Outcomes of intra-articular injection of sodium hyaluronate for the treatment of osteoarthritis of the knee.
Bibliographic record
Abstract
BACKGROUND: Intra-articular injection of hyaluronic acid has become an intervention step between conservative and operative treatment of knee osteoarthritis. This is recommended by the American College of Rheumatology (ACR) and the European League Against Rheumatism (EULAR). However, the expected outcomes and the selection criteria are undetermined and controversial. A few articles have mentioned the long-term result of Sodium Hyaluronate in failed conservative treatment. OBJECTIVE: Determine the clinical outcomes of treatment with three intra-articular Sodium Hyaluronate injections (500-730 kilodalton (KDA), Hyalgan) in knee-osteoarthritis patients who failed conservative treat-ment. MATERIAL AND METHOD: This was an uncontrolled, retrospective-cohort study with at least a 24-month followup period. The outcomes of the treatment were evaluated by questionnaires and telephone calls. The primary efficacy parameter was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and the secondary efficacy parameter was delay or cancellation of any surgical treatments during the followup period. Patients who had undergone surgical treatments were placed in the non-response group. The response group has repeated treatment every year. RESULTS: One hundred and eighty-three patients (208 knees) treated with intra-articular Sodium Hyaluronate were classified into three groups according to radiographic assessment. In group 1, narrowing joint space (Ahlback grade 1-2), WOMAC score improved from 70.46 to 26.55 (p < 0.0001), 41 in 46 patients (44/49 knees) did not require any surgical treatments. In group 2, bony attrition (Ahlback grade 3-4), WOMAC score improved from 70.19 to 40.38 (p < 0.0001), 47 in 70 patients (51/78 knees) did not require surgical treatment. In group 3, lateral subluxation (Ahlback grade 5) WOMAC score improved from 64.71 to 32.67 (p < 0.0001), 58 in 67 patients (69/81knees) did not require surgical treatment. The result from WOMAC subscale analysis revealed an improvement in pain, stiffness, and function in all groups (p < 0.0001), but did not improve in ambulatory status. CONCLUSION: Intra-articular Sodium Hyaluronate injection, used in knee-osteoarthritis patients who failed conservative treatment, was effective in visible cartilage patients (Ahlback grade 1, 2) without mechanical problems involved. In severe osteoarthritis patients (Ahlback grade 3, 4, 5), this treatment was of less benefit if those patients were young, active, and expected independent ambulation. Surgical treatment may be a procedure of choice to meet patient expectation in improving function and ambulatory status. On the other hand, if patients were old and inactive with household ambulation, using intra-articular Sodium Hyaluronate was beneficial in improving pain, stiffness, and function but not ambulation level with 86.56% of excellent or good in overall satisfaction level. Thus, the radiographic evaluation, age, ambulatory status, and patient expectation may be the key factors to determine successful outcomes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".