The Effectiveness of Intra-Articular Injection of Hypertonic Saline in Pain Control and Function of Patients with Knee Osteoarthritis
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Abstract
Background: To report the effectiveness of intra-articular injection of hypertonic saline in pain reduction and function improvement of patients with knee osteoarthritis.
Methods: Patients with knee pain and dysfunction who fulfilled the American College of Rheumatology criteria and whose illness was sub-acute or chronic were enrolled. We performed a single Intra-articular injection of 5cc of hypertonic saline solution 5%. Measured outcomes were Visual Analogue Scale (VAS) score and Knee injury and osteoarthritis outcome score (KOOS) evaluated before and 1 month after intervention.
Results: a total of 28 patients with mean age of 66.3 years were surveyed. Overall, study participants reported clinically and statistically significant reduction in VAS and KOOS subscales for symptoms, pain, function, daily living, sports, recreational activities and quality of life in one month of follow-up with respect to the patients’ mean baseline scores which were reduced by 24.47%, 42.74%, 54.96%, 43.78% and 63.63%, respectively (P-value<0.05 for all comparisons). Although obese patients (BMI≥30 kg/m2) showed less improvement in terms of pain, sports and quality of life subscales of KOOS subscales, compared with non-obese patients (BMI<30 kg/m2), VAS scale difference was not significant.
Conclusions: Intra-articular injection of hypertonic saline yields a statistically and clinically significant short-term pain reduction and functional improvement of patients with knee osteoarthritis.
1. Raeissadat SA, Tabibian E, Rayegani SM, Rahimi-Dehgolan S,
Babaei-Ghazani A. An investigation into the efficacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: A systematic review and meta-analysis. J Pain Res. 2018;11:2537-50. doi: 10.2147/JPR.S175441. [PubMed: 30498370]. [PubMed Central: PMC6207244].
2. Raeissadat SA, Rayegani SM, Forogh B, Hassan AP, Moridnia M, Rahimi Dehgolan S. Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. J Pain Res. 2018;11:111-7. doi: 10.2147/JPR.S142755. [PubMed: 29379312]. [PubMed Central: PMC5757972].
3. Shanfield S, Campbell P, Baumgarten M, Bloebaum R, Sarmiento A. Synovial fluid osmolality in osteoarthritis and rheumatoid arthritis. Clin Orthop Relat Res. 1988;(235): 289-95. [PubMed: 3416536].
4. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: A systematic review and network meta-analysis. Ann Intern Med. 2015;162(1): 46-54. doi: 10.7326/M14-1231. [PubMed: 25560713].
5. Ike RW, Arnold WJ, Rothschild EW, Shaw HL. Tidal irrigation versus conservative medical management in patients with osteoarthritis of the knee: A prospective randomized study. Tidal Irrigation Cooperating Group. J Rheumatol. 1992;19(5):772-9. [PubMed: 1613709].
6. Goldenberg DL, Egan MS, Cohen AS. Inflammatory synovitis in degenerative joint disease. J Rheumatol. 1982;9(2):204-9. [PubMed: 7097678].
7. Najafi S, Sanati E, Khademi M, Abdorrazaghi F, Mofrad RK, Rezasoltani Z. Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial. Toxicon. 2019;165:69-77. doi: 10.1016/j.toxicon.2019.04.003. [PubMed: 30995453].
8. Nguyen C, Lefevre-Colau MM, Poiraudeau S, Rannou F. Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):184-9. doi: 10.1016/j.rehab.2016.02.008. [PubMed: 27103055].
9. Dawes PT, Kirlew C, Haslock I. Saline washout for knee osteoarthritis: Results of a controlled study. Clin Rheumatol. 1987;6(1):61-3. doi: 10.1007/bf02201002. [PubMed: 3581699].
10. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial. JAMA. 2017;317(19):1967-75. doi: 10.1001/jama.2017.5283. [PubMed: 28510679]. [PubMed Central: PMC5815012].
11. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR Jr, et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: A meta-analysis of evidence level 1 studies. Am J Sports Med. 2017;45(11):2647-53 doi: 10.1177/0363546516680607. [PubMed: 28027657].
12. Freeman JW, Empson YM, Ekwueme EC, Paynter DM, Brolinson PG. Effect of prolotherapy on cellular proliferation and collagen deposition in MC3T3-E1 and patellar tendon fibroblast populations. Transl Res. 2011;158(3):132-9. doi: 10.1016/j.trsl.2011.02.008. [PubMed: 21867978].
13. Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. J Pain Res. 2017;10:1179-87. doi: 10.2147/JPR.S127633. [PubMed: 28553139]. [PubMed Central: PMC5439936].
14. Sit RWS, Wu RWK, Reeves KD, Rabago D, Chan DCC, Yip BHK, et al. Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: A protocol for a triple-blinded randomized controlled trial. BMC Complement Altern Med. 2018;18(1):157. doi: 10.1186/s12906-018-2226-5. [PubMed: 29764447]. [PubMed Central: PMC5952445].
15. Bar-Or D, Rael LT, Brody EN. Use of saline as a placebo in intra-articular injections in osteoarthritis: Potential contributions to nociceptive pain relief. Open Rheumatol J. 2017;11:16-22. doi: 10.2174/1874312901711010016. [PubMed: 28400868]. [PubMed Central: PMC5366377].
