Andrey M. Savchenko,

MD, Central Institute of Traumatology and Orthodepics, Moscow, Russia

COMPLEX OZONE-BASED CONSERVATIVE THERAPY FOR HIP JOINT OSTEOARTHRITIS

Osteoarthritis is an important problem of public health, one of the most disabling and costing diseases worldwide. Hip joint osteoarthritis (also known as coxarthrosis) usually affects people aged 40-60 years and in most cases progresses steadily and leads to disability. This degenerative disease still has no efficient treatment, although various methods of cure result in some improvement, like injections of hyaluronic acid or PRP (platelet rich plasma). Recent studies argue that ozone therapy of osteoarthritis reduces inflammation, stimulates the fibroblastic joint repairing abilities [Benvenuti 2006], prove the efficacy of ozone in the reduction of pain and inflammation in osteoarthritis, recovering mobility [Al-Jaziri et al. 2008, Ciobutaru et al. 2014, Mishra et al. 2011, Shallenberger 2011].

For many years, we have used intra-articular ozone-oxygen therapy to diminish articular damage and pain and impove the joint functions, and we have already proved the efficacy of injecting the gas mixture for coxarthritis in 108 patients [Burmakova, Savchenko 2011]. The patients were divided into two identical by sex, age, degree of manifestation of changes in the hip joint of the group. In the control group, patients received a traditional conservative treatment of coxarthrosis, and intra-articular injections of the ozone-oxygen mixture were added to the treatment in the main experimental group. The results indicated high efficacy and safety of the ozone therapy in coxarthrosis of various degrees.

A decade of our clinical experience demonstrate analgesic, anti-inflammatory, immune-modulatory and trophic effects of ozone therapy. We have developed a new variation of the injection technique - the front access to the hip joint, which is a modification of anterior arthroscopic access. The puncture is performed in the position of the patient lying on their back. The point of needle pricking is located 1-1.5 cm below the ligament on a line drawn from the tip of the anterior superior ostium of the ilium bone distally to the femur. After local anesthesia with a 15 cm needle, the femoral neck is reached and an intra-articular injection is performed, using 5.0-7.0 ml of ozone-oxygen mixture (with an ozone concentration of 20 mg\l). With good tolerability, the volume of the ozone-oxygen mixture with each injection increases (maximum volume is 20.0 ml). Active oxygen improves the metabolism of joint and cartilage tissues, preventing further destruction, restoring microcirculation in affected tissues and exerts a regenerating effect. As a result of modulation of the prostaglandin system, which forms intracellular antioxidant defense of the organism, ozone therapy realizes the anti-inflammatory effect of ozone. The analgesic effect of ozonotherapy is due to oxidation of mediators that induce pain, as well as inhibition of catabolic cartilage enzymes. As a result of enhanced release in oxygen tissues, the cation-anion ratio in the altered cell membrane is restored.

To maximize the therapeutic efficacy, we suggest a complex ozone-based method of osteoarthritis cure consisting of synergic combination of 3 successive types of intra-articular injections – (1) ozone-oxygen gas mixture, (2) autologous blood plasma (as a variation of PRP technique), and (3) hyaluronic acid medications for viscosupplementation. Such a complex ozone-based treatment, accompanied with taking chondroprotective medications and regular physical activity (swimming, special hip exercises), patients recover function in walking, going up and down stairs, washing, dressing and working.

To assess the results of our synergic ozone-based cure for osteoarthritis, we have designed a 4-dimentional index basing on classic measures, with some modification [Savchenko 2017]: it scales the osteoarthritis symptoms before and after the treatment in 4 interrelated traditional categories – pain, rigidity and stiffness, movement restrictions, joint function limitations - subdivided into 20 subcategories, with the scores for each varying between 0 and 100 points and in which lower scores indicate better joint status. Unlike some of internationally renowned indicators, our index is free-of-charge for use.

The suggested complex conservative treatment of hip osteoarthritis has resulted into significant decreasing the total manifestation of symptoms, therefore, we can offer the intra-articular ozone therapy with consequent visco-supplementation as a promising, efficient and cost-effective conservative treatment for osteoarthritis, which helps to minimize the symptoms of the disease such as pain, rigidity, inflammation and to diminish further joint destruction.

References

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

2. Benvenuti P. Oxygen-ozone treatment of the knee, shoulder and hip. A personal experience. Rivista italiana di ossigeno-ozonoterapia. 2006; 5:135–44.

3. Bocci V. Ozone as Janus: this controversial gas can be either toxic or medically useful. Mediators Inflamm. 2004; 13(1):3–11.

4. Burmakova G.M., Savchenko A.M. Intra-articular ozone therapy in complex treatment of hip arthrosis. Medicinskiy sovet. N# 7-8, 2011. Pp. 35-38.

5. Ciobutaru C, Ilescu M, Mandru T, Panait M, Argir O. The role of Ozone Therapy in mantaining articular function and in relieving the pain for patients with knee osteoarthritis. ARS Medica Tomitana. 2014; 1(76):25-9.

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

7. Savchenko, Andrey M. Intra-articular ozone in complex treatment of osteoarthritis: assessing the results. Applied and Fundamental Studies : Proceedings of the 10th International Academic Conference. May 20-21, 2017, St. Louis, USA. Science and Innovation Center Publishing House, Ltd., 2017. .

8. Shallenberger F. Prolozone™–Regenerating Joints and Eliminating Pain. J Prolother. 2011; 3(2):630–8.