TO COMPARE THE EFFICACY OF GENICULAR NERVE BLOCK AND INJECTION OF HYLAN G-F 20 VERSUS GENICULAR NERVE BLOCK ONLY FOR IMPROVING PAIN AND FUNCTION OF GRADE-II AND GRADE-III OSTEOARTHRITIS KNEE
Authors: Gupta Nabarun , Kumar De Saumen , Haldar Rathindra Nath 
Published: May 2021

Introduction: Osteoarthritis (OA) of knee joint is a degenerative joint disease; heterogeneous and progressive in nature. Clinically presented with
stiffness, swelling and pain which leads to a decrease in the quality of life. The presence of chronic knee pain has been found to be a strong predictor
of future disability and dependency in older adults. Usually managed conservatively but if conservative treatment fails, Total Knee Replacement
(TKR) is traditionally considered. This is associated with multiple perioperative morbidities. On the contrary, many patients are not suitable for
surgical procedure and some do not want to go for surgical intervention. As many patients are not surgical candidates due to co-morbidities or
unwillingness; other treatment options available are being sought for. The genicular nerve block (GNB) reduces pain and improves patient
functions by blocking pain transmission of the sensory nerves. Combining this genicular nerve block with viscosupplementation (Injection Hylan
G-F 20) appears to play a role and can be tried in patients suffering in grade II and grade III (radiological grading) osteo arthritis. There is paucity of
information so as to compare the efcacy of genicular nerve block and injection of Hylan G-F 20 versus genicular nerve block only.
Material And Methods: This Parallel group open label randomized controlled trial was done between July, 2018 to December, 2019 (Eighteen
months). Patients with knee pain in grade II and III, OA knee attending the PMR OPD in IPGME&R, Kolkata in the specied tenure was considered
for the study. The selected patients were allotted by random table. All the procedures were performed by single person. A total number of 60 patients
with knee osteoarthritis of grade II and III, who did not respond with conservative management were included. Combined therapy of intra-articular
injection of Hylan G-F 20 and genicular nerve block in Group 1 (Genicular Nerve Block and Injection Hylan G-F 20) and Genicular Nerve Block
only in Group 2, performed to 30 patients in each arm. The three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and
inferior medial (IM) genicular nerves] were selected. Patients were evaluated initially (0 week) and at the 4th and 12th week followed up after
intervention using VAS and WOMAC scale. Ultrasound guided genicular nerve block conducted under strict asepsis after proper dressing and
draping with the visualization of genicular nerves (upper medial, upper lateral and lower medial quadrant) by musculoskeletal probe of Ultrasound
machine (SAMSUNG/ Model PT60A/Musculoskeletal probe 12MHz). Injection Hylan G-F 20 (6 ml) intra-articular injection was given under
strict asepsis.
Results: 47% patients in group 1 and 67% patients in group 2 were in between 60-69 years. There is female preponderance in both the groups.
WOMAC-pain score for dual intervention at 4th week was statistically signicantly lower compared to WOMAC-pain score obtained at any time
of observation and any type of intervention. WOMAC- stiffness score for dual intervention at 4th week was statistically signicantly lower
compared to WOMAC- stiffness score obtained at any time of observation. WOMAC SCORE: The changes in each intervention group at 0-week,
4th week and 12th week were statistically signicant. Statistically signicant difference of two groups were lost during 4th and 12th weeks
observation. VAS: During 4th and 12th weeks observation, statistically signicantly different VAS score was observed among the two
interventions; Genicular nerve block with injection consistently had a lower VAS score. This nding imply that Genicular nerve block alone did
reduce the pain; however, reduction was greater in case of Genicular nerve block with Injection Hylan G-F 20 in both 4th and 12th week of
observation.
Conclusion: Genicular Nerve Block with injection HYLAN GF 20 (Combined Therapy Group) and Genicular Nerve Block alone are effective
method of pain reduction in osteoarthritis knee. Combined Therapy doesn't have an added advantage as per WOMAC Score. But Combined
therapy has a denite advantage over Genicular Nerve Block alone as per VAS Score.