Publication Details
Abstract
Objective to compare the clinical efficacy and functional outcomes of a combined intra-articular injection of hyaluronic acid (HA)and corticosteroid against HA injection alone in patients with symptomatic knee osteoarthritis (OA). In this prospective comparative study, 62 patients with knee OA (Kellgren-Lawrence grade 2 and 3) were randomly allocated into two categories. The Combination Category (31 patients) received an injection contained both HA and corticosteroid in the first week followed by an injections of HA alone weekly for the next 2 weeks. The HA-only Category (31 patients) received an injection of HA alone weekly for three weeks. The primary outcome was the change in the Visual Analog Score (VAS) for pain at 1 month, 3-months and 6-months. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Patient Global Assessment (PGA). There was statistically insignificant differences regarding age, gender, BMI, stage of knee OA, baseline VAS, baseline WOMAC and baseline PGA between two categories. Both categories showed improvement from baseline in VAS and WOMAC scores at all follow-up intervals. the Combination Category demonstrated statistically superior results regarding VAS at 1-month, the mean reduction in VAS score was significantly greater in the Combination Category (31. 6±8. 3) compared to HA-only Category (42. 7±8. 9) with p value<0. 05. However, both categories demonstrated statistically insignificant differences at 3-month and 6-month follow up. The Combination Group showed superior result in WOMAC scores at 1-month follow-up, the mean reduction in WOMAC score was significantly more in Combination Category (32. 5±7. 2) in comparison with HA-only Category (41. 2±7. 6) with p value <0. 05. There was no statistically significant difference in WOMAC score at 3-month and 6-month between the two Categories. Patient Global Assessment (PGA) showed improvement from baseline at all follow-up time points. PGA showed statistically significant improvement at 1-month follow-up examination in Combination Category. Number of patients with good or very good assessment was 25 (80. 6%) in Combination Category while the number was 14 (45. 2%) in HA-only Category with p value <0. 05, but difference was insignificant at 3-month and 6-month follow-up. A combination therapy of corticosteroid and HA injection is significantly more effective than HA injection alone in providing rapid pain relief and early patient satisfaction within first month. However, for medium-term functional improvement at 3-6 months, both treatments are equally effective. The combination therapy is a valuable strategy for patients requiring rapid symptoms control while aiming for medium-term benefit.