Effects of Hyaluronic Acid Injection and Exercise Treatments in Knee Osteoarthritis
Condition: Knee Osteoarthritis
MeSH terms: Osteoarthritis; Osteoarthritis, Knee
Study type: Interventional

Summary: 
      Background: Osteoarthritis (OA) is one of the most common joint diseases that most often
      causes physical disability. Physical therapy modalities, exercise programs and
      intra-articular injections are widely used in the treatment of OA.

      Purpose: The aim of this study is to investigate the effects of adding different exercise
      treatments to hyaluronan injection on proprioception, muscle strength and quality of life in
      patients with knee OA.

      Methods: A total of 54 patients were included in the study and were randomized into three
      groups. Quadriceps strengthening exercises were applied to the patients in Group 1, a home
      exercise program was applied to the patients in Group 2, and no exercise program was applied
      to the patients in Group 3. Additionally, all patients received patient education and
      intra-articular hyaluronic acid injection into the symptomatic knee. Standard forms were
      filled out to evaluate the patients' pain, functional status and quality of life. Muscle
      strength and proprioception were evaluated with an isokinetic dynamometer. Changes in the
      patients' walking parameters were evaluated by gait analysis. Evaluations were made at the
      beginning of treatment, at the end of treatment, and at the 3rd and 6th months of treatment.
    

Detailed description: 
      Background: Osteoarthritis (OA) is one of the most common joint diseases that most often
      causes physical disability. The most common type of osteoarthritis with the highest incidence
      in the clinic is knee osteoarthritis. Physical therapy modalities, exercise programs and
      intra-articular injections are widely used in the treatment of knee OA.

      Purpose: The aim of this study is to investigate the effects of adding different exercise
      treatments to hyaluronan injection on proprioception, muscle strength and quality of life in
      patients with knee OA.

      Methods: A total of 54 patients with stage II and III primary knee OA were included in the
      study. The patients included in the study were divided into 3 groups by randomization. For
      randomization, envelopes containing the letters A, B and C were prepared for the patients
      included in the study. The patients included in the study randomly selected one of the
      envelopes. Patients who chose the envelope with the letter A were included in the 1st group,
      patients who chose the envelope with the letter B were included in the 2nd group, and
      patients who chose the envelope with the letter C were included in the 3rd group. The
      researchers who made the assessment measurements were unaware of which patient was in which
      group. Statistical analysis of the results was performed by a biostatistician who had no
      information about the therapies the patient groups received. Quadriceps strengthening
      exercises were applied to the patients in Group 1 with the isokinetic dynamometer device, a
      home exercise program was applied to the patients in Group 2, and no exercise program was
      applied to the patients in Group 3. Additionally, all patients received patient education and
      intra-articular hyaluronic acid injection (once a week, 3 times in total) into the
      symptomatic knee. Standard forms were filled out to evaluate the patients' pain, functional
      status and quality of life. Western Ontario and McMaster Universities Osteoarthritis Index
      (WOMAC), Lequesne knee index and The Health Assessment Questionnaire (HAQ) scales were used
      to evaluate the patients' functional status and quality of life. Visual Analogue Scale (VAS)
      was used to evaluate the pain conditions of the patients. Muscle strength and proprioception
      were evaluated with an isokinetic dynamometer. Changes in the patients' walking parameters
      were evaluated by gait analysis. Evaluations were made at the beginning of treatment, at the
      end of treatment, and at the 3rd and 6th months of treatment.
    

Intervention name(s): Intra-articular hyaluronic acid injection
Intervention type(s): Other
Intervention description(s): Hyaluronic acid was injected into the symptomatic knees of the patients a total of 3 times, once a week for 3 weeks.
Injections were administered by the physician using a lateral approach with the patient lying on his back and the knee in full extension.
After each injection, patients were warned to apply cold to avoid possible local reactions and not to overload for 24 hours.
Hyaluronic acid preparation was in the form of 2.5 ml solutions obtained biotechnologically, containing 10 mg sodium hyaluronan in each milliliter.
The hyaluronan in solution was of medium molecular weight (0.9 million daltons) but still lower molecular weight than the hyaluronan in normal healthy synovial fluid.
Intervention MeSH terms: Hyaluronic Acid
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Knee Osteoarthritis; Hyaluronic Acid Injection; Exercise; Gait Analysis; Proprioception