Abstract
Background
We compared the effects of repeated co-injections of corticosteroids plus hyaluronic
acid (HA) with the effects of HA injections alone in patients with knee osteoarthritis.
Methods
A double-blind randomized controlled trial was conducted between October 2016 and
July 2017 at a medical center. Patients (n = 57) who fulfilled the clinical and radiographic
criteria for knee osteoarthritis established by the American College of Rheumatology
with a Kellgren-Lawrence score of 2 or 3 were included. They were assigned to either
the HA group (n = 29) or corticosteroids plus HA group (n = 28), and injections were
administered under ultrasound guidance once a week for 3 consecutive weeks. Western
Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were the primary
outcomes. Physical functional performance (10-m fast walking and chair-rising time)
and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were secondary outcomes.
The assessment was performed prior to injections, 1 week, and 1, 3, and 6 months after
injections. Data were analyzed through repeated-measures analysis of covariance.
Results
Both groups experienced decreased pain and improved physical function and physical
functional performance over time. We found significant group × time interaction effects
favoring the corticosteroids plus HA group in WOMAC-pain (P = .005) and physical function (P = .005), chair-rising time (P = .032), and KOOS-pain (P = .001).
Conclusions
Repeated co-injections of corticosteroids plus HA more effectively decreased pain
and improved physical function and physical functional performance than injections
of HA alone from 1 week through 6 months posttreatment.
Keywords
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Article Info
Publication History
Published online: December 23, 2021
Footnotes
Funding: This study (Clinicaltrials.gov: NCT02949466) was partially supported by research grants from Shin Kong Wu Ho-Su Memorial Hospital ( 2019SKHADR037 , 2020SKHADR035 , and 2021SKHADR032 ) and the Ministry of Science and Technology, Taiwan ( MOST-102-2314-B-341-001 , MOST 104-2314-B-002-118-MY3 , MOST-105-2314-B-341-002 , MOST-105-2314-B-002-049-MY3 , MOST-106-2314-B-341-003-MY2 , MOST 108-2314-B-341-003 , MOST 108-2314-B-002-127-MY3 , and MOST 109-2314-B-341-001 ). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of Interest: None.
Authorship: Study conception: RLH, WCL, CPW. Recruitment of patients: RLH. Acquisition of data: RLH, WCL, CPW. Analysis and interpretation of data: RLH, WCL. Drafting the article or revising it critically for essential intellectual content: RLH, CPW, WCL. Final approval of the article: RLH, WCL, CPW. All authors had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, and had a role in writing this manuscript.
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