Efficacy and Safety of Hyaluronan Treatment in Combination Therapy With Home Exercise for Knee Osteoarthritis Pain

Abstract 

Stitik TP, Blacksin MF, Stiskal DM, Kim JH, Foye PM, Schoenherr L, Choi E-S, Chen B, Saunders HJ, Nadler SF. Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain.

Objective

To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee.

Design

Single-blinded, parallel-design, 1-year clinical study with sequential enrollment.

Setting

University-based outpatient physiatric practice.

Participants

Sixty patients (18 men, 42 women; age, ≥50y) with moderate-to-severe pain associated with OA of the knee.

Interventions

(1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP).

Main Outcome Measures

The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales.

Results

The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL (P<.01) and 5-HYL groups (P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events.

Conclusions

The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.

Key Words: Exercise, Hyaluronic acid, Injections, intraarticular, Osteoarthritis, Rehabilitation