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A Comparative Assessment of Autologous Conditioned Serum and Ozone for Knee Osteoarthritis Treatment: Mid-Term Follow up

Masoud Hashemi, Hossein Adlkhoo, Payman Dadkhah, Ramin Rohanifar, Mehrdad Taheri
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Abstract

Background: Knee osteoarthritis is a common disease associated with knee pain, physical disability, and joint stiffness. The use of non-surgical treatment methods in patients with knee osteoarthritis is important. Autologous conditioned serum (ACS) is a new regenerative therapeutic method that was investigated by a limited number of clinical trials. So far, using ACS in patients with Knee osteoarthritis remains to be controversial among physicians. Thus, the current study was carried out to compare the therapeutic effects of intra-articular ACS and ozone injections in patients with knee osteoarthritis.
Materials and Methods: This prospective, double-blind randomized clinical trial was conducted among 60 patients (30= interleukin-1 receptor antagonist (IL-1Ra) group, 30= ozone group) with knee osteoarthritis, who referred to the Pain Management Clinic of Akhtar Educational Hospital during 2018 to 2019. In the IL-1Ra group, 2 ml of IL-1Ra was injected into the knee joint. The regimen protocol consisted of 4 injections, performed on the first, seventh, fourteenth, and twenty-first days of the treatment and ozone group, 10 ml of ozone (30 μg/ml) + 5 ml of lidocaine 1% were injected into the knee joint. The regimen protocol consisted of 3 injections, performed on the first day of the treatment, one month after the first injection, and two months after the first injection. The severity of pain was assessed by the patients’ self-report of pain and using the visual analog scale (VAS), before the treatment and 1, 3 and 6 months after the treatment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires were also measured at before and 6 months following treatment.
Results: The changes in the VAS pain at different time periods showed statistically significant differences in the two groups, (P=0.0001). There was no significant difference between the two groups before the treatment and one month and three months after the initiation of the treatment; however, there was a significant difference between the two groups six months after the initiation of the treatment (P=0.0001). KOOS scores of symptoms, daily activities, and athletic and recreational functions were significantly higher in the IL-1Ra group, and the WOMAC scores of physical function and joint stiffness and the overall scores were significantly higher in the IL-1Ra group, (p<0.05).
Conclusion: The intra-articular injection of IL-1Ra is a low-invasive, safe, effective, and long-acting method. In patients with knee osteoarthritis, clinical improvements and responses to the intra-articular IL-1Ra injection are better and longer compared to ozone injection. Therefore, it can be considered as a suitable choice in treating patients with chronic knee pain.

 


Keywords

Autologous conditioned serum, Ozone, knee osteoarthritis, Outcome

References

M HawamdehZ, Al‑Ajlouni JM. The clinical pattern of knee osteoarthritis in jordan: A hospital based study. Int J Med Sci. 2013;10:790‑5.

Pearse EO, Craig DM. Partial meniscectomy in the presence of severe osteoarthritis does not hasten the symptomatic progression of osteoarthritis. Arthroscopy. 2003;19:963‑8.

Hunt SA, Jazrawi LM and Sherman OH: Arthroscopic management of osteoarthritis of the knee. J Am Acad Orthop Surg. 2002;10:356‑63.

Bocci V. Ozone as Janus: This controversial gas can be either toxic or medically useful. Mediators Inflamm. 2004;13:311.

Al-Jaziri AA, Mahmoodi SM. Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis. Saudi Med J. 2008;29(4):553–7.

Babaei-Ghazani A, Karimi N, Forogh B, et al. Comparison of ultrasoundguided local ozone (O2-O3) injection vs corticosteroid injection in the treatment of chronic plantar fasciitis: a randomized clinical trial. Pain Med. 2018.

Karimzadeh A, Raeissadat SA, Erfani-Fam S, Sedighipour L, Babaei-Ghazani A. Autologous whole blood versus corticosteroid local injection in treatment of plantar fasciitis: A randomized, controlled multicenter clinical trial. ClinRheumatol. 2017;36 (3):661–9.

Hashemi M, Jalili P, Mennati S, Sh M, et al. The effects of prolotherapy with hypertonic dextrose versus prolozone (intraarticular ozone) in patients with knee osteoarthritis. Anesth Pain Med. 2015;5(5):e27585.

Raeissadat SA, Rayegani SM, Sadeghi F, Rahimi-Dehgolan S. Comparison of ozone and lidocaine injection efficacy vs dry needling in myofascial pain syndrome patients. J Pain Res. 2018;11:1273–9.

Velio Alvaro Bocci VA. Scientific and medical aspects of ozone therapy: state of the art. Arch Med Res. 2006;37(4):425–35.

Wang B, Dong GZ, Yx J, Yan CS. Case–control study on therapeutic effects of ozone and triamcinolone acetonide on the treatment of meniscal injury. ZhongguoGu Shang. 2014;27(4):295-8.

Borrelli E, Alexandre A, Iliakis E, Alexandre A, Bocci V. Disc herniation and knee arthritis as chronic oxidative stress diseases: the therapeutic role of oxygen ozone therapy. J Arthritis. 2015;4:161.

Manoto SL, Maepa MJ, Motaung SK. Medical ozone therapy as a potential treatment modality for regeneration of damaged articular cartilage in osteoarthritis. Saudi J Biol Sci. 2018;25(4):672–9.

