Intra-articular ozone or hyaluronic acid injection: Which one is superior in patients with knee osteoarthritis? A 6-month randomized clinical trial

Abstract

PurposeKnee osteoarthritis (OA) is a common disease, imposing a great burden through pain and decreased function. There are many therapeutic modalities including non-pharmacologic choices and oral, topical, and intra-articular medications. New studies have shown promising results for ozone application in knee OA. Our aim was to compare the effects of ozone therapy versus hyaluronic acid (HA) intra-articular injection in knee OA patients.MethodsIn this randomized clinical trial, a total of 174 patients with more than 3 months of chronic pain or swelling in the knee joints along with consistent imaging findings were enrolled and randomly allocated into two groups of HA and ozone, which were planned to undergo 3 weekly injections of HA (Hyalgan®) and 10 mL of a 30 μg/mL ozone solution, respectively. Patients were evaluated at baseline and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire.ResultsNo major adverse events were detected in this study. Total WOMAC score decreased from 40.8±9.8 to 20.4±4.9 (p<0.01) in the ozone group and from 38.5±7.9 to 17.1±4.2 (p<0.01) in the HA group. A similar trend was observed in pain improvement according to VAS. Pain, stiffness, and function significantly improved in both the groups, but no between-group difference was found.ConclusionAlthough both ozone and HA can be effectively used for improving function and reducing pain in selected knee OA patients, neither of the two showed any superiority at 6-month follow-up.

Short‐Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta‐Analysis

“…Ninety‐three eligible articles were identified, after excluding overlapped abstracts between the databases; 53 abstracts were retrieved for detailed evaluation. Fourteen randomized‐controlled trials remained for analysis after removing 39 unsuitable articles. Finally, only eight studies were chosen for having the necessary data to be included in the meta‐analysis (Figure ).…”

“…Second, the meta‐analysis indicates that the application of ozone is an effective option for reducing pain in patients with OA in the short term; however, the level of clinical efficacy of ozone gradually decreased with time. Some studies on the short‐term effects of ozone IA infiltrations showed that the clinical effect of ozone lasted for at least 3 months but had completely disappeared by the sixth month . The duration of effectiveness can be due to the anti‐inflammatory properties of the ozone, rather than to intraarticular structural improvement and can be shorter in advanced grades …”

“…Some studies on the short-term effects of ozone IA infiltrations showed that the clinical effect of ozone lasted for at least 3 months but had completely disappeared by the sixth month. 13,30 The duration of effectiveness can be due to the anti-inflammatory properties of the ozone, rather than to intraarticular structural improvement and can be shorter in advanced grades. 13 Ozone IA seems to have a therapeutic effect similar to the IA application of corticosteroids in terms of duration.…”

“…13,30 The duration of effectiveness can be due to the anti-inflammatory properties of the ozone, rather than to intraarticular structural improvement and can be shorter in advanced grades. 13 Ozone IA seems to have a therapeutic effect similar to the IA application of corticosteroids in terms of duration. In patients with knee OA, it has been observed that corticosteroids decrease pain in the short term (1 month) 28,37 ; however, some disadvantages are mentioned, such as the probable adverse effect on articular cartilage due to repeated exposure to corticosteroids.…”

“…Fourteen randomized-controlled trials 13,18-20,22-31 remained for analysis after removing 39 unsuitable articles. Finally, only eight studies were chosen for having the necessary data to be included in the meta-analysis 13,19,20,24,26,[29][30][31] (Figure 2).…”