Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

Abstract

OBJECTIVES:This study aimed to evaluate the clinical outcomes of intra-articular infiltration with hyaluronic acid and dexamethasone alone and in combination in the treatment of knee osteoarthritis (OA).METHOD:This prospective randomized trial evaluated 44 patients undergoing treatment for OA. Patients were selected through clinical and radiological analysis using the American College of Rheumatology criteria. We included patients aged between 50 and 70 years who presented with K-L stage ≤2 knee OA and normal limb alignment. Patients with a previous history of knee injury (ligamentous, meniscal or traumatic), infection, patellofemoral OA or chondroprotective drug use in the previous year were excluded. Participants were randomized into 3 groups and underwent treatment with viscosupplementation (VS, n=16), viscosupplementation plus dexamethasone (VD, n=16) or dexamethasone (DX, n=12). All patients were evaluated before and 6 weeks, 3 months and 6 months after infiltration. Analysis included a physical examination, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire (total score and domain subscores) and an evaluation of knee extensor and flexor strength and proprioception using an isokinetic dynamometer.RESULTS:VS significantly improved the WOMAC total score and subscores for pain, stiffness and function for up to 6 months after infiltration. It also improved knee extensor and flexor strength during the same period. Proprioception was not affected by any of the treatments.CONCLUSIONS:VS alone improved pain, stiffness and function according to the WOMAC total score and subscores and improved knee extensor and flexor strength, but not proprioception, for up to six months after infiltration. These findings suggest that VS has a positive effect on quadriceps arthrogenic inhibition.

Intra-Articular Hybrid Hyaluronic Acid Injection Treatment in Overweight Patients with Knee Osteoarthritis: A Single-Center, Open-Label, Prospective Study

“…Unlike intra-articular corticosteroids, intra-articular AI restores the ideal rheological properties of the sinovial fluid, but does not produce an immediate analgesic effect. Some studies agree that the clinical efficacy of intra-articular AI is maintained up to 6 months after treatment before undergoing involution [33].…”

“…In recent years, several studies and literature reviews have been carried out to assess the long-term effectiveness of intra-articular AI in KOA, but the evidence is always limited [6,[30][31][32][33]. Viscosupplementation improves pain, stiffness, and function, in addition to improving the strength of the flexed knee muscles.…”

“…A control-case study showed a significant improvement in knee pain and function 5 weeks after treatment in patients treated with HA infiltration compared to placebo, with these effects being maintained only up to the 25th week [33]. Sun et al [34] conducted a study to evaluate the effectiveness of single intra-articular injections of cross-linked hyaluronic acid (HYA-JOINT Plus) compared to the single injections of Synvisc in patients with KOA.…”

Comparing the effectiveness of ultrasound guidedversusblind genicular nerve block on pain, muscle strength with isokinetic device, physical function and quality of life in chronic knee osteoarthritis: a prospective randomized controlled study

“…Muscle weakness in the quadriceps and hamstring muscles is commonly seen in patients with knee OA [ 24 ]. In a study comparing the effects of intraarticular corticosteroid and hyaluronic acid injections on muscle strength, it was found that intraarticular hyaluronic acid injection is an effective treatment for improving isokinetic muscle strength.…”

Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others?

“…Two level II studies (69 patients; 92 44 patients 93 ) compared IA-Orthovisc to an IA-corticosteroid. The first level II study 92 reported on several pain and function outcomes up to 6-month follow-up, including VAS (100 mm) pain, the Lequesne functional index, and range of knee flexion.…”