A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis

Int J Rheum Dis. 2018 Jan;21(1):134-139. doi: 10.1111/1756-185X.13123. Epub 2017 Aug 9.

Abstract

Background and aim: Comparison between the effect of sonographic guided and blind knee injection of hyaluronic acid has been evaluated in this study.

Methods and materials: Sixty-one patients with primary knee osteoarthritis were randomly allocated into two groups and received intrabursal injection of hyaloronic acid over 3 weeks. The difference between baseline amounts of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score and visual analogue scale (VAS) score and these amounts after 6 and 12 weeks were calculated and subsequently compared between the two groups.

Results: Among all scores and indices, WOMAC pain and function subscales changed significantly (both in the short-term and long-term follow-up). The mean differences of WOMAC subscale pain in those who had received intra-articular injection under the guidance of sonography were significantly higher than those in patients who had received blind injections after 6 and 12 weeks. The mean differences of WOMAC subscale function in those who had received ultrasonography guided intra-articular injection were significantly higher than those in patients, who had received blind injections after 6 and 12 weeks. The mean in differences of the 10-cm VAS (both at rest and after 50-feet walk) in the two groups was statistically significant after 6 weeks, but did not remain significant after 12 weeks.

Conclusion: Application of sonography might improve the response of patients to intra-articular injection of hyaloronic acid, at least in certain clinical indices.

Keywords: WOMAC score; blind injection; hyaloronic acid; knee osteoarthritis; sonography.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Anatomic Landmarks*
  • Biomechanical Phenomena
  • Disability Evaluation
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Injections, Intra-Articular
  • Iran
  • Knee Joint / diagnostic imaging
  • Knee Joint / drug effects*
  • Knee Joint / physiopathology
  • Male
  • Middle Aged
  • Osteoarthritis, Knee / diagnostic imaging
  • Osteoarthritis, Knee / drug therapy*
  • Osteoarthritis, Knee / physiopathology
  • Pain Measurement
  • Prospective Studies
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Interventional*
  • Viscosupplements / administration & dosage*
  • Viscosupplements / adverse effects

Substances

  • Viscosupplements
  • Hyaluronic Acid