Mishra SK, Pramanik R, Das P, et al. Role of intra-articular ozone in osteo-arthritis of knee for functional and symptomatic improvement. Ind J Phys Med Rehabilit. 2011;22(2):65-9.

Orlowsky EW, Kraus VB. The role of innate immunity in osteoarthritis: when our first line of defense goes on the offensive. J Rheumatol. 2015;42:363-71.

Woodell-May J, Matuska A, Oyster M, et al. Autologous protein solution inhibits MMP-13 production by IL-1beta and TNFalpha-stimulated human articular chondrocytes. J Orthop Res. 2011;29:1320–6.

Wehling P, Moser C, Frisbie D. Autologous Conditioned Serum in the Treatment of Orthopedic Diseases. Biodrugs. 2007;21:323-32.

Dhillon MS, Behera P, Patel S, Shetty V. Orthobiologics and platelet rich plasma. Indian J Orthop. 2014;48:1-9.

Evans CH, Chevalier X, Wehling P. Autologous Conditioned

Serum. Phys Med RehabilClin N Am. 2016;4:893-908.

BaselgaGarcía-Escudero J, Miguel Hernández Trillos P. Treatment of Osteoarthritis of the Knee with a Combination of Autologous Conditioned Serum and Physiotherapy: A Two-Year Observational Study. PLoS One. 2016;10:e0145551.

Baltzer AW, Moser C, Jansen SA, Krauspe R. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage. 2009;17:152-60.

Baltzer AW, Ostapczuk MS, Stosch D, Seidel F, Granrath M. A New Treatment for Hip Osteoarthritis: Clinical Evidence for the Efficacy of Autologous Conditioned Serum. Orthop Rev (Pavia). 2013;5:59-64.

Becker C, Heidersdorf S, Drewlo S, de Rodriguez SZ, Kramer J, Willburger RE. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression: an investigator-initiated, prospective, double-blind, reference-controlled study. Spine (PhilaPa 1976). 2007;32:1803-8.

Wright-Carpenter T, Opolon P, Appell HJ, Meijer H, Wehling P, Mir LM. Treatment of Muscle Injuries by Local Administration of Autologous Conditioned Serum: Animal Experiments Using a Muscle Contusion Model. Int J Sports Med. 2004;25:582-7.

Frisbie DD, Ghivizzani SC, Robbins PD, et al. Treatment of experimental equine osteoarthritis by in vivo delivery of the equine interleukin-1 receptor antagonist gene. Gene Ther. 2002;9:12-20.

Geburek F, Lietzau M, Beineke A, Rohn K, Stadler PM. Effect of a single injection of autologous conditioned serum (ACS) on tendon healing in equine naturally occurring tendinopathies. Stem Cell Res Ther. 2015;6:126.

Lai LP, Stitik TP, Foye PM, et al. Use of plateletrich plasma in intra-articular knee injections for osteoarthritis: a systematic review. PM R. 2015;7:637-48.

Baselga Garcia-Escudero J, Miguel Hernandez Trillos P. Treatment of osteoarthritis of the knee with a combination of autologous conditioned serum and physiotherapy: a twoyear Observational Study. PloS One. 2015;10:e0145551.

Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS) – Development of a Self-Administered Outcome Measure. J Orthop Sports Phys Ther. 1998;28(2):88-96.

Bellamy N. WOMAC Osteoarthritis Index User Guide. Version VII. 2004; p: 14.

Lopes de Jesus CC, dos Santos FC, de Jesus L, Monteiro I, Sant’ana M, Trevisani VFM. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: a randomized, double-blinded, placebo-controlled study. PLoS ONE. 2017;12(7):179-85.

Lequesne MG. The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 1997;24:779-81.

Giombini A, Menotti F, di Cesare A, et al. Comparison between intraarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis. J BiolRegulHomeost Agents. 2016;30(2):621-5.

Duymus TM, Mutlu S, Dernek B, et al. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):485-92.

Raeissadat SA, Rayegani SM, Forogh B, Hassan Abadi P, Moridnia M, Rahimi-Dehgolan S. Intra-articular ozone or hyaluronic acid injection: which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial. J Pain Res. 2018;11:111–7.

Invernizzi M, Stagno D, Carda S, Grana E, Picelli A. Safety of intraarticular oxygen-ozone therapy compared to intra-articular sodium hyaluronate in knee osteoarthritis: a randomized single blind pilot study. Int J Phys Med Rehabil. 2017;5:385.

Pavelka K, Gatterova J, Olejarova M, Machacek S, Giacovelli G, Rovati LC. Glucosamine sulfate use and delay of progression of knee osteoarthritis: a 3-year, randomized, placebo-controlled, double-blind study. Arch Intern Med. 2002;162(18):2113e23.

Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K,

et al. Development of criteria for the classification and reporting of osteoarthritis. Classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;39(10):29-49.

Richards MM, Maxwell JS, Weng L, Angelos MG, Golzarian J. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. Phys Sportsmed. 2016;44:101-8.

De Windt TS, Vonk LA, Slaper-Cortenbach ICM, Van Den Broek MPH, Nizak R, MHP Van Rijen, et al. Allogeneic mesenchymal stem cells stimulate cartilage regeneration and are safe for single stage cartilage repair in humans upon mixture with recycled autologous chondrons. Stem Cells. 2017;35:256-64.




DOI: https://doi.org/10.22037/nbm.v1i1.25891