Impact of Intra-articular Infusion of Hyaluronic Acid on Gait Pattern of Patients with Knee Osteoarthritis in Tehran, Iran

  • Sirous Azizi Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-3251-6322
  • Sharif Najafi Assistant Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0001-9544-4525
  • Zahra Rezasoltani Associate Professor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0003-1864-9388
  • Afsaneh Dadarkhah Instructor, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0002-0103-7046
  • Bahare Mohebi Resident, Department of Physical Medicine and Rehabilitation, Imam Reza Hospital, School of Medicine AND Clinical Biomechanics and Ergonomics Research Center, AJA University of Medical Sciences, Tehran, Iran https://orcid.org/0000-0001-6130-0726
Keywords: Hyaluronic acid; Osteoarthritis; Gait analysis; Knee Injury and Osteoarthritis Outcome Score

Abstract

Background: Intra-articular hyaluronic acid (IAHA) injection is one of the treatments of knee osteoarthritis (KO) that increase synovial fluid elasticity and viscosity, therefore decrease pain and increase function. However, its effect on the patient’s gait is not clear objectively. The purpose of this study is to examine the impact of IAHA injection on gait pattern in patients with KO.

Methods: After receiving informed consent of patients, the demographic questionnaire and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were filled by them. Knee range of motion (ROM) and gait pattern were measured by goniometer and Zebris gait analyzer made in Germany. IAHA injection was performed three times weekly for fifteen days. One week, one month, three months, and six months after the last injection, KOOS, the knee ROM, and gait were examined again.

Results: Stride length, stride time, cadence, gait velocity, quality of life (QOL), and knee ROM showed improvement after the injection (P < 0.05).

Conclusion: Intra-articular infusion of hyaluronic acid (HA), by increasing the elasticity and viscosity of the fluid in the joint, leads to pain reduction and improvement in gait parameters and QOL in patients with KO.

References

1. Chuang SH, Huang MH, Chen TW, Weng MC, Liu CW, Chen CH. Effect of knee sleeve on static and dynamic balance in patients with knee osteoarthritis. Kaohsiung J Med Sci 2007; 23(8): 405-11.
2. Peat G, McCarney R, Croft P. Knee pain and osteoarthritis in older adults: A review of community burden and current use of primary health care. Ann Rheum Dis 2001; 60(2): 91-7.
3. Hinman RS, Bennell KL, Metcalf BR, Crossley KM. Balance impairments in individuals with symptomatic knee osteoarthritis: A comparison with matched controls using clinical tests. Rheumatology (Oxford) 2002; 41(12): 1388-94.
4. Masui T, Hasegawa Y, Yamaguchi J, Kanoh T, Ishiguro N, Suzuki S. Increasing postural sway in rural-community-dwelling elderly persons with knee osteoarthritis. J Orthop Sci 2006; 11(4): 353-8.
5. Bedson J, Jordan K, Croft P. The prevalence and history of knee osteoarthritis in general practice: A case-control study. Fam Pract 2005; 22(1): 103-8.
6. Toledo SD, Trapani K, Feldbruegge E. Rheumatic diseases. In: Braddom R, editor. Physical medicine and rehabilitation. Philadelphia, PA: Saunders; 2011. p. 769-73.
7. Hassan BS, Mockett S, Doherty M. Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects. Ann Rheum Dis 2001; 60(6): 612-8.
8. Garsden LR, Bullock-Saxton JE. Joint reposition sense in subjects with unilateral osteoarthritis of the knee. Clin Rehabil 1999; 13(2): 148-55.
9. Hall MC, Mockett SP, Doherty M. Relative impact of radiographic osteoarthritis and pain on quadriceps strength, proprioception, static postural sway and lower limb function. Ann Rheum Dis 2006; 65(7): 865-70.
10. Sharma L, Pai YC. Impaired proprioception and osteoarthritis. Curr Opin Rheumatol 1997; 9(3): 253-8.
11. Dieppe P, Lim K. Osteoarthritis and related disorders: Clinical features and diagnostic problems. In: Klipple J, Dieppe P, editors. Rheumatology. 2nd ed. London, UK: Mosby; 1998. p. 831-6.
12. Dixon AS, Jacoby RK, Berry H, Hamilton EB. Clinical trial of intra-articular injection of sodium hyaluronate in patients with osteoarthritis of the knee. Curr Med Res Opin 1988; 11(4): 205-13.
13. Messier SP, Loeser RF, Hoover JL, Semble EL, Wise CM. Osteoarthritis of the knee: Effects on gait, strength, and flexibility. Arch Phys Med Rehabil 1992; 73(1): 29-36.
14. Dahl LB, Dahl IM, Engstrom-Laurent A, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis 1985; 44(12): 817-22.
15. Braddom R. Physical medicine and rehabilitation. Philadelphia, PA: Saunders; 2011. p. 101-2.
16. Navarro-Sarabia F, Coronel P, Collantes E, Navarro FJ, de la Serna AR, Naranjo A, et al. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: The AMELIA project. Ann Rheum Dis 2011; 70(11): 1957-62.
17. Skwara A, Ponelis R, Tibesku CO, Rosenbaum D, Fuchs-Winkelmann S. Gait patterns after intraarticular treatment of patients with osteoarthritis of the knee--hyaluronan versus triamcinolone: A prospective, randomized, doubleblind, monocentric study. Eur J Med Res 2009; 14(4): 157-64.
18. Huang TL, Chang CC, Lee CH, Chen SC, Lai CH, Tsai CL. Intra-articular injections of sodium hyaluronate (Hyalgan(R)) in osteoarthritis of the knee. A randomized, controlled, double-blind, multicenter trial in the Asian population. BMC Musculoskelet Disord 2011; 12: 221.
19. Lester D, Zhang K. Gait analysis of knee arthritis treated with hyaluronic acid. J Arthroplasty 2009;
25(8): 1290-4.
20. Tang SF, Chen CP, Chen MJ, Pei YC, Lau YC, Leong CP. Changes in sagittal ground reaction forces after intra-articular hyaluronate injections for knee osteoarthritis. Arch Phys Med Rehabil 2004; 85(6): 951-5.
21. Smiderle C, Scapin M, Baldo M, Ronconi L, Marcolin G, Villaminar R. Gait analysis of changes in clinical and biomechanical parameters in osteoarthritis knee patients after intraarticular infiltration with high molecular weight hyaluronic acid. Gait Posture 2008; 28: S24-S25.
Published
2019-12-05
Section
Original Article(s)