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THU0544 Clinical and Radiologic Assessment of Intra-Articular Hyaluronic Acid Injection Versus Ultrasound in Management of Primary Osteoarthritis of the Knee (A Prospective Study)
  1. A. Allam1,
  2. N. M. El-Gazzar1,
  3. M. A.-S. El Sergany1,
  4. H. M. El Saadany1
  1. 1Physical Medicine, Rheumatology and Rehabilitation, Faculty of medicine, Tanta University, Tanta, Egypt


Background Osteoarthritis (OA), the most common form of arthritis, is a chronic disease characterized by slow degradation of cartilage, pain, and increasing disability.

Objectives The aim of this work was to compare the effect of 2 commonly used lines of treatment; intra-articular Hyaluronate & ultrasound when combined with static exercises in the treatment of primary OA of the knee.

Methods 30 patients with symptomatic primary OA of the knee participated in a randomized, blinded (outcome assessors), gender-matched prospective study involving clinical and radiologic assessment. They were diagnosed according to American College of Rheumatology criteria.

Exclusion criteria included: Severe OA, Secondary causes of OA, other causes of knee pain (traumatic and inflammatory), OA with knee effusion, recent intra-articular steroid injection one month before the start of the study.

Degree of pain was assessed by Visual Analogue Scale (VAS) during walking and at rest and Lequesne’s Pain Function Index (LPFI). Also, tenderness, morning stiffness and medial Joint Space Width (JSW) were measured for all patients before, after treatment and after 2 months follow up. Patients were not allowed to use any other medications during duration of the study.

Patients were classified into 2 groups according to the line of treatment: Group I: 15 patients received intra-articular Sodium hyaluronate (Hyalgan) single injection per week for five weeks(1). Group II: 15 patients received continuous ultrasonic waves of 1 MHz frequency and 1 watt/cm2 power(2), applied for 10 minutes to the knee every other day for five weeks. All patients practiced home exercise therapy (static) for the knee 5times/day.

Results Clinically, IA hyaluronate combined with exercises improved VAS during walking, at rest, tenderness, morning stiffness and LPFI (P<0.001) after treatment and at the follow up compared with the results before treatment. Similarly, continuous ultrasound combined with exercises improved VAS during walking, at rest, tenderness, LPFI (P<0.05) and morning stiffnesss (P<0.001) after treatment and at the follow up compared with the results before treatment. It was observed that improvement in clinical parameters in hyaluronate group was higher than ultrasound group (P<0.05). Radiologically, There was no statistically significant difference as regard measurement of medial JSW for either groups (P>0.05). However there was statistically non-significant stoppage of progression of JS loss in patients received hyaluronate observed after treatment but not maintained after 2 months.

Conclusions Our study demonstrated the efficacy of both lines of treatment (IA Hyaluronate and continuous ultrasound) combined with exercises in improving pain and function in patients with mild to moderate OA knee. Both immediately after treatment and maintained for 2 months. Inter-group analysis showed superiority of IA hyaluronate.


  1. Neustadt DH (2006): Intra-articular injections for osteoarthritis of the knee. Cleve Clin J of Med;73(10):897-911.

  2. Özgönenel L, Aytekin E and Durmuşo□lu G (2009): Double-Blind Trial of Clinical Effects of Therapeutic Ultrasound in Knee Osteoarthritis. Ultrasound Med Biol;35(1):44-49.

Disclosure of Interest None Declared

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