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. Design: Single-blinded, parallel -design, 1-year clinical study with sequential enrollment. Setting: University-based outpatient physiatric practice. Participants: Sixty patients (18 men, 42 women; age, >= 50y) with moderate-to-severe pain associated with OA of the knee. Interventions: (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 wit weekly intra-articular hyaluronate injections (3-HYL+HEP). Main Outcome Measures: The primary outcome measure was a 100-mm visual analog scale for pain after a 50-foot walk (15.24m). 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 3mo 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.