Effectiveness of intra‑articular ozone injections on outcomes of post‑arthroscopic surgery for knee osteoarthritis

Wang,Xiangjiang; Wang,Guiqing; Liu,Chunlei; Cai,Daozhang

doi:10.3892/etm.2018.6101

Effectiveness of intra‑articular ozone injections on outcomes of post‑arthroscopic surgery for knee osteoarthritis

Authors:
- Xiangjiang Wang
- Guiqing Wang
- Chunlei Liu
- Daozhang Cai
View Affiliations

Affiliations: Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China, Department of Orthopedics, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong 511508, P.R. China
Published online on: April 25, 2018 https://doi.org/10.3892/etm.2018.6101
Pages: 5323-5329
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The purpose of the present study was to evaluate intra‑articular ozone injection following arthroscopic surgery for knee osteoarthritis (OA) with regard to its efficacy in pain reduction, joint function and quality of life improvement. The present study retrospectively evaluated 80 patients with symptomatic knee OA (Kellgren‑Lawrence grade II or III), who either did or did not receive 20 ml of 20 µg/ml ozone as an intra‑articular injection after arthroscopic surgery. The minimum follow‑up period was 12 months. The outcomes evaluated for knee OA were pain on the Visual Analogue Scale (VAS), Lequesne Index, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Clinical Global Impression (CGI). The VAS score in the ozone group was significantly better than that in the control group at all post‑operative follow‑up time‑points (P<0.05). The ozone group also exhibited a significantly greater improvement in Lequesne Index scores (P<0.05). In the ozone group, the score on the WOMAC‑pain, WOMAC‑stiffness and WOMAC‑function subscales, as well as the total WOMAC score decreased significantly (P<0.05). Furthermore, in the ozone group a significantly higher number of patients (P<0.05) with better CGI grades was encountered compared with that in the control group at the 12‑month follow‑up assessment, despite comparable baseline values in all aforementioned clinical measures between the two groups of patients. The present study suggests that intra‑articular ozone injections after arthroscopic surgery may effectively improve the outcomes of arthroscopic surgery in terms of pain relief, functional improvement and quality of life in patients with knee OA of Kellgren‑Lawrence grade II or III.

