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BACKGROUND: Intraarticular injection of corticosteroids after arthroscopic shoulder surgery is one of the effective methods to relieve shoulder pain and stiffness after surgery. However, whether the use of corticosteroids will increase the complications associated with arthroscopic shoulder surgery is still controversial. OBJECTIVE: To evaluate the safety and clinical efficacy of corticosteroid injections after arthroscopic shoulder surgery. METHODS: The electronic databases including PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for clinical controlled trials of corticosteroid injection into the articular cavity after arthroscopic shoulder surgery from the inception of the databases to September 2019. Data extraction and quality appraisement were performed independently by two investigators according to inclusion and exclusion criteria. Merging and analysis of effect quantities was conducted on RevMan 5.3 software. RESULTS AND CONCLUSION: (1) A total of six comparative studies were included. A total of 7 418 patients were enrolled, of which 3 920 were in the corticosteroid injections group and 3 498 in the control group. (2) Meta-analysis showed that there was no significant difference in tear rate, Constant score, ASES score and UCLA score between the two groups [OR=0.71, 95%CI[0.45, 1.13], P=0.15; MD=-0.99, 95% CI(-12.44, 10.46), P=0.87; MD=-0.12, 95%CI(−1.80, 1.56), P=0.89; MD=−1.46, 95%CI(−3.22, 0.30), P=0.10]. The infection rate of corticosteroid injections group was higher than that of control group (P 0.05). (3) The results showed that the injection of corticosteroids did not increase the rate of postoperative tear, but the injection of corticosteroids within one month after the operation would increase the rate of postoperative infection. Therefore, when using corticosteroids after the operation, clinicians should weigh the advantages and disadvantages according to the actual situation of patients, and pay attention to avoid injecting intraarticular hormone treatment within 1 month after operation.
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PURPOSE: Osteoarthritis (OA) of the temporomandibular joint (TMJ) elicits cartilage and subchondral bone defects. Growth hormone (GH) promotes chondrocyte growth. The aim of this study was to evaluate the efficacy of intra-articular injections of GH to treat TMJ-OA.MATERIALS AND METHODS: Monosodium iodoacetate (MIA) was used to induce OA in the TMJs of rats. After confirming the induction of OA, recombinant human GH was injected into the articular cavities of rats. Concentrations of GH and IGF-1 were measured in the blood and synovial fluid, and OA grades of cartilage and subchondral bone degradation were recorded by histological examination and micro-computed tomography.RESULTS: MIA-induced OA in the rat TMJ upregulated insulin-like growth factor-1 (IGF-1) rather than GH levels. GH and IGF-1 concentrations were increased after local injection of GH, compared with controls. Locally injected GH lowered osteoarthritic scores in the cartilage and subchondral bone of the TMJ.CONCLUSION: Intra-articular injection of GH improved OA scores in rat TMJs in both cartilage and subchondral bone of the condyles without affecting condylar bone growth. These results suggest that intra-articular injection of human GH could be a suitable treatment option for TMJ-OA patients in the future.
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Objective: To study the effect of intraarticular injection of crosslinked-chitosan in the treatment of knee osteoarthritis in rabbits. Methods: Thirty-two New Zealand white rabbits were randomly divided into 4 groups (groups A, B, C, and D; 8 rabbits in each group). The knee osteoarthritis models were prepared by anterior cruciate ligament transection in the left hind in groups A, B, and C. At 4 weeks after operation, the rabbits were received intraarticular injection of 0.6 mL crosslinked-chitosan in group A, 0.3 mL chitosan (once per 2 weeks, for twice) in group B, and 0.3 mL saline (once per 2 weeks, for twice) in group C. The rabbits in group D were treated with sham operation in the left hind, and received intraarticular injection of 0.3 mL saline (once per 2 weeks, for twice). At 8 weeks, the macroscopic observation, histological examination (HE staining, Safranin-fast green double staining, and Mankin score), scanning electron microscopy (SEM) observation, and immunohistochemical staining of collagen type Ⅱ were performed. Results: Macroscopic and SEM observations showed that the cartilage in group D was basically the same as normal and better than that in groups A and B, and the abrasion of cartilage in group C was the most serious. The histological observation results in groups A and B were slightly similar and better than those in group C, but not up to the structure of group D. The macroscopic score and Mankin score of groups B and C were significantly higher than those of group D ( P0.05). Immunohistochemical staining results showed that the collagen type Ⅱ positive percentage of chondrocytes was significantly higher in group D than that in groups B and C, and no significant difference was found between group A and group B ( P>0.05). Conclusion: The crosslinked-chitosan can significantly improve the osteoarthritis of the rabbit knee, delay the pathological changes of osteoarthritis, and decrease the frequency of injection.
