Knee osteoarthritis is a chronic disease that is frequently observed among the musculoskeletal system diseases, and is characterized by pain in the knee joint and limitation of movement, which can limit activities of daily living. Knee osteoarthritis is more common in obese patients. While physiotherapy agents, personalized exercise programs, analgesics, nonsteroidal anti-inflammatory drugs, as well as hyaluronic acid (HA) injections can be preferred in the treatment of knee osteoarthritis, surgery can be applied in advanced cases unresponsive to treatment. In many studies conducted with intra-articular HA injections, which have gained popularity in recent years, it has been reported that HA administration in knee osteoarthritis has a low risk of side effects and is effective in improving the functional status of the patient.
Our case was a 70-year-old male, with a body mass index of 35, and was diagnosed with bilateral knee osteoarthritis according to the diagnostic criteria of the American College of Rheumatology, in addition to the diagnosis of obesity, and he was at the level of bilateral Stage 3 according to the Kellgren-Lawrence Staging in his direct X-ray (3). Despite 20 sessions of physical therapy, her complaints continued. The patient could not use nonsteroidal anti-inflammatory drugs due to side effects.
15 mg in each milliliter of the patient's 2 knees once a week, for a total of 2 weeks. 2 ml HA (Orthovisc®, Anika Therapeutics, 2 ml, 30 mg) injection containing sodium hyaluronan was administered. As the injection method, the knees were brought to 35 degrees semiflexion while the patient was lying in the supine position, and the application was made under aseptic conditions from the outer side of the patellar tendon with an anterior approach. The patient was asked to practice at home by giving knee joint range of motion home exercises training. Before and 3 weeks after the application, the level of pain was evaluated with the VAS pain scale (4) and the level of activities of daily living was evaluated with the Lysholm Knee Scoring Scale (5), which consists of 8 items, which analyzes the pain and functional status in the knee.
As a result; The patient's VAS pain value decreased from 8 to 5 in the 1st month after the treatment. The Lysholm Knee Scoring Scale decreased from 16 to 34. A bilateral increase of 1 cm in quadriceps diameter was observed. The patient tolerated the application well and no side effects were observed.
It was thought that intra-articular HA application, which has a low risk of side effects and proven effectiveness in providing pain and functional well-being, can be recommended in cases where obesity is a factor in the emergence and rapid progression of knee osteoarthritis and does not respond to the applied treatments.
Anahtar Kelimeler: osteoarthritis, hyaluronic, acid