Injections Combined with Exercise Effective for Knee OsteoarthritisExercise has been shown to benefit patients with knee osteoarthritis (OA). Different exercise programs have been studied such as quadriceps muscle strengthening and progressive resistive exercises.
At the same time, the use of sodium hyaluronate injected into the joint has also been studied. Given weekly over three to five weeks, these injections work well for patients with moderate-to-severe knee pain.
Perhaps combining exercise with hyaluronate injections (HYL) would work even better. That's the focus of this study. Researchers asked two questions: how well do these two treatments work when combined together? Is a combined treatment approach safe?
Sixty patients with moderate-to-severe pain from knee OA were divided into three groups. Group one received weekly HYL for three weeks (3-HYL). Group two had three weekly HYL combined with a home exercise program (3-HYL+HEP). Group three received five weekly HYL injections (5-HYL).
Pain was used as the primary measure of results. Pain was measured after each patient walked 50 feet. A baseline test was done before treatment and at regular intervals up to one year after treatment.
There was no difference in baseline scores among the three groups. All patients rated their pain as moderate-to-severe. After treatment, everyone reported improved function and at least 20 per cent improvement in their pain levels.
There was much faster and better pain relief in the 3-HYL+HEP group when compared with the other two groups. The results lasted through the final follow-up visit after 52 weeks. Patients in the 5-HYL group also had better results than the 3-HYL group. At the end of the year, there were no differences between the 3-HYL+HEP group and the 5-HYL group.
This study showed there may be an added benefit of using HYL with exercise in cases of moderate-to-severely painful knee OA. Pain relief was faster, greater, and longer lasting for the HYL+HEP group compared with the other two groups receiving only HYL. The authors suggest it may be possible to use fewer HYL injections when patients participate in a HEP.
Todd P. Stitik, MD, et al. Efficacy and Safety of Hyaluronan Treatment in Combination Therapy with Home Exercise for Knee Osteoarthritis Pain. In Archives of Physical Medicine and Rehabilitation. February 2007. Vol. 88. No. 2. Pp. 135-141.
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