AB0600 VISCOSUPPLEMENTATION VERSUS PHYSICAL REHABILITATION IN KNEE OSTEOARTHRITIS COMPARATIVE STUDY ABOUT 117 CASES

Abstract

Background: Viscosupplementation with hyaluronic acid, and physical rehabilitation are part of the adjunct treatments for osteoarthritis, and particularly knee osteoarthritis.They can be used alone or combined. Objectives: To compare the efficacy of rehabilitation and viscosupplementation in patients followed for stage II and III osteoarthritis. Methods: This is a cross-sectional study, conducted in the department of rheumatology of the University Hospital ofIbn Rochd, Casablanca, between August 2020 and December 2020. Inclusion criteria: patients with stage II and III knee osteoarthritis fulfilling the ACR criteria. The diagnosis was made on standard x-rays including antero-posterior and lateral views. The functionalassessmentwas made with functional algo indices, WOMAC and Lequesnne. Pain was assessed with a visual analogue scale (VAS) on Day 0 and after 3 months. The patients were divided into 3 groups of 39 patients, the first (G1) received an infiltration of hyaluronic acid according to different protocols (multiple injections or single injection), the second (G2) benefited from a rehabilitation program twiceor three timesa week for three months, and the third group (G3) benefited from viscosupplementation associated with rehabilitation. Patients who received an intra-articular corticosteroid injection in the last 3 months were excluded. Results: There were 117 patients. The mean age was 59.6 ± 8.6, with a female predominance of 96.8%. Knee osteoarthritis was clinically patent for 5.8 years, with an average of 7.4 painful flares. Gonarthrosis was bicompartmental in 52 patients and tri-compartmental in 18 patients. 45% had a family history of osteoarthritis. 28% were hypertensive, 18 patients were diabetic and 51.87% were obese according to the body mass index, with an average of 30.5 ± 5.2 kg/m2. 65% had already received oral anti-arthritis drugs for an average of 1 year. Functional improvement was approximately 38% in G1, 26% in G2, and 42% in G3. A significant algo-functional improvement was noted in G1 (p = 0.04) and G3 (p = 0.03). LEQUESNE's index went from an average of 8 in the 3 groups to an average of 4 inG1 and G3 versus 6 in G2, which corresponds to an average handicap (p = 0.2). The final value of the WOMAC index in G1 was 26.57 versus 32.21 in G2 (p = 0.01) and versus 22.36 in G3 (p = 0.02). Conclusion: In our study, the final evaluation showed a decrease in pain and an improvement in functional capacity ranging from 36 to 58%. This improvement in algo-functional indices was significantly more marked in G3[1]. Our study shows that the combination of visco-supplementation with physical rehabilitation gives better results by improving the algo-functional indices than by visco-supplementation alone. Our findings are consistent with the results of the literature[2].