Intra articular hyaluronic acid versus intra articular triamcinolone hexacetonide in primary osteoarthritis of knee: a comparative study


  • Sabeena Kizhedath Department of Pharmacology, Govt. Medical College Ernakulam, Kerala, India
  • Gopesh Valoth Department of Pharmacology, Govt. Medical College, Thrissur, Kerala, India
  • Bindhu Vasudevan Department of Community Medicine, Govt. Medical College, Ernakulam, Kerala, India



Hyaluronic acid, Intra-articular, Osteoarthritis, Triamcinolone hexacetonide, Visual analog scale


Background: Osteoarthritis (OA) is a painful, chronic disease with widespread burden on patients, communities, social and health care systems. Intraarticular (IA) Hyaluronic acid (HA) and corticosteroids are established treatments for OA knee. However, concerns exist regarding effect, duration, safety, effectiveness across population and heterogeneity. Aim of the study is to compare the efficacy and safety of IA HA with THA in the treatment of primary osteoarthritis knee.

Methods: A descriptive cross-sectional study was done among 30 patients. One group (n=15) received IA THA 20mg/2mL on day 0 and other group (n=15) received IA HA 20mg/2 mL on day 0, 7 and 14 under aseptic precautions. The efficacy assessment using VAS for overall pain, joint line tenderness and 15m walking time in seconds were recorded. Side effects if any were noted.

Results: Comparing both treatments IA THA provided superior short-term pain relief. But HA showed sustained benefit up to six months.

Conclusions: OA being a chronic disease process, we need a drug which has a long-lasting effect. Additive effect of HA and THA can be considered for better efficacy.


Dhar HL. Common disease and elderly. Bombay Hospital Journal. 2002 Jan;44(1):61-7.

Hadler NM. Knee pain is the malady not osteoarthritis. Ann Intern Med. 1992;116(7);598-9.

Wehling P, Evans C, Wehling J, Maixner W. Effectiveness of intra-articular therapies in osteoarthritis: a literature review. Therapeutic Advances in Musculoskeletal Disease. 2017;9(8):183-96.

Lawrence RC, Felson DT, Helmic CG. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States Part II. Arthritis Rheum. 2008;58:26-35.

Brant D, Smith GN Jr, Simon LS. Intraarticular injection of hyaluronan as treatment for knee osteoarthritis-what is the evidence? Arthritis Rheum. 2000,43:1192-203.

Mandell BFF, LipaniJ. Refractory osteoarthritis. Differential diagnosis and therapy. Rheum Dis Clin North Am. 1995; 21:163-78.

Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. The Journal of rheumatology. Supplement. 1993;39:3-9.

Grecomoro G, Piccione F, Letiza G. Therapeutic synergism between hyaluronic acid and dexamethasone in the intra-articular treatment of osteoarthritis of the knee: a preliminary open study. Curr Med Res Opin. 1992;13:49-55.

Leardini G, Mattara L, Franceschini M. Intra-articular treatment of knee osteoarthritis. A comparative study between hyaluronic acid and 6 methyl prednisolone acetate. Clin Exp Rhematol. 1991;9:375-81.

Pietrogrande V, Melanotte PL, Agnolo DB. Hyaluronic acid versus methylprednisolone intra articularly injected for the treatment of osteoarthritis of the knee. Curr Ther Res. 1991;50:691-70.

Guidolin DD, Ronchetti IP, Lini E. Morphological analysis of articular cartilage biopsies from a randomised clinical study compoaring the effects of 500-730Da sodium hyaluronate (Hyalgan) and methyl prednisolone acetate on primary osteoarthritis of the knee.Osteoarthritis Cartlage. 2001;9:371-81.

Adams ME, Atinson MH, Lussier AJ. The role of viscosupplementation with Hylan G-F20 (Synvisc in the treatment of osteoarthritis of the knee: a canadianmulticeenter trial comparing hylan G-F20 alone,hylan G-F20 with non-steroidal anti inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoartritis Cartilage. 1995;3:213-25.

