Efficacy Analysis of Arthroscopic Surgery Combined with Intra-articular Chitosan Injection for Stage II-III Knee Osteoarthritis in Patients with Abnormal Body Weight

Abstract

Objective: Weight is an influential factor in knee osteoarthritis (KOA). However, the effect of abnormal body weight on chitosan’s efficacy in treating KOA is unclear. This study aimed to explore the differences in the effectiveness of arthroscopic surgery combined with intra-articular chitosan injection for KOA in patients with abnormal body weight.

Methods: Patients with stage II-III KOA (Kellgren–Lawrence rating, K-L) undergoing arthroscopic surgery were recruited for this clinical study from January 2020 to September 2021. Based on body mass index (BMI) and intra-articular chitosan injection, patients with KOA undergoing arthroscopic surgery (138 patients) were divided into four groups: low-weight-non-injection (Lw-N, BMI <18.5); low-weight-chitosan injection (Lw-CS, BMI <18.5); overweight-non-injection (Ow-N, BMI ≥25); overweight-chitosan injection (Ow-CS, BMI ≥25). A 2-year follow-up was conducted to evaluate various indicators, including the visual analogue scale (VAS) and the Western Ontario and McMaster Universities osteoarthritis index score (WOMAC). Statistical analyses were performed using relevant parametric or non-parametric tests.

Results: In total, 138 patients with KOA were included in this study. There were no significant differences in gender, age, and incidence of chronic residual pain after arthroscopy among the four groups (p > 0.05). The proportion of patients undergoing subsequent knee arthroplasty during the 2-year follow-up period was significantly higher in the Ow-CS group (20/35) than in the Lw-CS group (12/39) (p < 0.05). The K-L rating showed an overall increasing trend over time, with the K-L rating in the Ow-N and Ow-CS groups significantly higher than that in the Lw-CS group at the final follow-up (p < 0.05). VAS and WOMAC scores significantly decreased at 1 and 3 months post-arthroscopy and then increased. One month after arthroscopy, VAS was significantly lower (p < 0.05) in the intra-articular chitosan injection groups (Lw-CS and Ow-CS) compared with the non-injection groups (Lw-N and Ow-N). VAS was lower in the Ow-CS group than in the Lw-CS group (p < 0.05). There was no significant difference in WOMAC between the intra-articular chitosan injection and non-injection groups at each time point (Lw-N vs. Lw-CS, Ow-N vs. Ow-CS, p > 0.05).

Conclusion: Arthroscopic surgery combined with intra-articular chitosan injection shows short-term positive effects in treating KOA. Intra-articular chitosan injection appears to have a greater short-term pain relief effect in obese patients.

Keywords

Abnormal body weight / Arthroscopic surgery / Intra-articular chitosan injection / Knee osteoarthritis / Postoperative chronic residual pain

References

[1] Sharma L. Osteoarthritis of the knee. N Engl J Med. 2021; 384(1): 51–59.

[2] Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. Jama. 2021; 325(6): 568–578.

[3] Sun AR, Udduttula A, Li J, Liu Y, Ren PG, Zhang P. Cartilage tissue engineering for obesity-induced osteoarthritis: physiology, challenges, and future prospects. J Orthop Translat. 2021; 26: 3–15.

[4] Messier SP, Beavers DP, Queen K, Mihalko SL, Miller GD, Losina E, et al. Effect of diet and exercise on knee pain in patients with osteoarthritis and overweight or obesity: a randomized clinical trial. Jama. 2022; 328(22): 2242–2251.

[5] Wang T, He C. Pro-inflammatory cytokines: the link between obesity and osteoarthritis. Cytokine Growth Factor Rev. 2018; 44: 38–50.

[6] Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2002; 347(2): 81–88.

[7] O’Connor D, Johnston RV, Brignardello-Petersen R, Poolman RW, Cyril S, Vandvik PO, et al. Arthroscopic surgery for degenerative knee disease (osteoarthritis including degenerative meniscal tears). Cochrane Database Syst Rev. 2022; 3(3): Cd014328.

[8] Palmer JS, Monk AP, Hopewell S, Bayliss LE, Jackson W, Beard DJ, et al. Surgical interventions for symptomatic mild to moderate knee osteoarthritis. Cochrane Database Syst Rev. 2019; 7(7): Cd012128.

[9] Gregori D, Giacovelli G, Minto C, Barbetta B, Gualtieri F, Azzolina D, et al. Association of Pharmacological Treatments with Long-term Pain Control in patients with knee osteoarthritis: a systematic review and meta-analysis. Jama. 2018; 320(24): 2564–2579.

