Efficacy and safety of hyaluronan treatment in combination therapy with home exercise for knee osteoarthritis pain.
OBJECTIVE
To assess the efficacy and safety of intra-articular injections of sodium hyaluronate combined with a home exercise program (HEP) in the management of pain associated with osteoarthritis (OA) of the knee.


METHODS
Single-blinded, parallel-design, 1-year clinical study with sequential enrollment.


METHODS
University-based outpatient physiatric practice.


METHODS
Sixty patients (18 men, 42 women; age, > or =50 y) with moderate-to-severe pain associated with OA of the knee.


METHODS
(1) Five weekly intra-articular hyaluronate injections (5-HYL); (2) 3 weekly intra-articular hyaluronate injections (3-HYL); or (3) a combination of an HEP with 3 weekly intra-articular hyaluronate injections (3-HYL+HEP).


METHODS
The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24 m). Secondary measures included the Western Ontario and McMaster Universities Osteoarthritis Index subscales.


RESULTS
The 3-HYL+HEP group had significantly faster onset of pain relief compared with the 3-HYL (P<.01) and 5-HYL groups (P=.01). All groups showed a mean symptomatic improvement from baseline (reduction in baseline pain at 3 mo was 59%, 49%, and 48% for the 3-HYL+HEP, 3-HYL, and 5-HYL groups, respectively) that was clinically and statistically significant. There were no between-group differences in the incidence or nature of adverse events.


CONCLUSIONS
The combined use of hyaluronate injections with HEP should be considered for management of moderate-to-severe pain in patients with knee OA.
Stitik
Todd P
TP
Department of Physical Medicine & Rehabilitation, UMDNJ New Jersey Medical School, Newark, NJ 07103, USA. stitikto@umdnj.edu
Blacksin
Marcia F
MF
Stiskal
Doreen M
DM
Kim
Jong H
JH
Foye
Patrick M
PM
Schoenherr
Lisa
L
Choi
Eun-Seok
ES
Chen
Boqing
B
Saunders
Howard J
HJ
Nadler
Scott F
SF
D000276:Adjuvants, Immunologic / Q000627:therapeutic use*; D000368:Aged; D004334:Drug Administration Schedule; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D016037:Single-Blind Method; D016896:Treatment Outcome
D000276:Adjuvants, Immunologic; D006820:Hyaluronic Acid