Indian Journal of Physical Medicine and Rehabilitation

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VOLUME 28 , ISSUE 3 ( July-September, 2017 ) > List of Articles


Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee

N Romi Singh, Jotin S Yengkhom, MS Chongreilen Chiru, Kaustav B Thakur, Utpalendu Debnath

Citation Information : Romi Singh N, Yengkhom JS, Chongreilen Chiru M, Thakur KB, Debnath U. Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee. Indian J Phy Med Rehab 2017; 28 (3):89-94.

DOI: 10.5005/jp-journals-10066-0009

License: CC BY 3.0

Published Online: 01-09-2017

Copyright Statement:  Copyright © 2017; The Author(s).



To find the effectiveness of single-dose intra-articular (IA) injection of high-molecular-weight hyaluronic acid (HMWHA) in patients suffering from primary osteoarthritis (OA) of knee.

Study design

A randomized control trial.

Duration of the study

One-and-a-half years, commencing from October 2014.


Physical Medicine and Rehabilitation (PMR) Department, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India.

Study population

All patients suffering from OA knee, who fulfilled the American College of Rheumatology (ACR) criteria for classification of idiopathic OA knee and attending the department during the study period.

Materials and methods

Sixty-five patients were randomized to receive either visco-supplementation with single-dose IA injection of HMWHA (study group) or methylprednisolone (control group) and follow-up was done at 1, 3, and 6 months. Outcome measures were done with Western Ontario and McMaster University (WOMAC) and visual analog scale (VAS) for pain.


Both the groups showed significant improvement in both WOMAC and VAS pain score at the end of 3 months. But at the end of 6 months, improvement in terms of WOMAC (p = 0.09) and VAS pain (p = 0.07) scores in control group was not significant, whereas the study group maintained statistically significant improvement.


A single dose of IA HMWHA is effective in reducing pain and disability in patients with primary OA of knee.

How to cite this article

Yengkhom JS, Nongmaithem RS, Chiru MSC, Thakur KB, Debnath U. Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee. Indian J Phy Med Rehab 2017;28(3):89-94.

  1. Osteoarthritis. In: Solomon L, Warwick D, Nayagam S, editors. Apley's system of orthopaedics and fractures. 9th ed. London: Hodder Arnold; 2010. pp. 87-102.
  2. Articular cartilage and subchondral bone in the pathogenesis of osteoarthritis. Ann N Y Acad Sci 2010 Mar;1192:230-237.
  3. ; Kim, JP.; Stikal, D., et al In: Frontera WR, DeLisa JA, Gans BM, Delisa's physical medicine & rehabilitation principles and practice. 5th ed. Vol. 1. Philadelphia (PA): Lippincott Williams & Wilkins; 2010. pp. 781-809.
  4. Comparative study of hamstring and quadriceps strengthening treatments in the management of knee osteoarthritis. J Phys Ther Sci 2014 Jun;26(6):817-820.
  5. Unloader braces for medial compartment knee osteoarthritis implications on mediating progression. Sports Health 2009 Sep;1(5):416-426.
  6. OARSI recommendations for the management of hip and knee osteoarthritis part II: OARSI evidence-based, expert consensus. Osteoarthritis Cartilage 2008 Feb;16(2):137-162.
  7. Hyaluronic acid (hyaluronan): a review. Vet Med 2008 Aug;53(8):397-411.
  8. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanisms of action. Arthritis Res Ther 2003 Jan;5(2):54-67.
  9. Hyaluronans in the treatment of osteoarthritis of the knee: evidence for disease-modifying activity. Osteoarthritis Cartilage 2005 Mar;139(3):216-224.
  10. High and low molecular weight hyaluronic acid differentially regulate human fibrocyte differentiation. PLoS One 2011 Oct;6(10):e26078.
  11. High molecular weight hyaluronic acid inhibits advanced glycation end product-induced NF-UB activation and cytokine expression. FEBS Lett 1999 Jun;453(3):283-287.
  12. Managing knee osteoarthritis: efficacy of hyaluronic acid injections. Acta Rheumatol Port 2013 Jul-Sep;38(3):154-161.
  13. Knee and hip osteoarthritis index. 1982. [cited 2014 Aug 19]. Available from: .
  14. A multicenter, randomized controlled trial comparing a single intra-articular injection of Gel-200, a new cross-linked formulation of hyaluronic acid to phosphate buffered saline for treatment of osteoarthritis of the knee. Osteoarthritis Cartilage 2012 May;20(5):350-356.
  15. Knee osteoarthritis in women. Curr Rev Musculoskelet Med 2013 Jun;6(2):182-187.
  16. Body mass index, occupational activity, and leisure-time physical activity: an exploration of risk factors and modifiers for knee osteoarthritis in the 1946 British birth cohort. BMC Musculoskelet Disord 2013 Jul;14:219.
  17. Relationship of knee specific lifelong daily activities with radiographic grading and functional disability in patients suffering from osteoarthritis of knee. IJPMR 2014 Dec;25(4):103-108.
  18. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthritis Cartilage 2010 Jan;18(1):24-33.
  19. Corticosteroid compared with hyaluronic acid injections for the treatment of osteoarthritis of the knee a prospective, randomized trial. J Bone Joint Surg Am 2003 Jul;85-A(7):1197-1203.
  20. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev 2006 Apr;2:CD005328.
  21. Hyaluronic acid in the treatment of osteoarthritis of the knee. Rheumatology (Oxford) 1999 Jul;38(7):602-607.
  22. Viscosupplementation with Hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 1998 May-Jun;20(3):410-423.
  23. Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis—a prospective clinical trial. Osteoarthritis Cartilage 2002 Sep;10(9):680-686.
  24. Acute arthritis after intra-articular hyaluronate injection: onset of effusions without crystal. Ann Rheum Dis 2001 May;60(5):518-520.
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