title: Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial.
abstract: BACKGROUND
  The treatment of knee osteoarthritis with hyaluronic acid or corticosteroid injection has been widely used. The purpose of this study was to compare the efficacy of hyaluronic acid (hylan G-F 20) with triamcinolone acetonide as a single intra-articular injection for knee osteoarthritis.
  
  
  METHODS
  This study was a prospective, randomized, double-blind clinical trial. Participants with symptomatic knee osteoarthritis were recruited. They were randomized to receive a single-shot, intra-articular injection of either 6 mL of hylan G-F 20 or 6 mL of a solution comprising 1 mL of 40-mg triamcinolone acetonide and 5 mL of 1% lidocaine with epinephrine. The primary outcomes were knee pain severity, knee function, and range of motion at 6 months. Ninety-nine patients were assessed before injection and underwent a 6-month follow-up. Patients and evaluators were blinded. Multilevel regression models were used to estimate differences between the groups.
  
  
  RESULTS
  At the 6-month follow-up, compared with patients who took hylan G-F 20, patients who took triamcinolone acetonide had similar improvement in knee pain, knee function, and range of motion. The difference in mean outcome scores between groups was, with regard to knee pain, a visual analog scale (VAS) score of 3 points (95% confidence interval [95% CI], -6 to 11 points); with regard to knee function, a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score of 0 points (95% CI, -8 to 6 points); and, with regard to range of motion, flexion of -1° (95% CI, -5° to 2°) and extension of 0° (95% CI, -0.5° to 0.5°). However, patients who took triamcinolone acetonide had better pain improvement from 24 hours until 1 week after injection; the mean difference between groups with regard to the VAS score was 12 points (95% CI, 5 to 20 points; p = 0.002) at 24 hours and 9 points (95% CI, 1 to 15 points; p = 0.018) at 1 week. At 2 weeks after injection, patients who took triamcinolone acetonide also had better knee functional improvement; the mean difference between groups for the modified WOMAC score was 6 points (95% CI, 0.7 to 12 points; p = 0.03). Both groups had improvement in pain, knee function, and range of motion during the 6-month follow-up (p < 0.0001).
  
  
  CONCLUSIONS
  Triamcinolone acetonide provided similar improvement in knee pain, function, and range of motion compared with hylan G-F 20 at the 6-month follow-up, with better pain control in the first week and better knee functional improvement in the second week.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand tammachotemd@gmail.com.
authors.forename: Nattapol
authors.initials: N
authors.lastname: Tammachote
authors.affiliation: Department of Orthopaedics, Faculty of Medicine, Thammasat University, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand.
authors.forename: Supakit
authors.initials: S
authors.lastname: Kanitnate
authors.affiliation: Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Department of Orthopaedics, Faculty of Medicine, Burapha University, Saen Sook Sub-district, Mueang District, Chonburi, Thailand.
authors.forename: Thanasak
authors.initials: T
authors.lastname: Yakumpor
authors.affiliation: Orthopaedic Outpatient Unit, Thammasat University Hospital, Khlong Nueng, Khlong Luang, Pathumthani, Thailand Hip and Knee Center, Bangkok Hospital Medical Center, Bangkok, Thailand.
authors.forename: Phonthakorn
authors.initials: P
authors.lastname: Panichkul
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D007719:Knee Joint / Q000187:drug effects* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D010147:Pain Measurement; D016059:Range of Motion, Articular / Q000187:drug effects / Q000502:physiology; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055675:Viscosupplements / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D055675:Viscosupplements; C049816:hylan; D006820:Hyaluronic Acid