Hyaluronic acid compared with corticosteroid injections for the treatment of osteoarthritis of the knee: a randomized control trail (original) (raw)
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Orthopedics and Rheumatology Open Access Journal, 2017
Background: Osteoarthritis is one of the most common degenerative disorders of cartilage in old age the treatment and prevention of which poses a tremendous challenge. The aim of this study was to compare the effects of hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis. Materials and Methods: In this clinical trial, 34patients with knee osteoarthritis were enrolled. Patients were randomly divided into two groups. In this study hyaluronic acid was administrated at a dose of 20mg per 2ml (3 infusions every 2 weeks) and triamcinolone acetate was administrated at a dose of 40mg per 1cc and 1cc of lidocaine (1injection). Pain, joint stiffness, movement restriction and grad of osteoarthritis were compared in the two groups. Results: The results showed that hyaluronic acid relieved movement restriction (41.58 to 28.35) (PV = 0.001) and corticosteroids reduced pain (14.52 to 12.52) (PV = 0/011) in patients Conclusion: The results suggested the effect of hyaluronic acid on reducing restriction of movement and corticosteroids on pain relief in patients.
Clinical Cases in Mineral and Bone Metabolism, 2017
Introduction. Although intra-articular injections of hyaluronic acid (HA) are common non-operative measures used in clinical practice in the management of symptomatic osteoarthritis, there is a great controversy on their efficacy and safety compared to corticosteroids (CSs). Efficacy. Conflicting results have been reported in clinical trials and meta-analysis due to methodological differences in study design, along with collection, analysis, and interpretation of data. Even if some studies reported small or no differences of HA compared with CSs (or inferred that HA is not more effective than saline as a placebo), in general CSs have shown to be superior in the short term (especially on pain control), while better results have been reported with HA at subsequent evaluations, but with only a moderate effect after 26 weeks. Safety. Mild or moderate adverse events have generally been reported after HA injections, the most common being injection site pain. HA is generally considered safe compared to CSs or saline. Furthermore, HA has shown to be safe also after a previous course of injections. Conclusions. Conflicting results have been reported on the efficacy and safety of HA. Guidelines are controversial and in most of the cases "uncertain" recommendations are provided due to inconclusive evidence in literature. However, HA does not seem to have significantly higher side effects when compared to saline or CSs injections, and provides better medium-term control of symptoms in patients with mild to moderate knee osteoarthritis.
International Journal of Orthopaedics Sciences, 2018
Background: Osteoarthritis (OA) knee is a most common chronic degenerative condition effecting old age group individuals. Intraarticular (IA) injections is the final non-operative modality and includes corticosteroids, viscosupplements and blood-derived products. In this study we compare the therapeutic efficacy of intra-articular hyaluronic acid (HA) and corticosteroids (CS) for OA knee. Methods: It is prospective randomized study done during April 2016 to January 2018. Total 100 patients with OA knee were enrolled and randomised into two groups. Patients receiving Hyaluronic acid (group A) and Corticosteroids (Group B). Patients were graded using Kellgren and Lawrence classification. Visual analogue score and Knee society score were calculated before giving injections and at 1st-month, 3rd-month and 6th-month post treatment and results were compared. Results: Group A and Group B includes 50 patient in each group. The mean age of the study population is 64 years with majority being females (81 patients). At one month, group B group had better pain relief and functional outcome compared to group A. At 3 months, Group A had better functional outcome, whereas, there was no significant difference in pain relief between both the groups. At 6 months, patients in both the groups had pain relief and improved functional outcome compared to baseline, but there was no significant difference in outcome between both the groups. Conclusion: Short term efficacy is better in CS compared to HA. Both group A and Group B had no significant difference in pain relief and functional outcome by the end of 6 months.
