Efficacy of Intra-articular Hyaluronic Acid and Triamcinolone Acetonide Combination Versus Hyaluronic Acid Alone in Knee Osteoarthritis.

backgroundOsteoarthritis (OA) is a chronic debilitating joint pathology and a major cause of disability worldwide. Treatment of knee OA primarily focuses on pain control and improvement of the quality of life of the patient. With the continuous increase in elderly population worldwide and consequent rise in knee OA, there is the need for new treatment strategies and optimal combination therapies for the treatment of patients suffering from early knee OA. Intra-articular injection of hyaluronic acid and corticosteroids has been demonstrated to be individually efficacious in the treatment of knee OA; however, they are both limited in the extent and duration of symptom relief.

objectivesThis study compared the efficacy of combined intra-articular injections of hyaluronic acid and triamcinolone versus hyaluronic acid alone in pain relief of Kellgren and Lawrence (K & L) grade 2 and 3 knee OA.

methodsThis was a hospital based randomized controlled double-blind study which included patients in attendance at the orthopaedic clinic, University of Benin Teaching Hospital (UBTH) with the diagnosis of Kellgren and Lawrence grade 2 and 3 Knee OA. The total sample size was 66, divided into two groups (A and B) of 33 respondents each. Patients in group A received combined hyaluronic acid, triamcinolone, lidocaine and sterile water intra-articularly into the affected knee, while those in group B received hyaluronic acid, lidocaine and sterile water only. Patients in both groups were evaluated using the 11 point numerical rating pain scale(NRS) and the short-form Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) function scale for pain and physical function status respectively at 0 week (prior to the injections) and 2, 4, 12 weeks after administration of the various agents. These were analyzed using the SPSS software, version 22 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered to be statistically significant.

resultsPatients in both groups had progressive improvement in their pain scores and physical function following intra-articular injections. However, the pain and physical function scores decreased more rapidly and to a much lower levels in the group A patients who received the combined treatment than in the group B patients who received hyaluronic acid alone (p=0.001).

conclusionsThe results from this study suggest a synergistic effect between hyaluronic acid and triamcinolone, thus making them a more efficacious treatment option compared to hyaluronic acid alone in the treatment of K & L grade 2 and 3 knee OA. The findings from this study were based on a 12-week follow-up, more studies are encouraged to validate the findings over a longer period.