Abstract
The benefits of surgical treatments for osteoarthritis (OA) of the knee are well established. There are also advances in non-surgical management techniques that can be used successfully, and these may be particularly suitable for patients with mild to moderate disease, or for those in whom surgery is contra-indicated. Intra-articular viscosupplementation is one such method, and studies have shown that this can give short-term symptomatic relief.
Our study looked at the patient perceived benefits of a course of Hylan G-F 20 (Synvisc¯) by comparing the modified Brief Pain Inventory short form (BPI-sf) scores before treatment and after three months. The BPI-sf is a validated, widely used, self-administered questionnaire that measures both sensory and reactive dimensions of the pain using scales of 0-10 or 0-100%. This study included 12 consecutive patients with OA of the knee treated with a course of three Synvisc¯ injections performed a week apart. The data were treated as non-parametric and therefore Wilcoxon signed rank tests were performed. The data are presented as median (IQR).
The results showed statistically significant (p<0.05), and clinically significant (reduction >1 point) improvements in worst, best, and average pain scores (over the previous 24 hours) three months following treatment compared to those before treatment. Relief obtained from routinely taken analgesia was significantly improved from 30%(12.5-57.5) to 75%(42.5-100) (p=0.009) following treatment. There were significant reductions in the interference of the pain with: general activity from 6(4.25-8.75) to 2.5(0-6.75), (p=0.006); mood from 6(2-8) to 0(0-5), (p=0.004); walking ability from 7.5(4-8.75) to 3.5(0.25-6), (p=0.004); normal work from 5.5(3.5-8) to 1.5(0-5), (p=0.009); relations with other people from 4(2-8) to 0(0-3.5), (p=0.006); sleep from 6(3.25-9.5) to 1.5(0-5.75), (p=0.004); enjoyment of life from 6(2.75-8.5) to 1.5(0-6), (p=0.005). All patients found the treatment acceptable.
We conclude that patients reported significant improvements in pain, physical and emotional functioning, and sleep three months following treatment with this viscosupplementation treatment.