The Journal of Bone and Joint Surgery, 2016
Background: The treatment of knee osteoarthritis with hyaluronic acid or corticosteroid injection has been widely used. The purpose of this study was to compare the efficacy of hyaluronic acid (hylan G-F 20) with triamcinolone acetonide as a single intra-articular injection for knee osteoarthritis. Methods: This study was a prospective, randomized, double-blind clinical trial. Participants with symptomatic knee osteoarthritis were recruited. They were randomized to receive a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1% lidocaine with epinephrine. The primary outcomes were knee pain severity, knee function, and range of motion at 6 months. Ninety-nine patients were assessed before injection and underwent a 6-month follow-up. Patients and evaluators were blinded. Multilevel regression models were used to estimate differences between the groups. Results: At the 6-month follow-up, compared with patients who took hylan G-F 20, patients who took triamcinolone acetonide had similar improvement in knee pain, knee function, and range of motion. The difference in mean outcome scores between groups was, with regard to knee pain, a visual analog scale (VAS) score of 3 points (95% confidence interval [95% CI], 26 to 11 points); with regard to knee function, a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of 0 points (95% CI, 28 to 6 points); and, with regard to range of motion, flexion of 21°(95% CI, 25°to 2°) and extension of 0°(95% CI, 20.5°to 0.5°). However, patients who took triamcinolone acetonide had better pain improvement from 24 hours until 1 week after injection; the mean difference between groups with regard to the VAS score was 12 points (95% CI, 5 to 20 points; p = 0.002) at 24 hours and 9 points (95% CI, 1 to 15 points; p = 0.018) at 1 week. At 2 weeks after injection, patients who took triamcinolone acetonide also had better knee functional improvement; the mean difference between groups for the modified WOMAC score was 6 points (95% CI, 0.7 to 12 points; p = 0.03). Both groups had improvement in pain, knee function, and range of motion during the 6-month follow-up (p < 0.0001). Conclusions: Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee functional improvement in the second week.
International Journal of Orthopaedics Sciences, 2021
Introduction: Osteoarthritis is a degenerative joint disease affecting middle aged to elderly population. Trial of conservative management in form of intra-articular injection with drugs like corticosteroid and hyaluronic acid have been in use for quite some time. We aim to test the efficacy of these drugs when given individually as well in combination in providing pain relief in patients with early-stage osteoarthritis. Materials and Methods: A prospective study conducted over a period of 4 years (2015-2019) was conducted with a sample size of 150 patients with 50 patients divided equally into 3 groups receiving corticosteroid, hyaluronic acid and combination of both respectively. Patients in age group of 40-65 years and with Kellgren Lawrence Grade I and II were included in the study. Functional scoring was evaluated pre-procedure, post-procedure at 1 month, and at regular interval of 3 months till 18 months. Visual analogue scale (VAS) and Knee society scoring (KSS) were used to evaluate the results. Results: Mean age of the patients included in the study was 57.3 years with 59% female and 41% male patients. Mean VAS score and mean KSS in corticosteroid group (CS) at 3 months follow-up were 4.92 and 152.81 respectively (p< 0.01). For the hyaluronic acid (HA) group, patients had a good relief till 9 months with a mean VAS at 9 months-4.91 and Mean KSS at 9 months-155.26 (p<0.01). However, the combined group showed significantly long pain free period upto 12 months (p<0.001). At end of followup, CS group, HA group and CS with HA group had 12, 8 and 3 patients respectively opting for surgical intervention. Conclusion: Intra-articular injections provide a good and long period of pain relief in early arthritis. Coinjection of steroids with hyaluronic acid are far superior to any of these drugs administered individually.
Osteoarthritis and Cartilage, 2022
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International Journal of Research in Orthopaedics
Background: Osteoarthritis of knee is a chronic degenerative joint disease which leads to pain, swelling and stiffness. Intra-articular hyaluronic acid or steroids are being used for its treatment. The purpose of the present study was to assess the effect of intra articular hyaluronic acid in comparison to steroids for knee osteoarthritis.Methods: A prospective randomized study including 70 patients (121 knees) diagnosed with osteoarthritis of knee, were randomly divided into two groups: 35 patients (58 knees) were given intra-articular hyaluronic acid and 35 patients (63 knees) were given intra-articular methylprednisolone. The outcome was evaluated with knee society score (KSS) and visual analog scale (VAS) before the injection and 1, 3 and 6 months after the injection.Results: The mean KSS pain and function scores increased while VAS decreased in both the groups. All the scores showed improvement at 6 months follow up. In both the groups, the scores at 6 months were significantly...
Managing knee ostheoarthritis: efficacy of hyaluronic acid injections
Acta reumatologica portuguesa, 2013
Osteoarthritis (OA) is the most common form of chronic arthritis worldwide. The etiology of pain in osteoarthritis is multifactoral, and includes mechanical and inflammatory processes. The use of intra-articular viscosupplementation in the nonoperative management of patients with osteoarthritis has become quite popular. Recent clinical data have demonstrated that the anti-inflammatory and chondroprotective actions of hyaluronic acid viscosupplementation reduce pain, from 4 to 14 weeks after injection, while improving patient function. Viscosupplements are comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events, and hyaluronic acid has more prolonged effects than IA corticosteroids. Although several randomized controlled trials have established the efficacy of this treatment modality, additional high quality randomized control studies with appropriate comparison are still required to clearly define the role of intra...