Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2019 Aug 17;20(1):376.
doi: 10.1186/s12891-019-2748-0.

Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis

Thierry Conrozier  1 , Florent Eymard  2 , Mickael Chouk  3 , Xavier Chevalier  2
Affiliations
Randomized Controlled Trial

Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis

Thierry Conrozier et al. BMC Musculoskelet Disord. .

Abstract

Background: Obesity and radiological severity have been identified to be independent predictors of a low rate of response to viscosupplementation (VS), in patients with knee osteoarthritis (OA). Is that enough to formally refute VS in such patients in whom surgery is sometimes contraindicated?

Objectives: To compare pain and function scores before and 6 months after knee VS, according to the weight status (obese versus non obese), the radiological severity (mild/moderate versus severe) and both combined.

Methods: Post-hoc analysis of a prospective, double blind, randomized, multicentre trial, comparing 2 viscosupplements, in patients with symptomatic knee OA. Patients were classified according to body mass index (BMI < or ≥ 30 kg.- 2), OARSI radiological grade (1-2 versus 3) and OMERACT-OARSI response criteria (Yes/No). WOMAC between-group comparisons (obese versus non-obese, OARSI 1-2 versus 3, and both combined) in all patients and in OMERACT-OARSI Responders, were achieved using Mannn-Whitney U test.

Results: One-hundred and sixty-six patients were analyzed: 28.3% were obese, 44% were OARSI grade 3, 42,2% were neither obese nor OARSI 3, whereas 14.5% were obese and OARSI 3. At baseline WOMAC pain score did not differ according to the patients sub-groups (p > 0.05). Six months after VS, WOMAC pain decreased significantly in all patient sub-groups (all p < 0.01). At month 6, WOMAC pain sub-score was significantly lower in non-obese than in obese patients (4.9 ± 4.1 versus 7.1 ± 4.9; p = 0.008) and in patients OARSI 1-2 versus 3 (4.8 ± 4.3 versus 6.4 ± 4.5; p = 0.009). However, in responder patients there was no difference in pain score and pain decrease related to the weight status and the radiological score.

Conclusion: These results do not confirm our previous conclusions that recommended not performing VS in obese patients with severe knee OA. Although the chances of being a responder were much reduced in these patients, the benefit of patients who respond to treatment was similar to that of subjects with normal weight and mild/moderate OA. Different pain phenotypes, more than overweight and advanced disease, might be the main reason for the success or failure of VS.

Keywords: Hyaluronic acid; Knee; OARSI score; Obesity; Osteoarthritis; Viscosupplementation; WOMAC; X-rays.

PubMed Disclaimer

Conflict of interest statement

Thierry Conrozier: received fees from LABRHA SAS for scientific consultant and, board member services.

Xavier Chevalier: received honoraria from LABRHA SAS as a board member

Mickael Chouk: None

Florent Eymard: None

References

    1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–388. doi: 10.1016/j.joca.2014.01.003. - DOI - PubMed
    1. Bruyère Olivier, Cooper Cyrus, Pelletier Jean-Pierre, Branco Jaime, Luisa Brandi Maria, Guillemin Francis, Hochberg Marc C., Kanis John A., Kvien Tore K., Martel-Pelletier Johanne, Rizzoli René, Silverman Stuart, Reginster Jean-Yves. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) Seminars in Arthritis and Rheumatism. 2014;44(3):253–263. doi: 10.1016/j.semarthrit.2014.05.014. - DOI - PubMed
    1. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol. 1993;Suppl; 39:3–9. - PubMed
    1. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: report of a task force of the standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Ann Rheum Dis. 2003;62:1145–1155. doi: 10.1136/ard.2003.011742. - DOI - PMC - PubMed
    1. Rillo O, Riera H, Acosta C, et al. PANLAR Consensus Recommendations for the Management in Osteoarthritis of Hand, Hip, and Knee. J Clin Rheumatol. 2016;22:345–354. doi: 10.1097/RHU.0000000000000449. - DOI - PubMed

Publication types

MeSH terms

Substances