Evaluation of the efficacy for pain relief of intra articular Hyaluronate injections in knee osteoarthritis

Background: Osteoarthritis (OA) is the most common age-related degenerative joint disease in the world. Most current pharmacological options are limited to alleviating pain and improving function. Viscosupplementation with intra-articular sodium hyaluronate offers another approach to the treatment by addressing the degradation of hyaluronic acid (HA) in the synovial fluid by the addition of exogenous HA, resulting in pain reduction and functional improvement. The primary purpose of this study is to evaluate the efficacy of 20mg/2ml Sodium Hyaluronate for relieving the symptoms of knee OA in an Indian setting.Materials & Methods: Forty five patients with symptomatic osteoarthritis diagnosed as Kellgren-Lawrence Grade I/II not responding to conservative management were administered three intra articular injections of Sodium Hyaluronate at weekly intervals. The subjects were followed up for 28 weeks and assessed by administering Western Ontario and McMaster University Osteoarthritis Index (WOMAC) Modified CRD-Pune version (LK3.1).Results: We noted a decrease in the Pain subscore of WOMAC from 6.07±1.23 to 2.48±0.63 between Week 0 and Week 28, considered statistically highly significant. Overall, total WOMAC score decreased significantly between Week 0 and Week 28. The commonly encountered adverse effect was injection site pain, seen in 33.3% of patients at Week 1, and 64.4% of patients at Week 2.Conclusion: We found that viscoelastic supplementation with three intra articular injections of Sodium Hyaluronate at weekly intervals is a simple, safe, effective and minimally invasive modality for conservative treatment of Early Grade (I & II) Osteoarthritis of the knee joint.