[10] Mao B, Pan Y, Zhang Z, Yu Z, Li J, Fu W. Efficacy and safety of hyaluronic acid intra-articular injection after arthroscopic knee surgery: a systematic review and meta-analysis. Orthop Surg. 2023; 15(1): 16–27.

[11] Zhou Y, Yang TB, Wei J, Zeng C, li H, Yang T, et al. Single-dose intra-articular ropivacaine after arthroscopic knee surgery decreases post-operative pain without increasing side effects: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2016; 24(5): 1651–1659.

[12] Slemenda C, Brandt KD, Heilman DK, Mazzuca S, Braunstein EM, Katz BP, et al. Quadriceps weakness and osteoarthritis of the knee. Ann Intern Med. 1997; 127(2): 97–104.

[13] Xu J, She G, Gui T, Hou H, Li J, Chen Y, et al. Knee muscle atrophy is a risk factor for development of knee osteoarthritis in a rat model. J Orthop Translat. 2020; 22: 67–72.

[14] Swiecicki A, Li N, O’Donnell J, Said N, Yang J, Mather RC, et al. Deep learning-based algorithm for assessment of knee osteoarthritis severity in radiographs matches performance of radiologists. Comput Biol Med. 2021; 133: 104334.

[15] Price DD, McGrath PA, Rafii A, Buckingham B. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983; 17(1): 45–56.

[16] Collins NJ, Misra D, Felson DT, Crossley KM, Roos EM. Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis Care Res (Hoboken). 2011; 63(Suppl 11): S208–S228.

[17] Rienstra W, Blikman T, Dijkstra B, Stewart R, Zijlstra W, van Raaij T, et al. Effect of preoperative duloxetine treatment on postoperative chronic residual pain after total hip or knee arthroplasty: a randomised controlled trial. BMJ Open. 2021; 11(11): e052944.

[18] Bennell KL, Paterson KL, Metcalf BR, Duong V, Eyles J, Kasza J, et al. Effect of intra-articular platelet-rich plasma vs placebo injection on pain and medial tibial cartilage volume in patients with knee osteoarthritis: the RESTORE randomized clinical trial. Jama. 2021; 326(20): 2021–2030.

[19] Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015; 49(10): 657–672.

[20] Huang PH, Wang CJ, Chou WY, Wang JW, Ko JY. Short-term clinical results of intra-articular PRP injections for early osteoarthritis of the knee. Int J Surg. 2017; 42: 117–122.

[21] Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. Jama. 2003; 290(23): 3115–3121.

[22] Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology. 2019; 293(3): 656–663.

[23] He WW, Kuang MJ, Zhao J, Sun L, Lu B, Wang Y, et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg. 2017; 39: 95–103.

[24] Morici L, Gonzalez-Fernandez P, Jenni S, Porcello A, Allémann E, Jordan O, et al. Nanocrystal-chitosan particles for intra-articular delivery of disease-modifying osteoarthritis drugs. Int J Pharm. 2024; 651: 123754.

[25] Richette P, Poitou C, Garnero P, Vicaut E, Bouillot JL, Lacorte JM, et al. Benefits of massive weight loss on symptoms, systemic inflammation and cartilage turnover in obese patients with knee osteoarthritis. Ann Rheum Dis. 2011; 70(1): 139–144.

[26] Aspden RM. Obesity punches above its weight in osteoarthritis. Nat Rev Rheumatol. 2011; 7(1): 65–68.

[27] Toda Y, Toda T, Takemura S, Wada T, Morimoto T, Ogawa R. Change in body fat, but not body weight or metabolic correlates of obesity, is related to symptomatic relief of obese patients with knee osteoarthritis after a weight control program. J Rheumatol. 1998; 25(11): 2181–2186.

[28] D’Agostino MA, Conaghan P, Le Bars M, Baron G, Grassi W, Martin-Mola E, et al. EULAR report on the use of ultrasonography in painful knee osteoarthritis. Part 1: prevalence of inflammation in osteoarthritis. Ann Rheum Dis. 2005; 64(12): 1703–1709.

[29] Yoshida S, Nishitani K, Yoshitomi H, Kuriyama S, Nakamura S, Fujii T, et al. Knee alignment correction by high tibial osteotomy reduces symptoms and synovial inflammation in knee osteoarthritis accompanied by macrophage phenotypic change from M1 to M2. Arthritis Rheumatol. 2023; 75(6): 950–960.

[30] Neogi T, Guermazi A, Roemer F, Nevitt MC, Scholz J, Arendt-Nielsen L, et al. Association of joint inflammation with pain sensitization in knee osteoarthritis: the multicenter osteoarthritis study. Arthritis Rheumatol. 2016; 68(3): 654–661.

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2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.