COMPARATIVE EFFECTIVENESS OF HYALURONIC ACID VS STEROID INJECTION AMONG OBESE PATIENTS WITH KNEE GRADE III OSTEOARTHRITIS

Abstract

Background: Knee osteoarthritis (OA) is a progressive degenerative joint disorder and a major contributor to chronic pain, reduced mobility, and impaired quality of life, particularly among older adults and individuals with obesity. Non-surgical management strategies frequently include intra-articular injections to alleviate symptoms and improve functional capacity. Hyaluronic acid (HA) and corticosteroid injections are commonly used therapeutic options; however, their comparative effectiveness, especially when combined with structured exercise programs, remains an area of ongoing clinical investigation in patients with advanced disease.

Objective: To compare the effectiveness of intra-articular hyaluronic acid injections combined with exercise versus corticosteroid injections combined with exercise in reducing pain and improving functional outcomes among patients with Grade III knee osteoarthritis.

Methods: A randomized controlled trial was conducted involving 16 patients diagnosed with Grade III knee osteoarthritis and a body mass index of ≥30 kg/m². Participants were randomly allocated into two equal groups. Group A received intra-articular hyaluronic acid injections (20 mg/2 mL) along with an exercise program, while Group B received intra-articular corticosteroid injections consisting of triamcinolone acetonide (40 mg) combined with lidocaine, alongside the same exercise regimen. Pain intensity was assessed using the Numeric Rating Scale (NRS), and functional status was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Assessments were performed at baseline, the second week, the sixth week, and the third month following intervention. Statistical analysis was conducted using repeated measures ANOVA and independent sample t-tests with a significance level set at p < 0.05.

Results: Participants in the hyaluronic acid group demonstrated a marked reduction in pain scores, with mean NRS values decreasing from 9.12±0.83 at baseline to 7.25±0.46 at two weeks, 5.00±1.19 at six weeks, and 2.37±0.51 at three months (p<0.001). In comparison, the corticosteroid group showed a decrease from 9.00±0.75 at baseline to 8.25±0.70, 7.12±0.83, and 6.00±0.75 across the same follow-up intervals (p<0.001). Functional outcomes also improved substantially in the hyaluronic acid group, with WOMAC scores declining from 83.62±6.54 at baseline to 72.37±5.39, 47.75±5.72, and 29.37±6.80 at subsequent evaluations (p<0.001). The corticosteroid group exhibited comparatively smaller improvements, with WOMAC scores decreasing from 83.75±4.62 to 80.12±5.54, 73.75±5.06, and 69.87±5.79 (p<0.001). Between-group analysis revealed significantly greater reductions in both NRS and WOMAC scores in the hyaluronic acid group at all follow-up time points after baseline (p<0.01).

Conclusion: Intra-articular hyaluronic acid injections combined with exercise demonstrated superior effectiveness in reducing pain and improving functional outcomes compared with corticosteroid injections combined with exercise among patients with Grade III knee osteoarthritis. These findings support the potential role of hyaluronic acid as a more beneficial conservative treatment option for sustained symptom management in this patient population.

Keywords: Exercise therapy; Hyaluronic acid; Injections, intra-articular; Osteoarthritis, knee; Pain measurement; Rehabilitation; Triamcinolone.