Knee osteoarthritis (OA) is a degenerative joint disease that affects millions. The search for effective treatments has been ongoing, with intra-articular hyaluronic acid (IAHA) injections, such as Ostenil Plus and Durolane, emerging as promising options. However, there’s a discrepancy between the medical evidence backing IAHA and the varied recommendations from international guidelines. So, how effective really is this treatment, and does the method of injection play a role in its success?

The Promising Potential of IAHA Injections for Knee OA

Recent studies have focused on analysing the benefits and safety of IAHA injections. A comprehensive literature review, including randomized controlled trials and meta-analyses, highlighted the following:

• Symptomatic Relief: IAHA, including Ostenil Plus, offers moderate relief to those with knee OA without significant safety concerns.
• Impressive Benefit/Risk Ratio: When looking at improvements in knee OA outcomes, IAHA might have one of the best benefit-to-risk ratios among pharmacologic options. Notably, patients experience an overall increase in quality-adjusted life years and significant delays in needing total knee replacement.

In light of these findings, it’s worth considering IAHA injections as a viable treatment option. However, the real game-changer might be in tailoring treatments by the stage of disease and specific patient characteristics. The future of IAHA treatment may involve identifying OA patient subgroups that show a more pronounced response to the treatment. Combining IAHA with other treatments might also offer optimised care for knee OA patients.

Optimising Treatment with Ultrasound Guidance

Viscosupplementation involves injecting hyaluronic acid into the knee. It has faced criticism due to inconsistent pain relief benefits. One major concern has been the accuracy of needle placement, especially in obese patients. Enter ultrasound (US) guidance.

A study analysed community-dwelling patients receiving HA knee injections, comparing outcomes between those getting injections with traditional landmark guidance and those with US guidance. The results were compelling:

• Similar Patient Cohorts: Both the US-guided and landmark-guided patient groups had similar demographics and arthritis severity.
• Surgery-Free Outcomes: A significant number of patients in the landmark-guided group (45.8%) required knee arthroplasty (surgery), compared to only 33.2% in the US-guided group. The difference was even more pronounced among obese patients, with 51.8% in the landmark-guided group requiring surgery compared to 34.8% in the US-guided group.

These findings suggest a clear conclusion: To optimise the benefits of viscosupplementation, ensuring accurate intra-articular needle placement via US guidance is crucial. When done right, patients receiving US-guided HA injections are less likely to require subsequent knee surgeries.

In Conclusion

Knee osteoarthritis is a challenging condition, but modern treatments like IAHA injections offer hope. When combined with advanced techniques like ultrasound guidance, these treatments can provide significant relief and improve the quality of life for many patients.

Dr. J. Hugh Coyne

Coyne Medical

Ultrasound-guided hyaluronic acid injections for knee osteoarthritis are available at Coyne Medical from £475.