To Examine the Ultrasound Guided Aspiration and Injection for Knee Osteoarthritis Patients with Joint Effusion---A Biomechanical and Motor Control Study

Knee osteoarthritis (OA) is caused by the degeneration of joints and results in a variety of symptoms including pain, stiffness, swelling, loss of motion ability, and sometimes effusion. The effusion in OA knee leads to decrease of isokinetic muscle strength, hamstring-quaddriceps co-contraction and abnormal gait patterns. With increasing prevalence of OA in Taiwan, various interventions have been introduced to relieve symptoms and reduce effusion accumulation. However, few studies researched the effect of these interventions. The purpose of this study is to investigate not only the clinical effect of echo-guided aspiration of suprapatellar effusion, intraarticular steroid injection and supplement of hyaluronic acid in OA patients with supapatellar effusion, but also the alterations of isokinetic muscle strength, hamstring/quadriceps co-contraction, and gait pattern. This study aims at the following three parts: 1.To investigate the short term and long term effect of echo-guided aspiration of suprapatellar effusion; 2.To investigate the short term and long term effect of echo-guided aspiration of suprapatellar effusion followed by intraarticular steroid or hyaluronic acid injection. 3.) To provide panoramic view of gait pattern alteration produced by echo-guided aspiration, intraarticular steroid and hyaluronic acid injection, and oral NSAID. The evaluation is made by the clinical assessment and objective measurement. This study is a three-year project. Patients with OA knee and suprapatellar effusion are diagnosed by X rays and belong to Kellgren-Lawrence grading scale 1~2 which suggests mild to moderate knee degenerative osteoarthritis, while the suprapatellar effusion is detected by sonographic examination. In the first year, 60 subjects are recruited and randomly divided into one experiment group and one control group. Each group contains 30 subjects. The experiment group receives echo-guided aspiration of suprapatellar effusion and oral NSAID while the control group receives oral NSAID only. Clinical symptoms, isokinetic muscle strength and hamstring/quadriceps co-contraction ratio are assessed in both groups before, immediately after and one week after medical management for short term effect evaluation of echo-guided aspiration. While the same assessment and the observation of effusion re-accumulation is done in both groups four weeks and twelve weeks after medical management for long term effect evaluation. In the second year, 90 subjects are recruited and randomly divided into three experiment groups. Each group contains 30 subjects. All of the three groups receive oral NSAID and echo-guided aspiration of suprapatellar effusion but is then managed differently. The first group then receives intra-articular steroid injection, the second group receives intra-articular hyaluronic acid injection, and the third group receives both intra-articular steroid and hyaluronic acid injection. The first year experiment group receiving NSAID and echo-guided aspiration of suprapatellar effusion serves as control group. Clinical symptoms, isokinetic muscle strength and hamstring/quadriceps co-contraction ratio are assessed in all groups before, immediately after and one week after medical management for short term effect evaluation of intra-articular steroid injection only, hyaluronic acid injection only and most important of all, the synergic effect of intraarticular steroid and hyaluronic acid injection. The same assessment and the observation of effusion re-accumulation is done in all groups four weeks and twelve weeks after medical management for long term effect evaluation. In the third year, 90 subjects are recruited and randomly divided into two experiment groups and one control group. Each group contains 30 patients. Both experiment groups receive echo-guided aspiration, and intraarticular steroid and hyaluronic acid injection. However, the first experiment group receives oral NSAID while the second experiment group doesn’t. The control group receives oral NSAID only. Gait analysis with surface EMG is done in all groups before and at 4 weeks, 8weeks and 12 weeks after medical management for evaluating gait pattern altered by echo-guided aspiration, intraarticular steroid and hyaluronic acid injection, and oral NSAID. The study investigates the effect of the interventions from clinical to biomechanical and motor control aspect. The results will provide us with further knowledge about the benefit of the interventions, and help us to reveal underlying mechanism.

Project ID:PC10301-1146
External Project ID:NSC101-2314-B182-047-MY3