A Single-blind Randomised Trial of Intra-Articular Hyaluronic Acid, Hypertonic Saline, and Physiotherapy in Knee Osteoarthritis

Abstract

Background. Knee osteoarthritis (OA) is an age-related progressive condition that has resulted in a significant burden worldwide. In this survey, we aimed to compare intra-articular hypertonic saline (HS) and hyaluronic acid (HA) safety and efficacy in the pain and function improvement of patients suffering from knee OA. Eventually, we made a comparison with physical therapy (PH), in a six-month follow-up. Methods. This study is a three-arm single-blinded randomized clinical trial evaluating 130 radiographically confirmed knee osteoarthritis patients suffering from chronic knee pain. A group of participants received three weekly injections of HA (Hyalgan ® ), while the other group experienced an injection of five milliliters of 5% HS and the third group engaged in ten-session physiotherapy. Patients assessed before intervention, one, three, and six months post-intervention using the visual analogue scale (VAS) for pain and Knee injury and osteoarthritis outcome score (KOOS) for function and quality of life (QOL). Results. In this study, We did not identify any remarkable adverse effects. All KOOS subscales scores decreased in the HA and HS group significantly. A similar trend was detected in pain improvement, considering VAS. PH group experienced only pain reduction but not function improvement. Comparing two injected agents, HS group obtained better scores not only in pain and symptom reduction, but also in function and QOL improvement. Conclusions. However, both HS and HA can be effectively used for improving function and reducing pain and unpleasant symptoms in knee OA patients, HS prolotherapy demonstrated more acceptable outcomes through six-month follow-up.

Effect of Mechanical Traction and Therapeutic Exercises in Treatment of Primary Knee Osteoarthritis

“…In our study there was a significant reduction of knee pain severity, functional disability and improvement of functional performance in the exercise group. These findings are in agreement with some previous investigations (11,12,(36)(37)(38)(39)(40).…”

“…Between groups comparison showed that traction and therapeutic exercises were more effective than therapeutic exercises alone in reduction of knee pain severity and functional disability and in increasing isometric quadriceps and hamstring muscle strength. This may be attributed to the combined positive effects of both therapeutic exercises (11,12,(35)(36)(37)(38)(39)(40)(41)(42)(43) and mechanical traction (16)(17)(18)(19)(20)(21)(22)(44)(45)(46)(47). Moreover, the application of traction before exercises may have provided an opportunity for greater pain reduction, greater normalization of quadriceps and hamstring activation patterns before exercise performance (25) opening a window for easier performance (26) and a greater force control during exercises (27).…”