Is Hyaluronic Acid Intra-Articular Injection Better Than Corticosteroid Intra Articular Injection At Reducing Pain In Patients With Knee Osteoarthritis?

OBJECTIVE: The objective of this selective EBM review is to determine whether or not “Hyaluronic Acid intra articular injection is better than Corticosteroid intra articular injection at reducing pain in patients with knee osteoarthritis.” STUDY DESIGN: Review of three double-blind, randomized control trials published between 2014 and 2016. All studies were published in English language in peer reviewed journals. DATA SOURCES: All three randomized control trials were found via PubMed. OUTCOMES MEASURED: The primary outcomes measured by the patient and investigator being improvement of knee pain severity, knee function, and range of motion after hyaluronic acid intra articular (IA) injection versus corticosteroid intra articular injection. RESULTS: Leighton et al demonstrated that NASHA hyaluronic acid as a single injection intraarticular treatment is a valuable treatment for knee osteoarthritis (OA), providing effectiveness that was non-inferior to methylprednisolone. It also indicated that the effect of NASHA hyaluronic acid as a single injection intra-articular treatment is longer lasting, with significantly improved pain response at 26 weeks compared to methylprednisolone with a p value of \u3c0.05. Tammachote et al demonstrated that patients who took triamcinolone acetonide had similar improvement in knee pain. Both hylan G-F 20 and triamcinolone acetonide are both effective at reducing pain from knee OA and there is not a significant difference in pain reduction between the two groups with a p value \u3e0.05. Bisicchia et al demonstrated that HYADD is effective at reducing pain from knee OA and more effective than corticosteroids with a p value \u3c0.0001. CONCLUSIONS: It can be concluded there is conflicting evidence whether or not hyaluronic acid intra-articular injection is better than corticosteroid intra articular injection at reducing pain in patients with knee OA. Based upon this evidence, both corticosteroids and hyaluronic acid intra articular injections are effective at reducing pain in patients with knee OA with no clear-cut answer if one is superior to the other. It was shown, however, that hyaluronic acid intra articular injections are possibly better long term in that they are longer lasting than corticosteroid intra articular injections