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Combined intra-articular injections (Hyaluronic acid, platelet-rich plasma, and corticosteroid) for osteoarthritis knee, an effective alternative treatment

Objective: Knee osteoarthritis (OA) is a common problem in the elderly but often difficult to manage in primary care. In literature, traditional nonsurgical managements, consisting of physical therapy, lifestyle modification, and pharmacologic therapy such as nonsteroidal anti-inflammatory drugs, are often ineffective or do not alleviate symptoms adequately. Viscosupplementation is a newly available option for patients with symptomatic knee OA that involves a series of intra-articular (IA) injections of hyaluronic acid (HA). Materials and Methods: In our study, we included 300 patients with primary knee OA who did not have diabetes mellitus as comorbidity. We gave IA injections (HA, platelet-rich plasma (PRP), and corticosteroid) to all patients with both unilateral and bilateral knee OA, under strict aseptic conditions, and followed them up for 18 months. Results: The exact mechanisms of action are unclear although increasing the viscoelasticity of the synovial fluid appears to play an important role. IA corticosteroid injections reduce inflammation and that can give pain relief. About 95% of our patients got pain relief at the end of 3 injections and remained pain free or had bearable pain till 25 months of follow-up. Conclusion: Based on our study, we can conclude that the combined IA injections (HA along with PRP and corticosteroid) for knee OA and is an effective and safe nonoperative modality of treatment, at least in the short term. The results were promising for relieving pain, improving knee function and quality of life, especially in younger patients and in mild-to-moderate OA cases and especially in those who were unwilling or medically unfit to undergo total knee replacement arthroplasty.