Changes in Knee Joint Space Width in Treatment with a New Hyaluronic-Based Hydrogel

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Objective: Our purpose was to assess the effect of a new hyaluronic acid-based (Hymovis®) injections on joint space width narrowing in patients diagnosed with knee osteoarthritis.

Methods: A prospective clinical trial was conducted in the Department of Orthopedics and Traumatology II from the Clinical County Hospital, Tîrgu Mureș, Romania. Thirty-five patients diagnosed with idiopathic knee osteoarthritis received two intraarticular injections with hyaluronic acid-based hydrogel (24 mg of hyaluronic acid/3 ml) at one-week interval. Anteroposterior radiographs were obtained before the injections, at six and twelve months after. Minimum joint space width was measured by two senior orthopaedics surgeons at each follow up. Each radiograph was measured again by the same evaluators two weeks apart.

Results: Thirty-one patients were present at the final follow-up. A minor reduction in mean weight was noticed (from 82.2 kg ± 16.2 kg to 80.9 kg ± 16.0, p > 0.398) without any correlation with joint space width narrowing. There were no major changes at the first follow up (6 months) regarding joint space narrowing. A reduction in joint space width was observed however at 12 months varying from 4.4 mm (SD ± 1.64, range 1.8-7.1) at the first assessment to 4.3 mm (SD ± 1.26, range 0.0-6.8) at the final follow-up but with no statistical difference (p=0.237).

Conclusion: No significant modification in joint space width at the final follow-up secondarily proved that two injections of Hymovis® may slow down narrowing in the knee joint space over a one-year period.

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  • 1. Heidari B. Knee osteoarthritis prevalence risk factors pathogenesis and features: Part I. Caspian J Intern Med. 2011 Spring;2(2):205-12.

  • 2. Zhang Y Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med. 2010 Aug;26(3):355-69.

  • 3. Neogi T. The epidemiology and impact of pain in osteoarthritis. Osteoarthritis Cartilage. 2013 Sep;21(9):1145-53.

  • 4. Hochberg MC Altman RD April KT et al - American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand hip and knee. Arthritis Care Res. 2012;64: 465-74.

  • 5. McAlindon TE Bannuru RR Sullivan MC et al - OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014;22:363-88.

  • 6. Altman RD Manjoo A Fierlinger A et al - The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015 Oct;16:321.

  • 7. du Souich P. Absorption distribution and mechanism of action of SYSADOAS. Pharmacol Ther. 2014 Jun;142(3):362-74.

  • 8. Strauss EJ Hart JA Miller MD et al - Hyaluronic acid viscosupplementation and osteoarthritis: current uses and future directions. Am J Sports Med. 2009 Aug;37(8):1636-44.

  • 9. Forsey RW Fisher J Thompson J et al - The effect of hyaluronic acid and phospholipid based lubricants on friction within a human cartilage damage model. Biomaterials. 2006 Sep;27(26):4581-90.

  • 10. Ong KL Anderson AF Niazi F et al - Hyaluronic Acid Injections in Medicare Knee Osteoarthritis Patients Are Associated With Longer Time to Knee Arthroplasty. J Arthroplasty. 2016 Aug;31(8):1667-73.

  • 11. Hunter DJ Zhang YQ Tu X et al - Change in joint space width: hyaline articular cartilage loss or alteration in meniscus? Arthritis Rheum. 2006 Aug;54(8):2488-95.

  • 12. Crema MD Nevitt MC Guermazi A et al - Progression of cartilage damage and meniscal pathology over 30 months is associated with an increase in radiographic tibiofemoral joint space narrowing in persons with knee OA--the MOST study. Osteoarthritis Cartilage. 2014 Oct;22(10):1743-7.

  • 13. Sakellariou G Conaghan PG Zhang W et al - EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis. 2017 Apr 7. pii: annrheumdis-2016-210815.

  • 14. Altman R Brandt K Hochberg M et al - Design and conduct of clinical trials in patients with osteoarthritis: recommendations from a task force of the Osteoarthritis Research Society. Results from a workshop. Osteoarthritis Cartilage 1996;4(4):217e43.

  • 15. Draft guidance for industry: clinical development programs for drugs devices and biological products for the treatment of osteoarthritis. U.S. Department of Health and Human Services Food and Drug Administration Center for Drug Evaluation and Research Center for Biologics Evaluation and Research Center for Devices and Radiological Health. 1999. Available from:

  • 16. Galesso D. An innovative chemistry for intra-articular hyaluronic acid: the MO.RE.® technology evolution of I.A.H.A therapy. 2013;12(3):3-7.

  • 17. Kellgren JH Lawrence JS. Radiological Assessment of Osteo-Arthrosis. Annals of the Rheumatic Diseases. 1957;16(4):494-502.

  • 18. Lee SY. Anterolateral Portal Is Less Painful than Superolateral Portal in Knee Intra-Articular Injection. Knee Surgery & Related Research. 2015;27(4):228-32.

  • 19. Lequesne M. Quantitative Measurements of Joint Space During Progression of Osteoarthritis: Chrondometry. Keuttner GV Ed. Rosemont IL: American Academy of Orthopaedic Surgeons 1995;427e44.

  • 20. Gallagher B Tjoumakaris FP Harwood MI et al - Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. Am J Sports Med. 2015 Mar;43(3):734-44.

  • 21. Oka H Akune T Muraki S et al - The mid-term efficacy of intra-articular hyaluronic acid injections on joint structure: a nested case control study. Mod Rheumatol. 2013 Jul;23(4):722-8.

  • 22. Benazzo F Perticarini L Padolino A et al - A multi-centre open label long-term follow-up study to evaluate the benefits of a new viscoelastic hydrogel (Hymovis®) in the treatment of knee osteoarthritis. Eur Rev Med Pharmacol Sci. 2016 Mar;20(5):959-68

  • 23. Smith MM. A hexadecylamide derivative of hyaluronan (HYMOVIS®) has superior beneficial effects on human osteoarthritic chondrocytes and synoviocytes than unmodified hyaluronan. J Inflamm (Lond). 2013;10:26.

  • 24. Shimizu C. Histomorphometric and biochemical effect of various hyaluronans on early osteoarthritis. J Rheumatol. 1998 Sep;25(9):1813-9

  • 25. Smith MM Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int. 1987;7(3):113-22.

  • 26. Ambrosio L Borzacchiello A Netti PA et al - Rheological study on hyaluronic acid and its derivative solutions. Journal of Macromolecular Science Part A. 1999;36 (7-8): 991-1000.

  • 27. Kon E1 Mandelbaum B Buda R et al - Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011 Nov;27(11):1490-501.

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