COMPARATIVE EFFICACY OF INTRA-ARTICULAR HYALURONIC ACID ALONE VERSUS COMBINED HYALURONIC ACID AND TRIAMCINOLONE ACETONIDE IN PATIENTS WITH KNEE OSTEOARTHRITIS: A PROSPECTIVE STUDY FROM A TERTIARY CARE CENTER

Abstract

Background: Knee osteoarthritis is a leading cause of pain and disability worldwide. Intra-articular hyaluronic acid (HA) is widely used for symptomatic relief, while corticosteroids such as triamcinolone acetonide provide rapid anti-inflammatory effects. The present study was conducted to compare the efficacy and safety of intra-articular HA alone versus HA combined with triamcinolone acetonide in patients with knee osteoarthritis. Methods: This prospective comparative study was conducted at the Bone and Joint Hospital, Barzulla, Government Medical College Srinagar, from November 2024 to November 2025. A total of 200 patients aged 30–50 years with knee osteoarthritis were enrolled and divided into two groups: Group A (n=100) received intra-articular HA alone, while Group B (n=100) received HA combined with triamcinolone acetonide. Pain and functional outcomes were assessed using Visual Analog Scale (VAS) and WOMAC scores at baseline, 2 weeks, 6 weeks, 12 weeks, and 24 weeks. Statistical analysis was performed using appropriate tests with p < 0.05 considered significant. Results: Both groups were comparable at baseline (p > 0.05). Significant reduction in VAS scores was observed in both groups; however, Group B showed greater improvement at all follow-up intervals. Mean VAS scores in Group A decreased from 7.18 ± 0.71 to 4.42 ± 0.68, whereas in Group B they decreased from 7.12 ± 0.69 to 3.98 ± 0.61 at 24 weeks (p < 0.001). Similarly, WOMAC scores improved significantly in both groups, with greater reduction in Group B (from 66.9 ± 6.5 to 43.3 ± 5.8) compared to Group A (from 67.4 ± 6.8 to 47.6 ± 6.1) (p < 0.001). A higher proportion of patients in Group B achieved ≥30% reduction in VAS (82% vs 66%, p = 0.01) and ≥20% improvement in WOMAC scores (79% vs 61%, p = 0.006). Adverse events were mild and comparable between the groups, with no serious complications reported. Conclusion: Both intra-articular HA alone and HA combined with triamcinolone acetonide are effective in managing knee osteoarthritis. However, the combination therapy provides superior pain relief, particularly in the early period, and results in better overall functional outcomeswithout increasing adverse effects. The addition of triamcinolone to HA may be considered a more effective therapeutic option in selected patients.