Background & Aims
Osteoarthritis (OA) knee: degenerative disease of knee joint. OA knee commonly leads to loss of knee joint cartilage, subchondral sclerosis and changes in capsule of joint and synovial membrane. Age, obesity, positive history in family, trauma, shape of joint, genetic susceptibility, inflammation etc. are few of the various factors that affect knee OA. Knee joint’s functional capacity is adversely affected by excessive weight on knee. OA of knee is a noteworthy reason leading to impairment of mobility. Pain from OA is a key reason for which patients look for medical help. Due to the finite lifespan of joint replacements with implant wear along with accompanying risk for joint revision, conservative treatment method are of major emphasis in the younger and middle- aged patients, with multiple co-morbidities and not willing for surgery. AIM: To compare the efficacy of different modalities of treatment available for osteoarthritis knee using WOMAC Score.
Methods
Analytical Cross Sectional study. Study duration: 2 years with 6 months follow up. Total 140 patients of osteoarthritis knee who were on conservative treatment or took Intra articular Platelet Rich Plasma, Intra articular Hyaluronic acid injection or had Radiofrequency Ablation of Genicular Nerves, were included in the study. All the patients were examined and investigated during their first visit and then regularly assessed for pain, stiffness and physical function using WOMAC Score at regular interval of 1 month for 6 months. Older patients in the study tended to be chosen for conservative management. In our study we used the modified- CRD Pune version of WOMAC index. The data obtained was than subjected to statistical analysis. WOMAC score: Western Ontario And McMaster Universities Osteoarthritis Index.
Results
For most of the months, mean pain score was lowest with IA Hyaluronic acid. The maximum fall was observed in Hyaluronic acid group in first 3 monthsThe difference between mean stiffness score became significant only after 2 months. The conservative group showed gradual decline till 5 months.In grade 3 OA all the four modalities were observed lowest pain scores were seen with RFA in all the follow up monthsThe difference between stiffness score in grade 3 OA amongst the groups was significant for most period. The lowest scores were observed in Hyaluronic acid group after 2 months. In first 2 months the lowest score was in RFA group. In grade 3 OA the p value for physical function was significant during whole observation period. The lowest scores were observed with hyaluronic acid group followed by RFA group. The scores of other two groups were higher and showed gradual decline.
Conclusions
Grading of osteoarthritis is important in determining treatment modalities. For patients with Grade II and Grade III OA patients with conservative treatment had poorer outcomes in terms of pain, physical function and stiffness. Patients with Grade III also had better pain scores upon treatment with RFA. Considering variable responses based on treatment modalities, individual patient needs should be kept in mind before opting for treatment. We suggest conducting similar studies with a larger patient sample size, with special emphasis on longer duration of follow up, patient affordability and quality of life in patients undergoing different modalities of treatment.
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Presenting Author
Bhuvna Ahuja
Poster Authors
Bhuvna Ahuja
MD (Anesthesiology )
Lok Nayak Hospital, New Delhi, India
Lead Author
Topics
- Access to Care