Type of Article:  Original Research

Volume 11; Issue 1 (February 2023)

Page No.: 4453-4460

DOI: https://dx.doi.org/10.16965/ijpr.2022.192

Hyaluronic acid alone versus hyaluronic acid associated with adelmidrol for Intra-articular treatment of knee osteoarthritis: A long-term follow-up

Maria Chiara Vulpiani 1, Mario Vetrano 1, Sveva Maria Nusca 1, Eleonora Latini 1, Flavia Santoboni 1, Francesca Musa 1, Donatella Trischitta 1, Flaminia Coluzzi 2,3, Davide Lardo 4, Ernesto Ippolito 4.

1 Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences and Translational Medicine, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy.

2 Unit of Anesthesia, Intensive Care and Pain Medicine, Sant’Andrea University Hospital, Rome, Italy.

3 Department of Medical and Surgical Sciences and Biotechnologies, “Sapienza” University of Rome, Latina, Italy.

4 Department of Orthopaedic Surgery, University of “Tor Vergata”, Rome, Italy.

Corresponding Author: Prof. Ernesto Ippolito, Department of Orthopaedic Surgery, University of “Tor Vergata”, Rome, Italy. E-Mail: ernesto.ippolito@uniroma2.it


Maria Chiara Vulpiani: 0000-0002-9943-492X

Mario Vetrano: 0000-0002-8680-4004

Sveva Maria Nusca: 0000-0003-1746-7398

Eleonora Latini: 0000-0003-0032-215X

Flavia Santoboni: 0000-0001-9864-6333

Francesca Musa: 0000-0002-6774-3023

Donatella Trischitta: 0000-0002-1280-5143

Flaminia Coluzzi: 0000-0001-7184-5519

Davide Lardo: 0000-0002-3111-695X

Ernesto lppolito: 0000-0002-3706-7693


Background: Hyaluronic acid (HA) has been used for many years for intra-articular treatment of knee osteoarthritis with satisfactory results. HA associated with Adelmidrol – an anti-neuroinflammatory compound – have been only recently introduced in orthopedic clinical practice with good preliminary results.

Objective: To investigate whether HA associated with Adelmidrol provides better results than HA alone.

Methods: Two cohorts of patients with moderate knee osteoarthritis were treated. Cohort 1 received 5 weekly intra-articular injections of HA during 2017 while Cohort 2, 4 weekly intra-articular injections of HA associated with Adelmidrol during 2018. The patients of the two Cohorts were assessed by WOMAC scale, SF-12 questionnaire and PGIC scale at 1 week (T0), 6 months (T1), 1 year (T2), and 2 years (T3) after the end of treatment. All the data were statistically analyzed. A p-value of <0.05 was considered statistically significant.

Results: According to the WOMAC Scale Cohort 1 had higher mean scores than Cohort 2 at each follow-up time, with a statistically significant difference between the two cohorts at T3 (p<0.03) for all the WOMAC components, except for Stiffness. WOMAC Total mean score worsened statistically significantly only in Cohort 1, from T1 to T3 (T2 vs T1: p=0.0033; T3 vs T2: p=0.0007). The same happened for WOMAC Physical Function (T2 vs T1: p=0.0146; T3 vs T2: p=0.0046) and WOMAC Pain (T2 vs T1: p=0.0004; T3 vs T2: p=0.0002).  WOMAC Stiffness worsened statistically significantly in Cohort 1 from T2 to T3 (T3 vs T2: p=0.0041), while in Cohort 2 no change on WOMAC scale was statistically significant at any time-point, for any components. The mean scores of the SF-12 questionnaire were better in Cohort 2 than in Cohort 1 at each follow-up time for both the Physical and the Mental components, with a statistically significant difference between the two groups for the latter, at T0 (p=0.0001). In both cohorts the mean score of the Physical component decreased from T0 to T3, but the difference was not statistically significant between the two groups (p=0.25). The mean score of the Mental component slightly increased in Cohort 1 and decreased in Cohort 2, without statistically significant differences between the two groups at any time-point. PGIC showed that Cohort 2 scored significantly better than Cohort 1 at T3 (p=0.0336).

Conclusions: Overall, HA associated with Adelmidrol gave better long-term results than HA alone.

KEY WORDS: Hyaluronic acid, Adelmidrol, Palmitoylethanolamide, Knee, Osteoarthritis, Synovitis, Mastocytes, Intra-articular injections, Visco-induction.


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Cite this article: Maria Chiara Vulpiani, Mario Vetrano, Sveva Maria Nusca, Eleonora Latini, Flavia Santoboni, Francesca Musa, Donatella Trischitta, Flaminia Coluzzi, Davide Lardo, Ernesto Ippolito. Hyaluronic acid alone versus hyaluronic acid associated with adelmidrol for Intra-articular treatment of knee osteoarthritis: A long-term follow-up. Int J Physiother Res 2023;11(1):4453-4460. DOI: 10.16965/ijpr.2022.192