Efficacy of Intra-Articular Ozone Versus Hyaluronic Acid In Patients of Knee Osteoarthritis
DOI:
https://doi.org/10.51253/pafmj.v74i1.6957Keywords:
Hyaluronic acid, Osteoarthritis, Pain, Pain Measurement, AnalgesiaAbstract
Objective: To determine the analgesic efficacy of ozone gas versus hyaluronic acid solution in knee osteoarthritis patients.
Study Design: Quasi-experimental study.
Place and duration of study: Department of Pain Medicine, Combined Military Hospital, Rawalpindi Pakistan, from Jun to Dec 2020.
Methodology: Seventy patients suffering from knee osteoarthritis fulfilling the inclusion criteria were included in this study and were randomly assigned to two equal groups to undergo intra-articular knee injection using either Hyaluronic Acid (Group-H) or Ozone (Group-O). Improvement in the numeric rating scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale were recorded 1, 3 and 6 months after the procedure.
Results: In both groups, the pain score (Group-H Pre-procedure NRS =7.66±0.87 vs. Post-Procedure 6 month NRS = 4.74±0.70, Group-O Pre-procedure NRS = 7.86±0.88 vs. Post-Procedure 6 month NRS = 4.46±0.92) and WOMAC (Group-H Pre-procedure =77.60±7.93 vs. Post-Procedure 6 month =40.31±6.81, Group-O Pre-procedure=75.54±9.40 vs. Post-Procedure 6 month =38.37±8.98) score improved. However, the NRS pain score (p-value = 0.21) and patient WOMAC score (p-value = 0.31) were not significantly different between groups.
Conclusion: Neither Hyaluronic Acid nor Ozone appears superior in decreasing pain scores or physical limitations, particularly for knee osteoarthritis.
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References
Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip
and Knee Osteoarthritis: A Review. JAMA 2021 ; 325(6): 568-
https://doi.org/10.1001/jama.2020.22171
Kon E, Di Matteo B, Delgado D, Cole BJ, Dorotei A, Dragoo JL,
et al. Platelet-rich plasma for the treatment of knee
osteoarthritis: an expert opinion and proposal for a novel
classification and coding system. Expert Opin Biol Ther 2020 ;
(12): 1447-1460.
https://doi.org/10.1080/14712598.2020.1798925
Driban JB, Harkey MS, Barbe MF, Ward RJ, MacKay JW, Davis
JE, et al. Risk factors and the natural history of accelerated knee
osteoarthritis: a narrative review. BMC Musculoskelet Disord
; 21(1): 332.https://doi.org/10.1186/s12891-020-03367-2
Arden NK, Perry TA, Bannuru RR, Bruyère O, Cooper C,
Haugen IK, et al. Non-surgical management of knee
osteoarthritis: comparison of ESCEO and OARSI 2019
guidelines. Nat Rev Rheumatol 2021; 17(1): 59-66.
https://doi.org/10.1038/s41584-020-00523-9
Kan HS, Chan PK, Chiu KY, Yan CH, Yeung SS, Ng YL, et al.
Non-surgical treatment of knee osteoarthritis. Hong Kong Med
J 2019 ; 25(2): 127-133https://doi.org/10.12809/hkmj187600
de Sire A, Agostini F, Lippi L, Mangone M, Marchese S, Cisari
C, et al. Oxygen-Ozone Therapy in the Rehabilitation Field:
State of the Art on Mechanisms of Action, Safety and
Effectiveness in Patients with Musculoskeletal Disorders.
Biomolecules 2021; 11(3): 356.
https://doi.org/10.3390/biom11030356
Giombini A, Menotti F, Di Cesare A, Giovannangeli F, Rizzo M,
Moffa S, et al. Comparison between intrarticular injection of
hyaluronic acid, oxygen ozone, and the combination of both in
the treatment of knee osteoarthrosis. J Biol Regul Homeost
Agents 2016; 30(2): 621-625.
