MedDocs Publishers ISSN: 2639-9229 International Journal of Innovative Surgery Open Access | Research Article Ozone + Arthroscopy: Improved Redox Status, Function and Surgical Outcome in Knee Osteoarthritis Patients Olga Sonia Leon Fernandez1*; Gabriel Takon Oru1; Juan Carlos Polo Vega1; Elizabeth Garcia Fernandez1; Renate Viebahn- Hänsler2; Roberto Torres-Carballeira3; Gilberto Lopez Cabreja3; Ramona Marzo Mendez3 1Pharmacy and Food Institute, University of Havana, Calle 222 # 2317 e/23 y 31, Coronela, Lisa, Habana, Havana 10 400, Cuba. 2Medical Society for the use of Ozone in Prevention and Therapy, Iffezheim/Baden-Baden, D-76473, Germany. 3National Institute of Rheumatology, Ministry of Public Health, 10 de Octubre e/Agua Dulce Cruz del Padre, Municipio Cerro, La Habana, Cuba. *Corresponding Author(s): Olga Sonia Leon Fernandez Abstract Pharmacy and Food Institute, University of Havana, Calle Introduction: Ozone preconditioning shows similarities 222 # 2317 e/23 y 31, Coronela, Lisa, Habana, Havana 10 to ischemic preconditioning mechanism which protects 400, Cuba. against ischemic reperfusion injury that is associated to sur- Tel: +53-7272-77-26; gical procedures as well as osteoarthritis clinical condition so the Objective of this study was to compare beneficial -ef Email: [email protected] & [email protected] fects of medical ozone before and 30 days after of arthros- copy with regard to who were not ozone pretreated. Received: Aug 04, 2020 Methods: Osteoarthritis patients (n = 40) were random distributed in two groups (n = 20 each): Group I Arthros- Accepted: Sep 22, 2020 copy (AT), patients who were not pretreated with ozone and Published Online: Sep 25, 2020 Group II (Ozone + AT), patients who received 20 ozone treat- Journal: International Journal of Innovative Surgery ments previous to AT. Before received the surgical procedure Publisher: MedDocs Publishers LLC and 30 days after (outcome) the systemic redox balance, pain, knee function and Quality of Life were assessed. Online edition: http://meddocsonline.org/ Copyright: © Leon Fernandez OS (2020). This Article Results: Ozone preconditioning increased protective sys- is distributed under the terms of Creative Commons temic biomarkers and decreased injury indicators. Improve- Attribution 4.0 International License ment of knee functions displayed positive changes before and the outcome of surgery in comparison with patient who didn´t received medical ozone. In line with above results Keywords: Ozone; Arthroscopy; Osteoarthritis; Outcome. Quality of Life showed similar picture. Both displayed higher positive changes after 30 days of arthroscopy (outcome). Conclusions: Ozone preconditioning + arthroscopy com- bination improved the redox balance, pain and GGT activ- ity in knee osteoarthritis patients therefore they received arthroscopy in better conditions.30 days after joint function and Quality of Life were greater than before surgical proce- dure and outcome improvement was higher in comparison with patients who were not treated previously with medical ozone. Cite this article: Leon Fernandez OS, Oru GT, Vega JSP, Fernandez EG, Viebahn-Hansler R, et al. Ozone + Arthros- copy: Improved Redox Status, Function and Surgical Outcome in Knee Osteoarthritis Patients. Int J Innov Surg. 2020; 3(1): 1011. 1 MedDocs Publishers Introduction using I/R injury in the liver [29] as a model. Taking into account the protective effects of medical ozone against side effects and Osteoarthritis (OA) is a common joint disease and the ma- adverse events which may contribute to the unsatisfactory out- jor cause of disability among the aging population. Progressive come of knee OA surgery, the aim of this project was to inves- articular cartilage degradation is central to OA, and is driven by tigate whether medical ozone preconditioning improves knee well-understood mechanisms of cartilage matrix catabolic ef- arthroscopy in two phases: Prior to surgery (how the patients fects and anti- anabolic effects of chondrocytes [1-5]. However, receive arthroscopy after ozone preconditioning) and 30 days OA is a disease that affects the synovial joint as well as the entire later (arthroscopy outcome) analyzed and displayed by systemic joint system [4]. Changes in periarticular musculature, and in ar- antioxidant-pro-oxidant status, Lysholm Knee Scoring Scale and ticular and periarticular tendons and ligaments, can induce sub- Quality of Life (Medical Outcome Study, MOS) of the patients. stantial biomechanical stress, associated with the loss of other joint homeostatic functions including lubricant production [6]. Materials and methods With the high prevalence of knee OA globally, OA is not only a primary cause of disability among older adults in the United Study design States but it is