Are Hyaluronic acid or Corticosteroid superior to lactated ringers in the short-term reduction of temporomandibular joint pain 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
PurposeArthrocentesis has been used for the management of patients with temporomandibular joint (TMJ) pain with good success. The additional use of hyaluronic acid or corticosteroid remains controversial. The purpose of this study is to compare Hyaluronic acid (HA), Corticosteroid (CS) and Lactated Ringers solution (LR) (placebo) after arthrocentesis.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. Subjects were evaluated clinically at one and three months. The primary outcome variable was pain at one month (VAS). Secondary outcome variables were pain at three months and analgesic consumption. Univariate, bivariate and multivariate statistics were computed with a P value < 0.05 considered significantResultsOne hundred and two subjects were enrolled in the study. Four subjects were lost to follow-up leaving 98 subjects for the final analysis. The mean age of the subjects in the HA, CS and LR groups was 39.6, 44.3 and 51.8 yrs, respectively. (P=0.02). There was no difference in the time to follow-up at one month between the groups (P=0.11). The mean pain reduction in the CS group was 19% (P=0.12) and 36% (P=0.02) for right and left sided procedures, respectively. The mean pain reduction in the HA group was 31% (P=0.01) and 34% (P=0.01) for right and left sided procedures, respectively. The mean pain reduction in the LR group was 43% (P<0.01) and 37% (P<0.01) for right and left sided procedures, respectively. There was no difference in pain reduction between groups (P=0.55). There was no difference in the use of narcotic (P=0.52) or non-steroidal anti-inflammatory drugs (P=0.71) between groups.ConclusionArthrocentesis alone is as efficacious as arthrocentesis with HA or CS in reducing TMJ pain.



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