at baseline, 30, and 60 days after treatment. Short Form (36) Health Survey (SF-36) was assessed at baseline and 60 days after treatment. One year after treatment, patients were called to know whether any of them had undergone arthroscopic partial meniscectomy (APM). All patients underwent magnetic resonance imaging using a 1.5-T Magnetic Resonance Imaging (MRI) scanner (Siemens Aera), which included a T2 mapping pulse sequence with multiple echoes at baseline and 60 days after treatment. Results: 40 patients were enrolled. WOMAC score, physical function subscale, PtGA and CoGA, and SF-36 showed a statistically significant difference between baseline and follow-up. One year after treatment, only one patient had undergone APM. A decrease in the T2 measurement was detected in the posterior horn medial meniscus in 39% of cases in both the red and red–white zone, and in 60% of cases in the white zone; in the posterior horn lateral meniscus in 55% of cases in both the red and white zones, and in 65% of cases in the red–white zone. Only for the latter, there was a statistically significant difference between baseline and posttreatment T2 measurements. Conclusion: This study supports the use of HA in the conservative management of DML as it is clinically effective and enhances meniscus healing as demonstrated by T2 measurements. Moreover, it reduces the need for APM at 1-year follow-up.

scholarly journals Effectiveness of conservative management of acute fissure in ano: a prospective clinical study of 165 patients

2017 ◽  
Vol 4 (9) ◽  
pp. 3028 ◽  
Author(s):  
Sajith Babu S. M. ◽  
Rachna Gupta ◽  
Lalmani Singh
Keyword(s):  
Clinical Study ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Symptomatic Relief ◽  
Symptom Relief ◽  
Treatment Regime ◽  
Female Dominance ◽  
Prospective Clinical Study ◽  
Fissure In Ano

Background: Fissure-in-ano is a common yet troublesome condition; if acute, the severity of patient discomfort and extent of disability far exceed that would be expected from a seemingly trivial lesion. The present study was carried out to study the effectiveness of conservative management in symptom relief in acute fissure in ano.Methods: The study was conducted in 165 patients with acute fissure in ano attending Surgery OPD and/or admitted in surgical wards of Sanjay Gandhi Memorial Hospital associated with Shyam Shah Medical College, Rewa during the period from 1st August 2015 to 31st July 2016. It was a prospective clinical study. All the study subjects underwent extensive clinical examination and were prescribed conservative treatment regime. Follow up was done at the end of 2 weeks, 4 weeks and 6 weeks and the data was analyzed. 165 patients diagnosed as having acute fissure in ano. The outcome was assessed based on the following parameters; symptomatic relief, pain relief based on visual analogue scale and healing of ulcer.Results: Most of the patients were young adults with a slight female dominance. Pain during defecation and bleeding per rectum were the major presenting complaints. 73.94% of patients achieved symptom relief within 2 weeks of conservative treatment. At 6 weeks follow up after giving conservative line of management, 97.58% achieved symptom relief with healing of ulcer. Mean pain score was reduced from 9.5±0.71 at the start of therapy to 1.33±0.69 at the end of 6 weeks of conservative therapy.Conclusions: Acute fissure in ano can be easily cured with systematic usage of conservative treatment regime. A proper follow up along with patient education can help to achieve good remission and avoid unnecessary surgical intervention.

scholarly journals Efficacy of intra-articular injection of combined platelet-rich plasma and hyaluronic acid in knee degenerative joint disease (182)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0030
Author(s):  
Pietro Randelli ◽  
FILIPPO RANDELLI ◽  
Fabio Sciancalepore ◽  
Chiara Fossati ◽  
Stefano Pasqualotto ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Conservative Treatment ◽  
Current Literature ◽  
Platelet Rich Plasma ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Knee Oa ◽  
Significant Difference ◽  
Early Oa

Objectives: Osteoarthritis (OA) of the knee is a debilitating disease whose prevalence has increased across the world with aging population. Platelet-Rich Plasma (PRP) and Hyaluronic Acid (HA) injections appear to be two of the main strategies for conservative treatment of early knee OA. The effectiveness of both treatments, however, is still under debate because contrasting results have been described in the current literature. Some pre-clinical studies evaluated the association of PRP and HA with encouraging results, highlighting the possibility of a synergistic effect between the two compounds and suggesting a possible use through combined intra-articular injections. The aim of this prospective randomized controlled double-blind clinical trial is to evaluate the efficacy of intra-articular injections of PRP and HA for the treatment of early stages of knee degenerative joint disease in improving joint function and reducing pain, compared to the intra-articular injections of PRP and HA alone. Methods: Patients with knee early OA were prospectively enrolled and then double-blinded randomly divided into three groups of fifty-eight subjects each: HA alone, PRP alone and PRP+HA group. Patients received three intra-articular injections with two-week interval period among each dose. Patients clinical outcome was evaluated through five questionnaires [The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner Activity, Visual Analogue Scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) Subjective Knee Form] before the treatment (T0) and after 3, 6 and 12 months from the first injection. Patients’use of paracetamol and supplementary analgesia for knee pain during the study was collected. Results: One hundred and seventy-four patients were enrolled in this study (age, 30-80 years; 108 females and 66 males) and 162 completed the 12-month follow-up. All patients showed significant clinical improvement after treatment. The analysis of covariance (ANCOVA) did not show statistically significant differences among the three groups for all the variables analysed at 6 and 12 months of follow-up (p>0.05).No significant differences were found in terms of adverse events (p=0.49) among the three groups of patients (p=0.92).The demand for paracetamol and supplementary analgesics was generally low and there were no significant differences among the groups (p=0.23 and p=0.56, respectively). Conclusions: Injections treatments for early knee OA are an important conservative therapeutic strategy. To date, the current literature presents many contrasting studies about the effectiveness of PRP or HA, but only a few consider the combined use of PRP and HA as attractive therapeutic option. Our study has not shown any significant difference in clinical and functional outcomes among the three experimental groups, suggesting a substantial equivalence of these three treatments. Thus, cost-effectiveness is in favor of HA injections in the conservative treatment of early OA.

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