COMPARISON OF FUNCTIONAL OUTCOME OF INTRAARTICULAR HYALURONIC ACID VERSUS STEROID INJECTION IN OSTEOARTHRITIS OF THE KNEE

Abstract

Background: Knee osteoarthritis (OA) is a common cause of pain and disability. In Pakistan, where total knee replacement is often unaffordable, intra-articular corticosteroid and hyaluronic acid injections are key nonoperative options, though their comparative effectiveness remains debated.

Objective: To evaluate the functional results of corticosteroid injections against intra-articular HA in individuals with early to moderate knee OA (Kellgren-Lawrence grades 1-2) at three months.

Methodology: This prospective comparative study, conducted at Ghurki Trust Teaching Hospital, Lahore, Pakistan (November 15, 2024 to March 20, 2025), enrolled 52 patients (aged 40–65 years) with K-L grades 1–2 knee OA. Patients were assigned to HA (n=26, 2 mL, 20 mg/mL) or corticosteroid (n=26, triamcinolone acetonide 40 mg/mL) groups using consecutive sampling. Injections were administered under ultrasound guidance. Functional outcomes were assessed using the Oxford Knee Score (OKS) at baseline and 3 months. Data were analyzed with SPSS v25.0 using chi-square test.

Results: Both groups were comparable in age (HA: 52.15 ± 6.50 years; steroid: 56.42 ± 5.80, p=0.060), gender, side, and comorbidities. Baseline OKS was higher in the HA group (28.00 ± 7.52 vs. 21.54 ± 6.25, p=0.025). At 3 months, the HA group showed greater OKS improvement (33.23 ± 7.50 vs. 25.00 ± 5.24, p=0.003). Hypothetically, by 2026 1HA patient (3.8%) and 2 steroid patients (7.7%) required TKR.
Conclusion: It was concluded that intra-articular hyaluronic acid provided significantly superior functional improvement compared to corticosteroid injections in patients with early to moderate knee osteoarthritis at 3 months, with a potentially lower progression to total knee replacement, thereby supporting its role as a more effective nonoperative intervention in resource-limited settings. HA injections yield superior functional outcomes compared to corticosteroids at 3 months for early to moderate knee OA, with a potentially lower TKR rate by 2026. Further research with longer follow-up is needed