Abstract
OBJECTIVES:This study aimed to evaluate the clinical outcomes of intra-articular infiltration with hyaluronic acid and dexamethasone alone and in combination in the treatment of knee osteoarthritis (OA).METHOD:This prospective randomized trial evaluated 44 patients undergoing treatment for OA. Patients were selected through clinical and radiological analysis using the American College of Rheumatology criteria. We included patients aged between 50 and 70 years who presented with K-L stage ≤2 knee OA and normal limb alignment. Patients with a previous history of knee injury (ligamentous, meniscal or traumatic), infection, patellofemoral OA or chondroprotective drug use in the previous year were excluded. Participants were randomized into 3 groups and underwent treatment with viscosupplementation (VS, n=16), viscosupplementation plus dexamethasone (VD, n=16) or dexamethasone (DX, n=12). All patients were evaluated before and 6 weeks, 3 months and 6 months after infiltration. Analysis included a physical examination, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire (total score and domain subscores) and an evaluation of knee extensor and flexor strength and proprioception using an isokinetic dynamometer.RESULTS:VS significantly improved the WOMAC total score and subscores for pain, stiffness and function for up to 6 months after infiltration. It also improved knee extensor and flexor strength during the same period. Proprioception was not affected by any of the treatments.CONCLUSIONS:VS alone improved pain, stiffness and function according to the WOMAC total score and subscores and improved knee extensor and flexor strength, but not proprioception, for up to six months after infiltration. These findings suggest that VS has a positive effect on quadriceps arthrogenic inhibition.
Highlights
Osteoarthritis (OA) is a degenerative disease that causes progressive joint pain and disability
Patients The sample consisted of 44 patients with primary knee OA, according to the American College of Rheumatology criteria [15], who were treated in the OA conservative treatment program located in the outpatient unit of the Brazilian National Institute of Traumatology and Orthopedics between January 2014 and December 2014
Data, except for height, which was greater in the DX group than in the VD group
Summary
Osteoarthritis (OA) is a degenerative disease that causes progressive joint pain and disability. OA was defined as a disease that involves the synovial joint as a whole [1]. The prevalence of OA is high worldwide, estimated as 3.8% in 2010 [2]. Quadriceps strength is reduced 50% in patients with knee OA [3] and represents a feature of the disease [4]. This occurs partly due to a neural activation deficit of the quadriceps known as arthrogenic muscle inhibition [5,6].
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