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Objective To compare and analyze the curative effects of mediopatellar plica syndrome under different therapies. Methods 147 patients with mediopatellar plica syndrome were enrolled in the study from January 2011 to January 2015 and divided into three groups refer to treatment: Group A, B and C. Each group was also divided in the youth group and the mid-age group. Different treatments were used in the three groups. Group A: drug therapy and physicotherapeutics; Group B: intraarticular injection regularly; Group C: arthroscopic surgical treatment. All patient conditions were assessed with Lysholm score. Results All patients received an average of 11 (9 ~ 13) months follow-up. No blood-vessel and nerve injured and infection occurred. Before receiving treatment, difference in Lysholm score of the three groups showed no statistical difference (F = 0.08, P = 0.926); after treatment, difference revealed significant difference (F = 15.48, P = 0.001). Compared with those before operation and after operation among the three groups, the Lysholm score was improved (tA = 3.43, tB = 6.74, tC = 7.99, P = 0.001). In the rangeability of Lysholm score, the Group C > B > A (F = 66.43, tAB = 5.97, tAC = 11.52, tBC = 5.55, P = 0.001);The general youth group > the general mid-age (t = 7.91, P = 0.001). Conclusion The best therapeutic method for mediopatellar plica syndrome is the arthroscopy. As for mid-age patients, it is necessary to inform them of possibility that prognosis is not well in preoperative planning.
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Objective:To investigate the curative efficacy of combined use of dexamethasone palmitate,vitamin B12 and lidocaine in the treatment of knee osteoarthritis and its effects on the seum levels of interleukin-1 (IL-1),matrix metalloproteinase-3 (MMP-3) and matrix metalloproteinase-1 (TIMP-1).Methods:84 patients with osteoarthritis of knee were selected from August 2014 to July 2015 in Sixth Affiliated Hospital of Xinjiang Medical University and divided into the observation group and the control group according to the order of admission,42 cases in each group.The observation group was given intra-articular injection of dexamethasone palmitate,vitamin B12 and lidocaine,and the control group was treated with traditional Chinese medicine.The clinical efficacy was evaluated after treatment.The changes of serum IL-1,MMP-3,TIMP-1 levels and visual analogue (VAS) score were compared before and at 1 months after treatment.Results:After treatment,the total effective rate of observation group was significantly higher than that of the control group (P＜0.05),the serum levels ofIL-1,MMP-3 levels and VAS score were significantly lower than those before treatment,serum TIMP-1 level was obviously higher than that before treatment(P ＜0.05),the serum levels of IL-1,MMP-3 levels were significantly lower in the observation group than those of the control group,while the serum TIMP-1 level was obviously higher than(P＜0.05) Conclusion:Intra-articular injection with dexamethasone palmitate,vitamin B12 and lidocaine could effectively decrease the levels of serum IL-1 and MMP-3,increase the level ofTIMP-1,and relieve the pain in the patients with knee osteoarthritis.
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Objective To study the intra-articular injection of tranexamic acid combined with drainage effectiveness and safety of clamping 6 hour program of perioperative blood loss of primary total knee replacement patients. Methods 76 cases of unilateral total knee replacement in our hospital for the study. In the control group, Sodium Chloride Solution was injected into the joint cavity to keep the drainage tube open. The experimental group underwent intra-articular injection of tranexamic acid combined with drainage clamping 6 hour treatment. The total blood loss and complications of the experimental group and the control group were compared and analyzed. Results There were no serious adverse reactions in the experimental group and the control group, the incidence rate was 5.26% and 7.89% respectively, and there was no significant difference (P<0.05). The total blood loss in the experimental group was (526.78 ± 229.09) mL, significantly less than that in the control group, and the total blood loss was (879.03 ± 246.80) mL, with statistical difference (P<0.05). The postoperative blood loss in the control group was (489.08 ± 267.80) mL, and the postoperative blood loss in the experimental group was (287.90 ± 245.78) mL, the difference was statistically significant (P<0.05). On the 7 day after operation, the patients in the experimental group and the control group received venous color Doppler ultrasonography, but no venous thrombosis was found. Conclusion The intra-articular injection of tranexamic acid combined with drainage clamping 6 hour scheme in reducing the initial application of patients with single knee arthroplasty, the clinical effect is ideal, can significantly reduce blood loss, high safety, has clinical significance.
