Intra-articular hyaluranic acid compared with progressive knee exercises in osteoarthritis of the knee: a prospective randomized trial with long-term follow-up

Abstract

The goal of this study was to determine whether hyaluronic acid (HA) or progressive knee exercises (PE) can improve functional parameters in patients with osteoarthritis (OA) of the knee. In a prospective clinical trial 200 knees (105 patients) with radiographic Kellgren Lawrence grade III OA were randomized and received either three intra-articular injections of hyaluronic acid (Hylan G-F 20) at one-week intervals or PE for 6 weeks. Patients were evaluated by use of the Hospital for Special Surgery (HSS) Knee Score and followed-up for 18 months. Total HSS score for HA and PE patients improved from 62.6 +/- 13.8 to 88.8 +/- 11.1 and from 65.4 +/- 12.3 to 88.3 +/- 9.1, respectively, at the end of the trial (P < 0.01). There were no statistically significant differences between the groups. Twenty-one patients of the HA group were excluded from the study because they had received another form of therapy. All patients in the PE group completed the trial. The patients who dropped out had also significant improvement from 57.0 +/- 12.9 to 76.7 +/- 11.9 (P < 0.01). This prospective randomized trial confirmed that both HA injections and PE result in functional improvement. HA injections also increase the levels of satisfaction of the OA patients.

Hyaluronic Acid in the Treatment of Osteoarthritis: What is New

“…In these studies (Carpenter & Motley, 2008;Cohen et al, 2008;Karatosun et al, 2008;Salk et al, 2005Salk et al, , 2006 (Table 3), the patients treated with hyaluronic acid showed a significant decrease in pain and disability at 6 months (Cohen et al, 2008;Salk et al, 2005Salk et al, , 2006, with the effects lasting 12 -13 months (Carpenter & Motley, 2008;Karatosun et al, 2008). Besides the reduction of these parameters, an improvement in ankle sagittal range of motions, and gait quality was observed (Karatosun et al, 2008 Table 3. Randomized controlled trials on ankle osteoarthritis.…”

“…In particular, in the studies performed by Salk (Salk et al, 2005(Salk et al, , 2006 and Cohen (Cohen et al, 2008), the patients, treated with a 1 -2 ml phosphate -buffered saline solution injection, reported a similar improvement in all parameters evaluated. Analogously, positive results were observed in patients, who followed a 6 weeks exercise therapy (muscle strengthening and ankle range of motion exercises) (Karatosun et al, 2008), and after arthroscopic lavage of osteoarthritic ankle joint (Carpenter & Motley, 2008). On the basis of these observations, no clear evidence on the efficacy of hyaluronic acid in reducing pain, and improving function, in ankle osteoarthritis, is provided.…”

“…Only few studies have been performed in ankle osteoarthritis and, among these, four were randomized / controlled trials (level of evidence 1) (Carpenter & Motley, 2008;Cohen et al, 2008;Karatosun et al, 2008;Salk et al, 2005Salk et al, , 2006, while seven studies (Hanson et al, 1999;Luciani et al, 2008;Mei -Dan et al, 2010;Sun et al, 2006;Valiveti et al, 2006;Witteveen et al, 2008Witteveen et al, , 2010 were case series (level of evidence 4). In all these studies, patients suffering from post -traumatic Kellgreen -Lawrence grade II -IV ankle osteoarthritis were enrolled.…”

“…Another possible reason of the limited benefit of hyaluronic acid can be related to its use mostly in post -traumatic osteoarthritis (Zhang & Jordan, 2010), which has a pathogenesis quite different from that of primary degenerative osteoarthritis. Finally, it must be considered that all studies (Carpenter & Motley, 2008;Hanson et al, 1999;Karatosun et al, 2008;Luciani et al, 2008;Mei -Dan et al, 2010;Salk et al, 2005Salk et al, , 2006Sun et al, 2006;Valiveti et al, 2006;Witteveen et al, 2008Witteveen et al, , 2010, but one (Cohen et al, 2008), were performed blindly, with any imaging guidance. This can be a valid explanation of several unsatisfactory results, because there is evidence that about one third of intraarticular injections are not delivered into the intra -articular cavity, when performed without a visual aid (Cunnington et al, 2010).…”

Hyaluronate for the Treatment of Ankle Osteoarthritis

“…To date, there are only 3 randomized controlled, double-blind trials ( Salt et al, 2006;Cohen et al , 2008;Karatosun et al, 2008) (Table 2) and a few case series in the search of the literature on viscosupplementation therapy for ankle OA (Table 3). Two recent reviews (Migliore et al, 2011;Sun et al, 2009) have provided an overview of clinical trials with hyaluronate therapy in ankle OA.…”