Hedayatabad JJ, Kachooei AR, Chaharjouy NT, Vaziri N,
Mehrad-Majd H, Emadzadeh M et al. The Effect of Ozone (O3)
versus Hyaluronic Acid on Pain and Function in Patients with
Knee Osteoarthritis: A Systematic Review and Meta-Analysis.
Arch Bone Jt Surg 2020;8(3):343-354.
https://doi.org/10.22038/abjs.2020.46925.2292. Erratum in:
Arch Bone Jt Surg 2021; 9(3): 367.
Li Q, Qi X, Zhang Z. Intra-articular oxygen-ozone versus
hyaluronic acid in knee osteoarthritis: A meta-analysis of
randomized controlled trials. Int J Surg 2018; 58: 3-10.
https://doi.org/10.1016/j.ijsu.2018.08.007
Raeissadat SA, Tabibian E, Rayegani SM, Rahimi-Dehgolan S,
Babaei-Ghazani A. An investigation into the efficacy of intraarticular ozone (O2-O3) injection in patients with knee
osteoarthritis: a systematic review and meta-analysis. J Pain Res
; 11: 2537-2550.https://doi.org/10.2147/JPR.S175441
Raeissadat SA, Rayegani SM, Forogh B, Hassan Abadi P,
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: 111-117.https://doi.org/10.2147/JPR.S142755
Invernizzi M, Stagno D, Carda S, Grana E, Picelli A, Smania N,
et al. Safety of intra-articular oxygen-ozone therapy compared
to intra-articular sodium hyaluronate in knee osteoarthritis: A
randomized single blind pilot study. Int J Phys Med Rehabil
; 5(1): 385-390.https://doi.org/10.4172/2329-9096.1000385
Lopes de-Jesus CC, Dos Santos FC, de Jesus LMOB, Monteiro I,
Sant'Ana MSSC, Trevisani VFM. Comparison between intraarticular ozone and placebo in the treatment of knee
osteoarthritis: A randomized, double-blinded, placebocontrolled study. PLoS One 2017; 12(7): e0179185.
https://doi.org/10.1371/journal.pone.0179185
Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S,
Kesiktas FN. Choice of intra-articular injection in treatment of
knee osteoarthritis: platelet-rich plasma, hyaluronic acid or
ozone options. Knee Surg Sports Traumatol Arthrosc 2017;
(2): 485-492.https://doi.org/10.1007/s00167-016-4110-5
de Sire A, Stagno D, Minetto MA, Cisari C, Baricich A,
Invernizzi M. Long-term effects of intra-articular oxygen-ozone
therapy versus hyaluronic acid in older people affected by knee
osteoarthritis: A randomized single-blind extension study. J
Back Musculoskelet Rehabil 2020; 33(3): 347-354.
https://doi.org/10.3233/BMR-181294
Babaei-Ghazani A, Najarzadeh S, Mansoori K, Forogh B,
Madani SP, Ebadi S, et al. The effects of ultrasound-guided
corticosteroid injection compared to oxygen-ozone (O2-O3)
injection in patients with knee osteoarthritis: a randomized
controlled trial. Clin Rheumatol. 2018; 37(9): 2517-2527.
https://doi.org/10.1007/s10067-018-4147-6
Sconza C, Respizzi S, Virelli L, Vandenbulcke F, lLacono F, Kon
E, et al. Oxygen-Ozone Therapy for the Treatment of Knee
Osteoarthritis: A Systematic Review of Randomized Controlled
Trials. Arthroscopy 2020; 36(1): 277-286.
https://doi.org/10.1016/j.arthro.2019.05.043
Iván Arias-Vázquez P, Tovilla-Zárate CA, Hernández-Díaz Y,
González-Castro TB, Juárez-RojopIE ,López-Narváez M L, et al.
Short-Term Therapeutic Effects of Ozone in the Management of
Pain in Knee Osteoarthritis: A Meta-Analysis. PM R 2019; 11(8):