16. Skogo NJ, Naili JE, Iversen MD, Brostrom EW, Hedstrom M. Younger age is associated with greater pain expression among patients with knee or hip osteoarthritis scheduled for a joint arthroplasty. BMC Musculoskelet Disord. 2019;20(1):365. doi: 10.1186/s12891-019-2740-8. [PubMed: 31391043]. [PubMed Central: PMC6686370].
Babaei-Ghazani A. An investigation into the efficacy of intra-articular ozone (O2-O3) injection in patients with knee osteoarthritis: A systematic review and meta-analysis. J Pain Res. 2018;11:2537-50. doi: 10.2147/JPR.S175441. [PubMed: 30498370]. [PubMed Central: PMC6207244].
2. Raeissadat SA, Rayegani SM, Forogh B, Hassan AP, Moridnia M, Rahimi Dehgolan S. Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. J Pain Res. 2018;11:111-7. doi: 10.2147/JPR.S142755. [PubMed: 29379312]. [PubMed Central: PMC5757972].
3. Shanfield S, Campbell P, Baumgarten M, Bloebaum R, Sarmiento A. Synovial fluid osmolality in osteoarthritis and rheumatoid arthritis. Clin Orthop Relat Res. 1988;(235): 289-95. [PubMed: 3416536].
4. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: A systematic review and network meta-analysis. Ann Intern Med. 2015;162(1): 46-54. doi: 10.7326/M14-1231. [PubMed: 25560713].
5. Ike RW, Arnold WJ, Rothschild EW, Shaw HL. Tidal irrigation versus conservative medical management in patients with osteoarthritis of the knee: A prospective randomized study. Tidal Irrigation Cooperating Group. J Rheumatol. 1992;19(5):772-9. [PubMed: 1613709].
6. Goldenberg DL, Egan MS, Cohen AS. Inflammatory synovitis in degenerative joint disease. J Rheumatol. 1982;9(2):204-9. [PubMed: 7097678].
7. Najafi S, Sanati E, Khademi M, Abdorrazaghi F, Mofrad RK, Rezasoltani Z. Intra-articular botulinum toxin type A for treatment of knee osteoarthritis: Clinical trial. Toxicon. 2019;165:69-77. doi: 10.1016/j.toxicon.2019.04.003. [PubMed: 30995453].
8. Nguyen C, Lefevre-Colau MM, Poiraudeau S, Rannou F. Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):184-9. doi: 10.1016/j.rehab.2016.02.008. [PubMed: 27103055].
9. Dawes PT, Kirlew C, Haslock I. Saline washout for knee osteoarthritis: Results of a controlled study. Clin Rheumatol. 1987;6(1):61-3. doi: 10.1007/bf02201002. [PubMed: 3581699].
10. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial. JAMA. 2017;317(19):1967-75. doi: 10.1001/jama.2017.5283. [PubMed: 28510679]. [PubMed Central: PMC5815012].
11. Saltzman BM, Leroux T, Meyer MA, Basques BA, Chahal J, Bach BR Jr, et al. The therapeutic effect of intra-articular normal saline injections for knee osteoarthritis: A meta-analysis of evidence level 1 studies. Am J Sports Med. 2017;45(11):2647-53 doi: 10.1177/0363546516680607. [PubMed: 28027657].
12. Freeman JW, Empson YM, Ekwueme EC, Paynter DM, Brolinson PG. Effect of prolotherapy on cellular proliferation and collagen deposition in MC3T3-E1 and patellar tendon fibroblast populations. Transl Res. 2011;158(3):132-9. doi: 10.1016/j.trsl.2011.02.008. [PubMed: 21867978].
13. Rezasoltani Z, Taheri M, Mofrad MK, Mohajerani SA. Periarticular dextrose prolotherapy instead of intra-articular injection for pain and functional improvement in knee osteoarthritis. J Pain Res. 2017;10:1179-87. doi: 10.2147/JPR.S127633. [PubMed: 28553139]. [PubMed Central: PMC5439936].
14. Sit RWS, Wu RWK, Reeves KD, Rabago D, Chan DCC, Yip BHK, et al. Efficacy of intra-articular hypertonic dextrose prolotherapy versus normal saline for knee osteoarthritis: A protocol for a triple-blinded randomized controlled trial. BMC Complement Altern Med. 2018;18(1):157. doi: 10.1186/s12906-018-2226-5. [PubMed: 29764447]. [PubMed Central: PMC5952445].
15. Bar-Or D, Rael LT, Brody EN. Use of saline as a placebo in intra-articular injections in osteoarthritis: Potential contributions to nociceptive pain relief. Open Rheumatol J. 2017;11:16-22. doi: 10.2174/1874312901711010016. [PubMed: 28400868]. [PubMed Central: PMC5366377].
16. Skogo NJ, Naili JE, Iversen MD, Brostrom EW, Hedstrom M. Younger age is associated with greater pain expression among patients with knee or hip osteoarthritis scheduled for a joint arthroplasty. BMC Musculoskelet Disord. 2019;20(1):365. doi: 10.1186/s12891-019-2740-8. [PubMed: 31391043]. [PubMed Central: PMC6686370].
| Files | ||
| Issue | Vol 5, No 1 (2019) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v5i1.3320 | |
| Keywords | ||
| Knee; Osteoarthritis; Injections; Intra-Articular Injections | ||
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How to Cite
1.
Tavana B, Azizi S, Najafi S, Taftian E, Maghbouli N. The Effectiveness of Intra-Articular Injection of Hypertonic Saline in Pain Control and Function of Patients with Knee Osteoarthritis. J Orthop Spine Trauma. 2020;5(1):21-24.
