Clinical and Functional Outcomes of Intra-articular Hyaluronic Acid Versus Corticosteroids in Knee Osteoarthritis: A Comparative Study

TL;DR

This study compares hyaluronic acid and corticosteroid injections for knee osteoarthritis, finding that hyaluronic acid provides longer-lasting pain relief and better function.

Contribution

The study demonstrates that hyaluronic acid offers sustained benefits over corticosteroids for knee osteoarthritis management.

Findings

Hyaluronic acid (HA) showed superior pain reduction and functional improvement from six weeks onward.

At three months, HA had significantly lower pain scores (NRS) and better WOMAC scores than corticosteroids.

Both treatments improved outcomes, but HA provided longer-lasting effects.

Abstract

Background: Knee osteoarthritis (OA) ranks among the top causes of pain and disability globally, with intra-articular hyaluronic acid (HA) and corticosteroids (CS) frequently employed for symptom relief. HA enhances joint lubrication and has anti-inflammatory properties, while CS provides rapid pain relief through inflammation suppression. This study evaluates the effectiveness of HA and CS injections in patients with Grade II and III knee OA.

Methods: A cross-sectional study was carried out involving 60 patients with Grade II or III knee OA (ages 40-60). The subjects were randomised to receive either intra-articular CS (40 mg triamcinolone acetonide with 2% lignocaine) or HA (6 ml, 48 mg sodium hyaluronate). At baseline, two weeks, six weeks, and three months after treatment, a numerical rating scale (NRS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to measure pain and functional outcomes, respectively. The unpaired t-test and repeated measures ANOVA were among the statistical analyses used.

Results: HA and CS groups significantly improved NRS and WOMAC scores over time (p = 0.001). However, the HA group exhibited superior pain reduction and functional improvement from six weeks onward. At three months, the median NRS score was significantly lower in the HA group (2 (IQR 1-2)) compared to the CS group (3 (IQR 3-4), p = 0.001). Similarly, the HA group's WOMAC score was significantly better (53.4 ± 9.91 vs. 64.2 ± 6.8, p = 0.001).

Conclusion: While both HA and CS injections effectively reduce pain and improve functionality of the knee joint, HA provides sustained pain relief and functional improvement beyond the short-term effects of CS. These findings support the use of HA as a preferred option for managing mild-to-moderate knee OA.