View Figures

View References

1	Hawamdeh M Z and Al-Ajlouni JM: The clinical pattern of knee osteoarthritis in jordan: A hospital based study. Int J Med Sci. 10:790–795. 2013. View Article : Google Scholar : PubMed/NCBI
2	Pearse EO and Craig DM: Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy. 19:963–968. 2003. View Article : Google Scholar : PubMed/NCBI
3	Hunt SA, Jazrawi LM and Sherman OH: Arthroscopic management of osteoarthritis of the knee. J Am Acad Orthop Surg. 10:356–363. 2002. View Article : Google Scholar : PubMed/NCBI
4	Jackson RW and Dieterichs C: The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration: A 4- to 6-year symptomatic follow-up. Arthroscopy. 19:13–20. 2003. View Article : Google Scholar : PubMed/NCBI
5	Figueroa D, Calvo R, Villalón IE, Meleán P, Novoa F and Vaisman A: Clinical outcomes after arthroscopic treatment of knee osteoarthritis. Knee. 20:591–594. 2013. View Article : Google Scholar : PubMed/NCBI
6	Forster MC and Straw R: A prospective randomized trial comparing intra-articular hyalgan injection and arthroscopic washout for knee osteoarthritis. Knee. 10:291–293. 2003. View Article : Google Scholar : PubMed/NCBI
7	Mathies B: Effects of viscoseal, a synovial fluid substitute, on recovery after arthroscopic partial meniscectomy and joint lavage. Knee Surg Sports Traumatol Arthrosc. 14:32–39. 2006. View Article : Google Scholar : PubMed/NCBI
8	Hempfling H: Intra-articular hyaluronic acid after knee arthroscopy: A two-year study. Knee Surg Sports Traumatol Arthrosc. 15:537–546. 2007. View Article : Google Scholar : PubMed/NCBI
9	Ulucay C, Altintas F, Ugutmen E and Beksaç B: The use of arthroscopic debridement and viscosupplementation in knee osteoarthritis. Acta Orthop Traumatol Turc. 41:337–342. 2007.(In Turkish). PubMed/NCBI
10	Zietz PM and Selesnick H: The use of hylan G-F 20 after knee arthroscopy in an active patient population with knee osteoarthritis. Arthroscopy. 24:416–422. 2008. View Article : Google Scholar : PubMed/NCBI
11	Bocci V: Ozone as Janus: This controversial gas can be either toxic or medically useful. Mediators Inflamm. 13:3–11. 2004. View Article : Google Scholar : PubMed/NCBI
12	Fernandez-Cuadros ME, Perez-Moro OS and Mirón-Canelo JA: Could ozone be used as a feasible future treatment in osteoarthritis of the knee? Diversity Equal Health Care. 13:232–239. 2016.
13	Swapan ΚΜ, Rajesh P, Pallab D, Partha PD, Asim KP, Jayanta R, Halder N and Rathindra NH: Role of intra-articular ozone in osteo-arthritis of knee for functional and symptomatic improvement. Ind J Phys Med Rehabil. 22:65–69. 2011.
14	Borrelli E, Alexandre A, Iliakis E, Alexandre A and Bocci V: Disk herniation and knee arthritis as chronic oxidative stress disieases: The therapeutic role of oxygen ozone therapy. J Arthritis. 4:1612015.
15	Zhang JF, Zhan XQ, Hu HW, Yang Q and Wang XH: Clinical results of medical ozone combined with sodium hyaluronate for knee osteoarthritis. Orthop J China. 5:362–365. 2010.(In Chinese).
16	Kellgren JH and Lawrence JS: Radiological assessment of osteo arthrosis. Ann Rheum Dis. 16:494–502. 1957. View Article : Google Scholar : PubMed/NCBI
17	Price DD, McGrath PA, Rafii A and Buckingham B: The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 17:45–56. 1983. View Article : Google Scholar : PubMed/NCBI
18	Hashemi M, Jalili P, Mennati S, Koosha A, Rohanifar R, Madadi F, Razavi SS and Taheri F: The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med. 5:e275852015. View Article : Google Scholar : PubMed/NCBI
19	Lequesne MG: The algofunctional indices for hip and knee osteoarthritis. J Rheumatol. 24:779–781. 1997.PubMed/NCBI
20	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. 15:1833–1840. 1988.PubMed/NCBI
21	Aaron RK, Skolnick AH, Reinert SE and Ciombor DM: Arthroscopic debridement for osteoarthritis of the knee. J Bone Joint Surg Am. 88:936–943. 2006. View Article : Google Scholar : PubMed/NCBI
22	Shin CS and Lee JH: Arthroscopic treatment for osteoarthritic knee. Knee Surg Relat Res. 24:187–192. 2012. View Article : Google Scholar : PubMed/NCBI
23	Huskin JP, Vandekerckhove B, Delincé P, Verdonk R, Dubuc JE, Willems S, Hardy P, Blanco FJ, Charrois O and Handelberg F: Multicentre, prospective, open study to evaluate the safety and efficacy of hylan G-F 20 in knee osteoarthritis subjects presenting with pain following arthroscopic meniscectomy. Knee Surg Sports Traumatol Arthrosc. 16:747–752. 2008. View Article : Google Scholar : PubMed/NCBI
24	Calunga J L, Menéndez S, León R, Chang S, Guanche D, Balbín A, Zayas J and García P: Application of ozone therapy in patients withknee osteoarthritis. Ozone: Science & Engineering. 34:469–475. 2012. View Article : Google Scholar
25	Bocci VA: Scientific and medical aspects of ozone therapy. State of the art. Arch Med Res. 37:425–435. 2006. View Article : Google Scholar : PubMed/NCBI
26	Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S and 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. 25:485–492. 2017. View Article : Google Scholar : PubMed/NCBI
27	Chansoria M, Upadhyay S, Panwar S, Shivhare P and Vyas N: Comparative efficacy of intraarticular injection of combination of ozone and steroid and ozone alone in patients with primary knee osteoarthritis: A prospective, randomized clinical analysis. J Recent Adv Pain. 2:11–14. 2016. View Article : Google Scholar
28	Invernizzi M, Stagno D, Carda S, Grana E, Picelli A, Smania N, Cisari C and Baricich A: 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. 5:3852017.
29	de Jesus Lopes CC, Dos Santos FC, de Jesus LMOB, Monteiro I, Sant'Ana MSSC and Trevisani VFM: Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study. PLoS One. 12:e01791852017. View Article : Google Scholar : PubMed/NCBI
30	Fernández-Cuadros ME, Pérez-Moro OS, Albaladejo-Florin MJ, et al: Ozone improves pain, function and quality of life in patients with knee osteoarthritis: A prospective quasi-experimental before-after study. Middle East J Rehabil Health. 4:e418212017.