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Objective To study the intra-articular injection of tranexamic acid combined with drainage effectiveness and safety of clamping 6 hour program of perioperative blood loss of primary total knee replacement patients. Methods 76 cases of unilateral total knee replacement in our hospital for the study. In the control group, Sodium Chloride Solution was injected into the joint cavity to keep the drainage tube open. The experimental group underwent intra-articular injection of tranexamic acid combined with drainage clamping 6 hour treatment. The total blood loss and complications of the experimental group and the control group were compared and analyzed. Results There were no serious adverse reactions in the experimental group and the control group, the incidence rate was 5.26% and 7.89% respectively, and there was no significant difference (P<0.05). The total blood loss in the experimental group was (526.78 ± 229.09) mL, significantly less than that in the control group, and the total blood loss was (879.03 ± 246.80) mL, with statistical difference (P<0.05). The postoperative blood loss in the control group was (489.08 ± 267.80) mL, and the postoperative blood loss in the experimental group was (287.90 ± 245.78) mL, the difference was statistically significant (P<0.05). On the 7 day after operation, the patients in the experimental group and the control group received venous color Doppler ultrasonography, but no venous thrombosis was found. Conclusion The intra-articular injection of tranexamic acid combined with drainage clamping 6 hour scheme in reducing the initial application of patients with single knee arthroplasty, the clinical effect is ideal, can significantly reduce blood loss, high safety, has clinical significance.
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OBJECTIVE:To observe clinical efficacy and safety of intraarticular injection of betamethasone and hyaluronate in the treatment of elderly knee osteoarthritis. METHODS:A total of 76 elderly patients with knee osteoarthritis were selected from our hospital during Jul. 2012 to Jul. 2015,and then divided into control group and observation group according to random number table,with 38 cases in each group. Control group was given intraarticular injection of Sodium hyaluronate injection 2 mL,once a week,for consecutive 3 weeks. Observation group was given Compound betamethasone injection 1 mL in the first week,and given sodium hyaluronate 2 mL,every week,in the following 2 weeks. Clinical efficacies and the occurrence of ADR as well as VAS score,WOMAC score,GQOLI-74 score and MMP levels before and after treatment were compared between 2 groups. RESULTS:Total response rate of observation group was 92.11％,which was significantly higher than 73.68％ of control group,with statistical significance (P0.05). After treatment,VAS,joint stiffness,joint pain and daily activity re-striction score as well as MMP-1,MMP-3 were decreased significantly in 2 groups,compared to before treatment;physical pain, physiological function,physiological limitations,vitality,social function,emotional function,mental health and GQOLI-74 total score were increased significantly,and the each index of observation group was significantly better than that of control group,with statistical significance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:The intraarticular in-jection of betamethasone and sodium hyaluronate in the treatment of elderly knee osteoarthritis can effectively reduce pain degree, improve knee function and quality of life,have good therapeutic efficacy and safety,the mechanism of which may be associated with the reduction of MMP level.
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BACKGROUND: Arthroscopic shoulder operations (ASS) are often associated with severe postoperative pain. Nerve blocks have been studied for pain in shoulder surgeries. Interscalene brachial plexus blocks (ISB) and an intra-articular injection (IA) have been reported in many studies. The aim of the present study is to evaluate the effect of ISB, a continuous cervical epidural block (CCE) and IA as a means of postoperative pain control and to study the influence of these procedures on postoperative analgesic consumption and after ASS. METHODS: Fifty seven patients who underwent ASS under general anesthesia were randomly assigned to one of three groups: the ISB group (n = 19), the CCE group (n = 19), and the IA group (n = 19). Patients in each group were evaluated on a postoperative numerical rating scale (NRS), their rescue opioid dosage (ROD), and side effects. RESULTS: Postoperative NRSs were found to be higher in the IA group than in the ISB and CCE groups both at rest and on movement. The ROD were 1.6 +/- 2.3, 3.0 +/- 4.9 and 7.1 +/- 7.9 mg morphine equivalent dose in groups CCE, ISB, and IA groups (P = 0.001), respectively, and statistically significant differences were noted between the CCE and IA groups (P = 0.01) but not in between the ISB and CCE groups. CONCLUSIONS: This prospective, randomized study demonstrated that ISB is as effective analgesic technique as a CCE for postoperative pain control in patients undergoing ASS.
