[Efficacy and role of topical treatment of gonarthrosis]

To relieve pain in patients with knee osteoarthritis, local treatments can be effective both for episodes of acute congestion, characterized by inflammatory pain, intraarticular effusion and risk of acute chondrolysis, and for slowly progressive disease (with a characteristic lack of effusion).

Local care is essential. Relief can be achieved by draining the effusion, associated with corticosteroid injections which may be repeated and followed by a 24 h rest. In case of failure or rapid development of chondrolysis, joint lavage (1 liter saline solution--two 2-mm needles) followed by cortico-steroid infiltration is indicated. Weight bearing should be avoided for 6 weeks (cane) until the effusion has been absorbed. In case of radiological evidence of chondrocalcinosis and chronic serous or bloody effusion, yttrium 90 synoviorthesis may be proposed as an alternative.

In patients with no effusion who continue to suffer despite physical and medical treatment, intraarticular injections of hyaluronic acid can be helpful. They are particularly effective in case of moderate disease. Hyaluronic acid is an interesting alternative to non-steroidal antiinflammatory drugs and is especially indicated after a rapidly progressive period of chondrolysis.