Comparative efficacy of intra-articular hyaluronic acid and corticosteroid injections in the management of knee osteoarthritis

Authors

  • Narendra Singh Kushwaha Department of Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India
  • Pushprajan Chauhan Department of Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India
  • Ashutosh Verma Department of Orthopaedics, King George Medical University, Lucknow, Uttar Pradesh, India
  • Rajan Kumar Kaushal Department of Orthopaedics, ESI, PGIMSR, Basaidarapur, New Delhi, India
  • Mohit Kumar Patel Trauma Centre, SGPGIMS, Lucknow, Uttar Pradesh, India
  • Shambhu Kumar Department of Orthopaedics, MABVIMS and Dr. RMLH, New Delhi, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20233262

Keywords:

Osteoarthritis, Corticosteroid, Hylan G-F 20, WOMAC, Visual analog scale, Knee society rating system, Gender differences

Abstract

Background: Osteoarthritis management includes a myriad of treatment modalities. This study compared the effects of corticosteroid and Hylan G-F 20 injections on knee osteoarthritis outcomes.

Methods: Patients were randomized to receive either corticosteroid or Hylan G-F 20 injections. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index, knee society rating system scores, and visual analog scale scores, collected at baseline, 3 months, and 6 months.

Results: Baseline demographic and clinical parameters were comparable between both groups. The corticosteroid group demonstrated a significant decrease in the WOMAC score over time (p<0.001). Hylan G-F 20 group showed significant improvements in both the WOMAC scores and Visual Analog Scale scores over time (p<0.01). Gender-based sub-analysis suggested both treatments were effective in men, while in women, significant benefits were seen only with Hylan G-F 20.

Conclusions: Both corticosteroid and Hylan G-F 20 demonstrated efficacy in managing knee osteoarthritis, albeit in different domains. The results suggest the need for individualized treatment plans and further research into potential gender-based variations in treatment response.

References

Glyn-Jones S, Palmer AJR, Agricola R. Osteoarthritis. Lancet. 2015;386(9991):376-87.

Losina E, Weinstein AM, Reichmann WM. Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res. 2013;65(5): 703-11.

Zhang W, Moskowitz RW, Nuki G. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartil. 2008; 16(2):137-62.

McAlindon TE, Bannuru RR, Sullivan MC. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartil. 2014;22(3):363-88.

Bellamy N, Campbell J, Robinson V. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2): CD005328.

Juni P, Hari R, Rutjes AWS. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;(10):CD005328.

Hepper CT, Halvorson JJ, Duncan ST. The efficacy and duration of intra-articular corticosteroid injection for knee osteoarthritis: a systematic review of level I studies. J Am Acad Orthop Surg. 2009;17(10):638-46.

Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther. 2003;5(2): 54-67.

Smith MM, Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int. 1987;7(3):113-22.

Altman RD, Manjoo A, Fierlinger A. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: a systematic review. BMC Musculoskelet Disord. 2015;16:321.

Bannuru RR, Schmid CH, Kent DM. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46-54.

Suresh KP. An overview of randomization techniques: An unbiased assessment of outcome in clinical research. J Hum Reprod Sci. 2011;4(1):8-11.

Juni P, Hari R, Rutjes AWS. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;(10):CD005328.

Bannuru RR, Natov NS, Obadan IE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009; 61(12):1704-11.

Bellamy N, Campbell J, Robinson V. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2): CD005328.

Rutjes AW, Jüni P, da Costa BR. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157(3):180-91.

Bannuru RR, Schmid CH, Kent DM. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162(1):46-54.

Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg. 2013;21(9):571-6.

McAlindon TE, LaValley MP, Harvey WF. Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients With Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2017;317(19):1967-75.

Felson DT, Niu J, Guermazi A. Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging. Arthritis Rheum. 2007;56(9):2986-92.

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Published

2023-10-26

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Original Research Articles