Brandt KD, Block JA, Michalski. Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. ORTHOVISC Study Group. ClinorthopRelat Res. 2001;385:130-43.

Miltner O, Schneider U, Siebert CH. Efficacy of intraarticularhyaluronic acid in patients with osteoarthritis-a prospective clinical trial. Osteoarthritis and Cartilage. 2002;10(9):680-6.

Brocq O, Tran G, Breuil V. Hiposteoarthritis: short term efficacy and safety of visco supplementation by Hylan G-F20.An open- label study in 22 patients. Joint Bone Spine. 2002;69:388-91.

Maheu E. Hyaluronan in knee osteoarthritis. A review of the clinical trials with Hyalgan. Eur J RhematolInflamm. 1995;15:17-24.

Henderson EB, Smit EC, Pegley F. Intra-articular injections of 750D hyaluronan in the treatment of osteoarthritis.A randomised single center double blind placebo- controlled trial of 91 patients demonstrating lack of efficacy.Ann Rheum Diss. 1995;53:529-34.

Berenbaum F, Grifka J, Cazzaniga S, D'amato M, Giacovelli G, Chevalier X, et al. A randomised, double-blind, controlled trial comparing two intra-articular hyaluronic acid preparations differing by their molecular weight in symptomatic knee osteoarthritis. Annals of the rheumatic diseases. 2012;71(9):1454-60.

Brandt, Kenneth D. Bloc, Joel A, Michaelsi, Joseph P. Clinical Orthopedics & Related Research. 2001;385;130-143.

Pal CP, Sadana A, Goyal A. Therapeutic efficacy of intraarticular Hyaluronic acid in osteoarthritis knee JBJD. 2017;32(1):44-9.

Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthritis Rheum. 2009;61:1704-17.

Bagga H, Burkhardt D, Sambrook P, March L. Longterm effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33:946-50.

Ghosh P, Guidolin D. Potential mechanism of action of intra-articular hyaluronan therapy in osteoarthritis: Are the effects molecular weight dependent? Seminar Arthritis Rheum. 2002;32:10-37.

Pozo MA, Balazs EA, Belmonte C. Reduction of sensory responses to passive movements of inflamed knee joints by hylan, a hyaluronan derivative. Exp Brain Res. 1997;116:3-9.

Diaz-Gallego L, Priweto JG, Coronel P. Apoptosis and Nitric oxide in an experimental model of osteoarthritis in rabbit after hyaluronic acid treatment. J Orthop Res. 2005;23:1370-6.

Yavuz U, Sami S, Albayraketal A. Efficacy comparisons of the intraarticular steroid agents in the patients with knee osteoarthritis. Rheumatology International. 2012;32(11):3391-6.

Wilder RL. Corticosteroids. In: lippel JH, Cornelia WM, Wortmann RL, eds. Primer on the rheumatic diseases. Atlanta: Arthritis Foundation.1997;427-31.

Pelletier JP, Haraoui B, Martel-Pelletier J. Modulation of cartilage degradation in arthritic diseases by therapeutic agents. Inflammatory disease and therapy. 1993;12:503.

Pelletier JP, Martel‐Pelletier J. Protective effects of corticosteroids on cartilage lesions and osteophyte formation in the pond‐nuki dog model of osteoarthritis. Arthritis and Rheumatology. 1989;32(2):181-93.

Caborn D, Rush J, Lanzeretal W. A randomised single blind comparison of the efficacy and tolerability of hylanG-F20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. The J of Rheu. 2004;31(2):333-43.




How to Cite

Kizhedath, S., Valoth, G., & Vasudevan, B. (2017). Intra articular hyaluronic acid versus intra articular triamcinolone hexacetonide in primary osteoarthritis of knee: a comparative study. International Journal of Basic & Clinical Pharmacology, 6(12), 2794–2799.



Original Research Articles