Efficacy of intra-articular corticosteroid and hyaluronic acid injections in preventing progression of early osteoarthritis of the knee in Indian population – A single centre prospective study with a follow-up of 18 months

Abstract

Introduction: Osteoarthritis is a degenerative joint disease affecting middle aged to elderly population. Trial of conservative management in form of intra-articular injection with drugs like corticosteroid and hyaluronic acid have been in use for quite some time. We aim to test the efficacy of these drugs when given individually as well in combination in providing pain relief in patients with early-stage osteoarthritis. Materials and Methods: A prospective study conducted over a period of 4 years (2015-2019) was conducted with a sample size of 150 patients with 50 patients divided equally into 3 groups receiving corticosteroid, hyaluronic acid and combination of both respectively. Patients in age group of 40 -65 years and with Kellgren Lawrence Grade I and II were included in the study. Functional scoring was evaluated pre -procedure, post-procedure at 1 month, and at regular interval of 3 months till 18 months. Visual analogue scale (VAS) and Knee society scoring (KSS) were used to evaluate the results. Results: Mean age of the patients included in the study was 57.3 years with 59% female and 41% male patients. Mean VAS score and mean KSS in corticosteroid group (CS) at 3 months follow-up were 4.92 and 152.81 respectively (p< 0.01). For the hyaluronic acid (HA) group, patients had a good relief till 9 months with a mean VAS at 9 months-4.91 and Mean KSS at 9 months-155.26 (p<0.01). However, the combined group showed significantly long pain free period upto 12 months (p<0.001). At end of followup, CS group, HA group and CS with HA group had 12, 8 and 3 patients respectively opting for surgical intervention. Conclusion: Intra-articular injections provide a good and long period of pain relief in early arthritis. Coinjection of steroids with hyaluronic acid are far superior to any of these drugs administered individually.