Very-high-molecular-weight vs high-molecular-weight hyaluronic acid injections show long-term sustained benefits in the treatment of osteoarthritis of the knee: a 15-year Indian cohort study

Journal of Cartilage & Joint Preservation Pub Date : 2024-12-01 DOI:10.1016/j.jcjp.2024.100213

Anish Kumar Aggarwal , Nakul Aggarwal , Jane Fitzpatrick

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Abstract

Introduction

Lack of confidence in intra-articular hyaluronic acid injections for osteoarthritis (OA) may result from conflicting guidelines and pooling of results for different molecular weight products.

Objectives

The objectives were to determine responder rates to injections of very-high-molecular-weight hyaluronic acid (VHMW-HA) vs high-molecular-weight hyaluronic acid (HMW-HA) for knee OA and treatment efficacy measured by the interval between follow-up injections.

Methods

A retrospective analysis of a 15-year cohort from a single center. Inclusion criteria: adults with Kellgren-Lawrence Grade III or IV knee OA treated with hyaluronic acid injections. Subjects were stratified into 2 groups based on the molecular weight of the hyaluronic acid. Outcome measures were responder rates with improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores of >30% from baseline vs nonresponders; those with a response lasting >6 months after each injection were considered sustained responders.

Results

In total, 2037 (female 1467 [72.02%] and male 570 [27.98%]) patients were treated. The overall primary responder rate was 73.44% (1496). VHMW-HA had significantly higher primary responders (75.21% vs 70.22%, P = .015) and significantly lower nonresponders (24.79% vs 29.78%, P = .015). As a subset of primary responders, the sustained responders had greater responses with VHMW-HA vs HMW-HA (85.54% vs 67.06%, P < .0001) and lower dropouts (14.46% vs 32.94%, P < .0001). The average interval between the first and the third injections was longer for VHMW-HA vs HMW-HA—5.67 vs 1.95 years (P < .0001).

Conclusions

About 73.44% of subjects responded to treatment with intra-articular hyaluronic acid. The sustained response was greater in VHMW-HA vs HMW-HA and VHMW-HA has a longer duration of effect than HMW-HA.

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一项为期15年的印度队列研究显示，超高分子量透明质酸注射与高分子量透明质酸注射在治疗膝关节骨关节炎方面显示出长期持续的益处

对骨关节炎（OA）关节内透明质酸注射缺乏信心可能是由于不同分子量产品的指导方针相互矛盾和结果汇总。目的确定注射超高分子量透明质酸（VHMW-HA）与高分子量透明质酸（HMW-HA）治疗膝关节OA的应答率，并通过随访注射间隔测量治疗效果。方法对单中心15年队列进行回顾性分析。纳入标准：接受透明质酸注射治疗的成人kelgren - lawrence III级或IV级膝关节OA。根据透明质酸的分子量将受试者分为两组。结果测量指标为：西安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分较基线改善30%的应答率和无应答率；每次注射后反应持续6个月的人被认为是持续应答者。结果共治疗患者2037例，其中女性1467例（72.02%），男性570例（27.98%）。总主要应答率为73.44%（1496例）。VHMW-HA的主要应答者（75.21% vs 70.22%, P = 0.015）显著高于无应答者（24.79% vs 29.78%, P = 0.015）。作为主要应答者的一个子集，持续应答者对VHMW-HA比HMW-HA有更大的应答(85.54%比67.06%,P <；0.0001)和更低的辍学率(14.46% vs 32.94%, P <；。)。VHMW-HA和hmw - ha第一次和第三次注射的平均间隔时间更长，分别为5.67年和1.95年(P <；。)。结论73.44%的患者对关节内透明质酸治疗有应答。VHMW-HA比HMW-HA的持续反应更大，VHMW-HA的作用持续时间比HMW-HA长。

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来源期刊

Journal of Cartilage & Joint Preservation

CiteScore

0.90

自引率

0.00%

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