Intra‑articular, single‑shot co‑injection of hyaluronic acid and corticosteroids in knee osteoarthritis: A randomized controlled trial

Wang, Shanzheng; Wu, Dongying; Chang, Qing; Guo, Yao; Wang, Chen; Fan, Weimin

doi:10.3892/etm.2018.6371

Cited by 14 publications

(11 citation statements)

References 36 publications

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“…meta-analysis indicates that Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months) [17] . By adhering to the joint cartilage, HA may protect the cartilage from CS erosion, improving the safety of CS application [18] .…”

Section: Discussionmentioning

confidence: 99%

To study results of articular triamcinolone versus hyaluronic acid injection in osteoarthrosis of knee

Dhond¹,

Agarwal²,

Sharma³

et al. 2021

Int. J. Orthop. Sci.

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To decide efficacy of TA vs HA in osteoarthritic patients. Most treatment modalities provide symptomatic relief but intra articular injections with TA and HA probably have the potential of altering the course of the disease. Methods: 60 subjects attending the study scheduled to be given the defined intra articular injection were enrolled as per the study selection criteria. Results: Mean age of cases in TA group was 57 years while it was 58.5 years for cases in HA group (p-0.322). Mean VAS score was comparable between TA and HA group at baseline (p-0.313). After 1 week of intra-articular injection, pain reduction was more in TA group as compared to HA (p<0.05). However, the results were comparable from week 3 onwards (p>0.05). By the end of 1 year, VAS score was comparable to baseline in TA group (p-0.81) while it was still significantly lower than baseline in HA group (p<0.05). Incidence of complications were comparable between two groups with flare ups seen in 13.3% and 6.7% cases of TA and HA group respectively. Acute synovitis developed in 3.3% and 6.7% cases of TA and HA group while 1 case (3.3%) of HA group developed Haemarthrosis. Conclusion:Study shows difference between the 2 intervention groups is the duration of effectiveness. TA mitigates pain faster than HA but the effect of HA is more sustained. Thus HA appears to be superior in duration of pain relief when compared to TA while pain relief is faster with TA.

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Section: Discussionmentioning

confidence: 99%

To study results of articular triamcinolone versus hyaluronic acid injection in osteoarthrosis of knee

Dhond¹,

Agarwal²,

Sharma³

et al. 2021

Int. J. Orthop. Sci.

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“…Intra-articular single shot co-injection of hyaluronic acid and corticosteroid is a recent go to method of treatment of osteoarthritis of knee due to their longer period of pain relief. Shan-Zhen Wang et al [14] in their study compared the effectivity between combined HA with CS injection and HA alone group, including 120 patients with osteoarthritis (included all patients from KL grade II to IV). The coinjection group showed better pain relief and functional scores at 1 week, 1 month, 3 months and 6 months.…”

Section: Discussionmentioning

confidence: 99%

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

Mr¹,

Mukherjee²,

Kr³

et al. 2021

Int. J. Orthop. Sci.

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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.

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“…However, there was no significant difference at 6 months. 63 Huang et al also found that intra-articular PRP injections were comparable to corticosteroids and hyaluronan in pain improvement at 3-month follow-up, but PRP injections were superior in long-term pain relief. 64…”

Section: Systematic Reviews and Meta-analysesmentioning

confidence: 97%

A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee

Peck

Slovek²,

Miro

et al. 2021

Orthopedic Reviews

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The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events. Recent FindingsOA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix. The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base. Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20

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Intra‑articular, single‑shot co‑injection of hyaluronic acid and corticosteroids in knee osteoarthritis: A randomized controlled trial

Cited by 14 publications

References 36 publications

To study results of articular triamcinolone versus hyaluronic acid injection in osteoarthrosis of knee

To study results of articular triamcinolone versus hyaluronic acid injection in osteoarthrosis of knee

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

A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee

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