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Humans , Analgesia , Anesthesia, Epidural , Anesthesia, General , Arthroscopy , Brachial Plexus , Equidae , Injections, Intra-Articular , Morphine , Nerve Block , Pain, Postoperative , Prospective Studies , ShoulderABSTRACT
Se realizó un estudio descriptivo y transversal de 100 pacientes que acudieron a la consulta especializada de artroscopia de la rodilla del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba (enero de 2007-diciembre del 2008), a fin de evaluar la efectividad de la inyección intraarticular de bupivacaína al 0,25 por ciento como método analgésico, antes de comenzar la cirugía o después de finalizarla. Los integrantes de la casuística se distribuyeron en 2 grupos de igual número; a los de un grupo se les administraron 30 mL de bupivacaína con epinefrina, 20 minutos previos a la operación, y a los del otro se les aplicó lo mismo, pero al concluir la intervención. Quedó demostrada la efectividad de la citada inyección después de la artroscopia, pues redujo la intensidad del dolor posoperatorio y el consumo de analgésicos con un mínimo de complicaciones; en cambio, su uso preventivo no fue efectivo
A cross-sectional and descriptive study was carried out in 100 patients attending the specialized outpatient department of knee arthroscopy at Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital of Santiago de Cuba (January 2007-December 2008) to evaluate the effectiveness of 0,25 per cent bupivacaine intraarticular injection as analgesic method before or after surgery. Patients of the case material were distributed in 2 equal groups; one group received 30 mL of bupivacaine with epinephrine 20 minutes before surgery, and the other received the same but after the intervention. The effectiveness of this injection was demonstrated after the arthroscopy as it reduced intensity of the postoperative pain and the use of analgesics with minimal complications; however their preventive use was not effective
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Humans , Male , Female , Analgesia , Arthroscopy , Bupivacaine , Injections, Intra-Articular , Knee , Secondary Care , Cross-Sectional Studies , Epidemiology, DescriptiveABSTRACT
OBJECTIVE: To assess the accuracy and confidence of the glenohumeral joint injection using an anterior approach in cadavers. METHOD: Eight shoulders from six cadavers were placed supine with arm abduction and external rotation. A single physiatrist performed all the ultrasonography guided injection using an anterior approach. A twenty-one gauge needle was placed into shoulder and intraarticular position was verified by small injection of blue dye. And then the anatomic dissection was done. RESULTS: Seven out of eight (87.5%) were judged to be accurately placed by the anatomic section. In one case, the needle tip was placed in supraglenoid space. In one of the seven accurate cases, the needle traversed the long head tendon of biceps muscle. Confidence of the injections was 87.5%. CONCLUSION: Ultrasonography guided glenohumeral injection using an anterior approach was efficient and safe.
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Arm , Cadaver , Head , Injections, Intra-Articular , Muscles , Needles , Shoulder , Shoulder Joint , TendonsABSTRACT
[Objective]To investigate the prophylactic effects of intra-articular injection of salvia miltiorrhiza on joint adhesion. [Methods]Twenty-four Japanese male rabbits were randomly divided into 3 groups.All right hind knees were made in this way: the auterior wall of suprapatellar bursae was scraped, the posterior wall of suprapatellar bursae and the infrapatellar fat pad were cut off. Each knee was injected with physiological saline 0.3 ml for group A, sodium hyaluronate injection 0.3 ml for group B, and salvia miltiorrhiza injection 0.3 ml for group C. All right hind knees were immobilized in the extension position with a long leg plaster cast for 4 weeks, and injected weekly.[Results]After 4 weeks, the joint movement range in group B or C was larger than that in group A (P<0.01), and there was no significant difference (P>0.05)compared to group B and group C. The scoring of joint adhesions in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C. The scoring of histological changed of the synovial membrane in group B or C was smaller than that in group A (P<0.01), and there was no significant difference(P>0.05)compared to group B and group C.Total collagens content of the synovial membrane in group B or C was smaller than that in group A (P<0.01), while that of group C was less than in group B(P<0.01). [Conclusion]Similarly to sodium hyaluronate, salvia miltiorrhiza can effectively prevent joint adhesions.
