Are Hyaluronic acid or Corticosteroid superior to lactated ringers in the short-term for improving function and quality of life after arthrocentesis?

Publication date: Available online 20 August 2016
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Gary F. Bouloux, Jolie Chou, Deepak Krishnan, Tara Aghaloo, Nora Kahenasa, Julie Ann Smith, Helen Giannakopoulos
PurposeAlthough arthrocentesis has been used for the management of patients with temporomandibular joint pain, the benefit of hyaluronic acid or corticosteroid remains uncertain. The purpose of this study is to assess the efficacy of hyaluronic acid (HA), corticosteroid (CS) and lactated ringers solution (LR) after arthrocentesis for changes in Quality of Life (QoL), jaw function (JFLS) and maximum incisal opening (MIO).MethodsThis is a prospective multicenter double blind randomized clinical trial. Consecutive subjects presenting to the oral and maxillofacial departments at Emory University, University of Pennsylvania, University of California Los Angeles, University of Cincinnati and Oregon Health Sciences University were enrolled in the study. Subjects were randomized to HA, CS or placebo. All subjects had arthrocentesis performed followed by the instillation of HA, CS or lactated ringers solution. All subjects were evaluated clinically at one and three months. The outcome variables were QOL, JFLS and MIO. Univariate, bivariate and multivariate statistics were computed with a P value < 0.05 considered significant.ResultsOne hundred and two subjects were enrolled in the study. Four subjects were lost to follow-up leaving 98 subjects for the analysis of data at one month. An additional 51 subjects were lost to follow-up at three months leaving 51 subjects for the data analysis at this time point. There was no difference between the groups for QOL Mental Health Composite Score (MCS) at one (P=0.70) or three (P=0.69) months. There was no difference between groups for the JFLS at one (P=0.71) or three (P=0.98) months. There was no difference between groups for MIO at one (P=0.47) or three (P=0.31) months. All groups showed within group improvements in JFLS and MIO at one and three months.ConclusionArthrocentesis alone is as efficacious as arthrocentesis with HA or CS in improving jaw function and MIO at one and three months. QoL is not improved with arthrocentesis alone or in combination with CS or HA.



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