Ananta N Panda, Sanket Mishra, Shubhranshu Choudhary, Deepak Nemani, Subrat Mohapatra, Adish Mittal
The addition of triamcinolone acetonide and lignocaine to intra-articular HA was associated with earlier pain relief, improved knee range of motion, reduced analgesic dependence, and higher patient satisfaction without increasing treatment-related complications. Combination therapy appears to be a safe and effective conservative treatment option for symptomatic primary knee OA not immediately requiring surgical intervention. However, because each arm was administered by a single, different surgeon, treatment and operator effects are fully confounded, and findings should be interpreted as reflecting the combined protocol rather than the drug regimen in isolation.
INTRODUCTION: Primary osteoarthritis (OA) of the knee is a very common cause of pain and disability among the general population with advancing age. Intra-articular hyaluronic acid (HA) injections are widely used for symptomatic relief, while corticosteroids are known to provide rapid anti-inflammatory effects. This study compared intra-articular HA alone with HA combined with triamcinolone acetonide and lignocaine, with the primary objective of comparing the between-group change in Visual Analogue Scale (VAS) pain score from baseline to 12 months and providing a viable conservative treatment option for patients not immediately requiring surgical intervention.
METHODS: A prospective comparative study was conducted over 18 months. A total of 354 patients with symptomatic primary knee OA were enrolled in this nonrandomized prospective comparative study and allocated to two treatment groups using an alternate (quasi-randomized) allocation sequence based on sequential order of enrollment. After exclusions, 320 patients completed the study (Group A: HA alone, n=162; Group B: HA + triamcinolone acetonide + lignocaine, n=158). Patients were followed at three weeks, six weeks, three months, six months, and 12 months. Pain was assessed using the VAS, knee range of motion measurement, and analgesic consumption profile, while patient satisfaction and adverse events were also recorded.
RESULTS: The mean VAS fell from 7.5±0.9 to 5.4±0.8 in Group A and from 7.6±0.8 to 3.4±0.7 in Group B by 12 months (between-group difference in change 2.1, p<0.001). At 12 months, fewer Group B patients required daily analgesics (29.1% vs 48.8%, p<0.001), and more reported excellent or good satisfaction (83.0% vs 60.5%, p<0.001), while adverse events were infrequent and comparable between groups aside from post-injection knee pain, which was less frequent in Group B (8.2% vs 17.3%, p=0.015).
CONCLUSION: The addition of triamcinolone acetonide and lignocaine to intra-articular HA was associated with earlier pain relief, improved knee range of motion, reduced analgesic dependence, and higher patient satisfaction without increasing treatment-related complications. Combination therapy appears to be a safe and effective conservative treatment option for symptomatic primary knee OA not immediately requiring surgical intervention. However, because each arm was administered by a single, different surgeon, treatment and operator effects are fully confounded, and findings should be interpreted as reflecting the combined protocol rather than the drug regimen in isolation.