1837 - The Effects of Viscosupplmentation on Locomotor Function in Early-Stage Osteoporotic Patients with Knee Osteoarthritis

Disclosures: All the Authors have no disclosures. INTRODUCTION: A critical appraisal of the current evidence-based research offers no guidance in the treatment of early stages of knee arthritis disability in the elderly population. Furthermore, the progressive loss of the cartilage integrity compromises function of the diseased knee during everyday activities. As a consequence, this results in different biomechanical strategies to compensate for the uncontrolled balance, thus predisposing osteoporotic Patients to falling and fragility fractures possibly leading to fatal consequences (1).The purpose of this study was to analyze hyaluronic acid (HA) effects exerted in terms of pain relief, improved knee functional outcomes and consequently locomotor function in osteoporotic elderly patients affected by early-stage knee osteoarthritis.METHODS: Twenty-four low-bone-density patients affected by knee osteoarthritis, were randomly selected to receive HA injection. Inclusion criteria were: age > 65 years, good general health and cognitive status, early arthritis (stage1/2, confirmed by x-rays), normal or controlled blood pressure, no eye and/or ear problems, low bone mineral density (BMD). All the Patients received one HA injection for three consecutive weeks. VAS, satisfaction index, KOOS (2), WOMAC (3), and gait parameters performing a instrumented Timed Up and Go (TUG) Test (4), were evaluated before and after the procedure at the beginning (T0), at week 1 (W1) and at week 2 (W2). The locomotor function was quantitatively evaluated extracting signals while performing a simple clinical test like the TUG test (Total, Sit-to Walk, Gait, Turning, Walk-to-Sit). The test was instrumented by a tri-axial accelerometer (Fig.1) worn on the lower back, by means of an elastic waist belt at the level of the fifth lumbar vertebra. RESULTS SECTION: All the Patients reported a significant reduction of VAS after HA injection: W1< T0 (p<0.001) and W2<W1 (p<0.05).KOOS and WOMAC Test was significantly improved after HA injection: W1>T0 (p<0.05) W2>W1 (p>0.001) accordingly with satisfaction index (T1 vs T0= ns, T2>T0 (p<0.005). Furthermore, Average Sit-to-Walk Velocity, W1<T0 (p<0.05) and W2<T0=(p<0.005), and Average Turning Velocity, W1<T0 (p<0.05) and W2<T0=(p<0.001), significantly decrease over time. Postural maintenance rate improved at 3 weeks: W1<T0 (p<0.05) and W2<T0 (p<0.01).DISCUSSION: Locomotor function disorders are growing public health problem due to their association with falls and fall-related injuries. This is the first study that quantitatively determines the effect of viscosupplementation on postural stability and risk of fall in osteoporotic subjects with osteoarthritis.Finding of our study revealed a significant improvement not only of knee function, but also of postural balance after viscosupplementation in osteoporotic Patients affected by early osteoarthritis. One of the explanatory factors for the postural stability improvement is pain relief obtained immediately after the first injection. Previous study assessed the effect of HA performed a TOG test using a balance device (5), but in our study we employed an accelerometer to obtain reliable real-time gait parameters during TOG test. SIGNIFICANCE/CLINICAL RELEVANCE: Even if osteoarthritis progression cannot be stopped, it is possible to reduce pain in the short term, improve functional outcomes and balance, which consequentially can significantly affect quality of life, reduce risk of falls and related-fragility fracture consequences.REFERENCES: 1) Pandya NK, Piotrowski GA, Pottenger L, Draganich LF. Pain relief in knee osteoarthritis reduces the propensity to trip on an obstacle.Gait Posture. 2007 Jan;25(1):106-11. Epub 2006 Mar 10.2) Roos EM, Roos HP, Lohmander LS, Ekdahl C and Beynnon BD Knee Injury and Osteoarthritis Outcome Score (KOOS) u2013 development of a self-administered outcome measure J Orthop Sports Phys Ther 1998, 28:88-963) Bellamy N, Buchanan WW, Goldsmith CH, Campbell J and Stitt LW Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee J Rheumatol 1988, 15:1833-404) Mellone S, Tacconi C, Chiari L. Validity of a Smartphone-based instrumented Timed Up and Go.Gait Posture. 2012 May;36(1):163-5. 5) Khalaj N, Abu Osman NA, Mokhtar AH, George J, Abas WA. Effect of intra-articular hyaluronic injection on postural stability and risk of fall in patients with bilateral knee osteoarthritis. ScientificWorldJournal. 2014;2014:815184.

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