among the top 10 causes of disability worldwide This prospective, longitudinal and randomized study was [7,8]. Current therapies focus on alleviating pain but pain con- approved by the joint institutional review board (Scientific trol remains poor in 50% of patients [9]. Furthermore, despite and Ethics Committees of the National Institute of Rheumatol- the large disease burden, there are currently no approved dis- ogy, Ministry of Public Health, Cuba, and Pharmacy and Food ease-modifying OA drugs (DMOADs) that can prevent or stop Institute, University of Havana, Cuba) in accordance with the the joint damage caused by the disease [10]. principles of the Declaration of Helsinki [30]. All patients gave Arthroscopy is one of the most common surgical procedures their informed consent to enrolment after receiving adequate used worldwide in knee OA [11]. Annually, there are about one information concerning the study (characteristics of the study, million such surgeries performed in the United States and in benefits and possible adverse effects). Before enrolment, all Sweden (population 9.5 million), the corresponding number participants attended a training program to familiarize them being about 35,000 [12,13]. Nevertheless, recent studies have with the study objectives and treatment plans. Eligible patients questioned its usefulness [14]. From a systematic review and were randomized using a computer-generated list of random meta-analysis of arthroscopic surgery with debridement, and/ numbers (Research Randomizer Form v 4.0). The random se- or partial meniscectomy comparing these with conservative quence was created using freely accessible tools which uses the management strategies, it is concluded that, on a long-term pseudo-random number generator [31], modified by [32]. The basis, patients undergoing knee arthroscopy versus those re- demographic characteristics and the medical history of the par- ceiving conservative management strategies have no important ticipants were recorded, and laboratory tests performed. Ra- benefits regarding pain or function. Although knee arthroscopy diographs of both knees were obtained using anteroposterior has traditionally been a common tool in the treatment of knee projection with support, lateral with 30° flexion, and Merchant OA, a published study [15] combined with a Cochrane review (45°) views. Arthroscopies were all carried out by a single ortho- of the literature up to 2006 [16], has resulted in NICE guidance pedic/arthroscopic surgeon. All patients received three doses of recommending that arthroscopy should not be used in knee os- antibiotic (cephazolin 1 g) as a prophylactic measure. teoarthritis [17]. Postsurgical pain treatment comprised oral metamizole/ As the above mentioned reports reveal contradictory criteria, dipyrone 1 g/8 h and cephazolin 500 mg/12 hrs for 7 days. this suggests that there is a major need to develop new and ef- Inclusion criteria fective complementary therapies. The physiopathological status of knee OA patients needing to undergo arthroscopy should play Men and women, aged 40–75, with body mass index (BMI) < an important role in the surgery outcome. Such patients display 35 kg/m2, OA grades III-IV as an indication for knee arthroscopic both systemic and local oxidative stress inside the joint [18,19], surgery resulting from radiographic and arthroscopic classifica- synovitis [20], pain [21] and ischemia/reperfusion (I/R) injury tion. associated with OA clinical condition [22]. Besides, arthroscopy Exclusion criteria itself promotes minor I/R injury through short and repetitive pressure periods (ischemia) in order to achieve a bloodless field Infectious conditions, use of anticoagulants, history of trau- followed by decompression periods (reperfusion). Therefore, if ma (dislocation or fracture), inflammatory arthritis, microcrys- knee OA patients are pre-treated/receive preconditioning be- talline arthropathies, history of septic arthritis, ligament injury, fore arthroscopy with an agent either avoiding or decreasing non-specific synovitis, angular deformity >10°, chondral lesions such undesirable events, a better surgical outcome may then be G-IV Outerbridge (>1 cm2), neoplasms, or allergy to any of the hoped for. Medical ozone is an ozone/oxygen mixture admin- components of the products under study. Patients taking anti- istered at low concentrations. It is able to improve the antioxi- oxidant agents within less than three months before arthros- dant protective endogenous system and decrease biomolecules copy were also excluded. oxidative damage by means of an ozone-oxidative pre-/post conditioning mechanism [23]. The efficacy of medical ozone has All patients were premedicated with endovenous midazolam been demonstrated in rheumatoid arthritis patients