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OBJECTIVE: To evaluate the effect of tear after passive ROM exercise during distension arthrography in patients with frozen shoulder. METHOD: Fifteen patients (male: 7, female: 8, mean 57.5 years old) who had complained of shoulder pain with decreased ROM at least 3 months prior were enrolled. Distension arthrogrphy of 35 ml of fluid which contained 10 ml of 1% lidocaine, 1 ml of depomedrol (40 mg), 19 ml of normal saline, and 5 ml of radiocontrast material was injected by a single physician. Then if there was no capsular tear, passive ROM exercise was performed for two minutes. RESULTS: In seven of the thirteen patients, the occurrence of capsular tear was observed after only distension arthrography. In five of the six patients without capsular rupture, the occurrence of capsular tear was observed by passive ROM exercise after distension arthrography. Two patients were interrupted because of severe pain. Clinical outcomes of occurrence of capsular tear by conventional distension arthrography and by passive ROM exercise after distension arthrography were similar. CONCLUSION: Passive ROM exercise after distension arthrography could serve as an effective method of capsular tear in patients with frozen shoulder.
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Humans , Arthrography , Bursitis , Injections, Intra-Articular , Lidocaine , Rupture , Shoulder PainABSTRACT
OBJECTIVE: To evaluate the accuracy of ultrasonography (US) guided intraarticular injection technique comparing to blind technique of the shoulder joint. METHOD: Thirty patients with hemiplegia clinically diagnosed as adhesive capsulitis of the shoulder joint were included. Each patient was treated with serial intraarticular injections with both blind and US guided technique, and then was confirmed by X-ray. We analyzed possible factor including range of motion of the shoulder joint, degree of shoulder subluxation, and clinical stage by Cyriax contributing to failure of intraarticular injection with blind technique. RESULTS: The accuracy of intraarticular injection using blind technique were 46.7% and 33.3% in each physician without significant interpersonal difference. However, US guided intraarticular injection showed the accuracy of 93.3%, significantly higher than blind technique (p<0.05). We could not find significant differences in clinical stage by Cyriax, degree of subluxation between success and failure group by blind technique. However, the range of external and internal rotation of the shoulder joint was more limited in failure group by blind technique (p<0.05). CONCLUSION: Ultrasonography guided injection into the shoulder joint improved the accuracy of injection without exposure to radiation and could be used as one of the promising treatment for patients with adhesive capsulitis of the shoulder.
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Humans , Bursitis , Hemiplegia , Injections, Intra-Articular , Range of Motion, Articular , Shoulder Joint , Shoulder , UltrasonographyABSTRACT
BACKGROUND: This study was designed to demonstrate the peripheral effect of ketamine on the synovia of the knee joint and evaluate the analgesic effect of an intraarticular ketamine injection following knee arthroscopy. METHODS: In a double blind randomized study, 80 ASA class 1 or 2 patients were selected for elective arthroscopic knee surgery. The patients received either 20 ml of normal saline (Group C, n = 19), 20 ml of 0.5% ropivacaine (Group R, n = 21), 1 mg/kg of ketamine mixed with 20 ml of normal saline (Group K, n = 20) or 1 mg/kg of ketamine mixed with 20 ml of 0.5% ropivacaine (Group RK, n = 20), intraarticularly, just prior to wound closure. Postoperative pain was evaluated using a visual analogue scale (VAS 0 to 100) score at 1, 2, 6, 12, 24 and 48 hours after the intraarticular injection, with the side effects found in the four groups also evaluated. The patients' requests for rescue analgesic were recorded, total doses of tarasyn calculated and the overall patient satisfaction also evaluated. RESULTS: The difference in the VAS scores for all time periods was not significant. The number of patients receiving rescue analgesics and the total doses received in Group C were greater than those for the other groups, but this was not significant. No side effects were observed in any of the patients. CONCLUSIONS: Ketamine and local anesthetics have been reported to have peripheral analgesic effects, with variable duration in the measurements of pain and hyperalgesia. However, we failed to demonstrate a peripheral analgesic effect on postoperative arthroscopic pain.
