Safety and Efficacy of High Molecular Weight Intra-Articular Hyaluronic Acid in the Management of Knee Osteoarthritis: A Prospective Study

Abstract

Intra-articular Hyaluronic acid (IAHA) injection provides intra-articular (IA) anti-inflammatory effect and improves synovial fluid flow dynamics and viscoelasticity. The aim of this prospective observational, clinical study was to evaluate the safety and efficacy of Hyaluronic Acid (HA) (40mg/2ml) 3 times with one week interval for the treatment of osteoarthritis (OA). Methods and materials: A total of 105 adults with OA were enrolled in the study. Each patient received 3 injection cycles of HA with one week interval. WOMAC OA Index was used to assess the effectiveness of injection and SF-36 to observe the change in quality of life. Physical examination was performed before injection and at the 3rd and 6th months following injection. Results: WOMAC score showed significant reduction from baseline (61.6) to 3rd treatment procedure visit (32.1), 3 months (16.2) and 6 months follow up visit (4.8) respectively (p<0.001). Significant improvement was observed in quality of life from baseline values to 3 month and 6 month follow up visit (p<.0001) Discussion: Studies have shown that HA is safe and well tolerated to achieve clinically significant improvement in patients with mild to moderate knee OA. It is presented that repeated IAHA injections are an effective treatment for knee OA, and reduce pain and contribute to recovery. It was concluded that HA with higher molecular weight improved pain more and suggested that the use of HA products may be effective in knee OA. A significant increase was observed in SF-36 parameters reporting quality of life with IAHA, and HMW-IAHA added to usual care is effective for knee OA in working individuals. Conclusion: Three weekly IA injections of HA provided pain relief and functional improvements with high treatment satisfaction in patients with painful knee OA lasted for a minimum 6 months.