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Humans , Analgesics , Anesthetics, Local , Arthroscopy , Hyperalgesia , Injections, Intra-Articular , Ketamine , Knee Joint , Knee , Pain, Postoperative , Patient Satisfaction , Synovial Fluid , Wounds and InjuriesABSTRACT
OBJECTIVE: To describe the frequency and the nature of acute local reactions following intraarticular hyaluronate injection. METHODS: Retrospective review of patients with osteoarthirtis of the knee treated with intraarticular hyaluronate injection between June, 2001 and March, 2002. The frequency, symptoms and signs, and duration and treatment of the local reactions were analyzed. RESULTS: Nineteen patients received 124 hyaluronates injections to knees. Seven (36.8%) patients developed local reactions in 9 (7.3%) knees. Transient pain occurred in 3 patients. However, persistent pain accompanied by swelling developed in 4 patients. Patients who developed transient pain did not required treatment with self-limiting course, but patients with joint swelling required arthrocentesis and intraarticular corticosteroid injection. CONCLUSION: Intraarticular hyaluronate injection was associated with significant local reactions. Local reactions were more frequent and severe than previously described with occasional development of joint swelling requiring arthrocentesis.
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Humans , Hyaluronic Acid , Injections, Intra-Articular , Joints , Knee , Osteoarthritis , Retrospective StudiesABSTRACT
OBJECTIVE: To evaluate the efficacy of intraarticular injection of hyaluronic acid and steroid in adhesive capsulitis of shoulder. METHOD: Thirty-nine patients with adhesive capsulitis of shoulder were assigned at random to receive intraarticular injection into the glenohumeral joint. The treatment groups were divided into three: group A, triamcinolone 1 ml and 1% lidocaine 3 ml and normal saline 25 ml; group B, hyaluronic acid 2 ml and 1% lidocaine 3 ml and normal saline 25 ml; group C, hyaluronic acid 2 ml and 1% lidocaine 3 ml. The same physical therapy program was carried out for all patients. Pain was assessed by visual analogue scale (VAS) and range of motion (flexion, abduction, internal rotation and external rotation) was measured before injection, and at 30 minutes, 1 week and 2 weeks after injection. RESULTS: The shoulder range of motion (ROM) and VAS of three groups were all improved at 30 minutes, 1 week and 2 weeks after injection compared with those of preinjection, but there was no significant difference in ROM and VAS among three groups. CONCLUSION: We concluded that intraarticular injection of hyaluronic acid would be a good treatment method in adhesive capsulitis of shoulder, specially in patients with risk of steroid use.
Subject(s)
Humans , Adhesives , Bursitis , Hyaluronic Acid , Injections, Intra-Articular , Lidocaine , Range of Motion, Articular , Shoulder Joint , Shoulder , TriamcinoloneABSTRACT
OBJECTIVE: To obtain a effect of intraarticular injection of Sodium Hyaluronate in the patient with degenerative osteoarthritis without restriction of activities of daily living. METHOD: Twenty-five patients were participated in this study. These patients are diagnosed as degenerative osteoarthritis by clinical symtoms and radiographic findings. Sodium hyaluronate, 2.5 ml, 3 mg/ampule, were injected intraarticulary without local anesthesia once a week for 5 times consecutively. For evaluation of the effectiveness of sodium hyaluronate, we assess the parameters for subjective and objective symtoms scored from 0 to 3 on 3 items, and for activities of daily living scored from 0 to 4 on 4 items. And then, we compared these data between pre-injection and at post-injection 2, 4, and 5 weeks. Changes of subjective and objective symtoms, and activities of daily living are assessed using Kellgren's X-ray grading of degenerative osteoarthritis. Improvement of the subjective pain is recorded by visual analogue scale. RESULTS: 1. Subjective and objective symtoms, and activities of daily living with time progression were significantly increased at post-injection 4, 5 weeks compared with pre-injection status (P<0.05). 2. Subjective and objective symtoms, and activities of daily living according to Kellgren's X-ray classification were significantly increased at stage II and III (P<0.05). 3. Visual analogue scale is significantly decreased after injection (P<0.05). CONCLUSION: Intraarticular injection of sodium hyaluronate showed improvement of patient's subjective and objective symtoms, and activities of daily living. The improvement was pronounced in the cases of high grade of degenerative osteoarthritis (stage II, III) according to Kellgren's X-ray classification as well as low grade (Stage I).