Intra-articular Hyaluronic Acid with Versus without Corticosteroids for Knee Osteoarthritis Among Patients Presenting at Dr. Ziauddin Hospital, Karachi, Pakistan: A Retrospective Cohort Study

Saad Shahid; Naseem Munshi; Athar Muniruddin Siddiqui; Uzma Azmatullah; Arham Azizi; Asim Aziz

doi:10.37185/LnS.1.1.982

Saad Shahid Dr. Ziauddin Hospital, Karachi, Pakistan
Naseem Munshi Dr. Ziauddin Hospital, Karachi, Pakistan
Athar Muniruddin Siddiqui Dr. Ziauddin Hospital, Karachi, Pakistan
Uzma Azmatullah Memon Medical Institute Hospital, Karachi, Pakistan
Arham Azizi Dr. Ziauddin Hospital, Karachi, Pakistan
Asim Aziz Dr. Ziauddin Hospital, Karachi, Pakistan

DOI: https://doi.org/10.37185/LnS.1.1.982

Keywords: Corticosteroids, Hyaluronic Acid, Intra-Articular Injections, Knee Osteoarthritis, Pain Management

Abstract

Objective: To compare the effectiveness of intra-articular hyaluronic acid injections with and without added
corticosteroid in patients with knee osteoarthritis.
Study Design: Retrospective cohort study.
Place and Duration of Study: This study was conducted at the Department of Orthopedic Surgery, Dr. Ziauddin
Hospital (North Nazimabad Campus) in Karachi, Pakistan from 1^st February 2025 to 30^th April 2025.
Methods: A total of 150 adults (aged 30–70) with symptomatic knee osteoarthritis who received a single intraarticular knee injection were identified: 75 patients received a 6 mL injection of cross-linked sodium
hyaluronate alone, and 75 patients received 6 mL of the same hyaluronic acid combined with 8g triamcinolone
hexacetonide. Pain was assessed by the Visual Analog Scale (VAS) at baseline and at 3, 12, and 24 weeks postinjection. Knee symptoms and function were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 12 weeks. SPSS version 23 was used for data analysis.
Results: At 3 weeks, mean VAS pain was 4.35 in the hyaluronic acid and corticosteroid group vs 5.97 in the
hyaluronic acid group (P=0.001). This advantage persisted at 12 weeks (P=0.001) and 24 weeks (P=0.001). Both
groups showed significant improvement from baseline in WOMAC scores at 12 weeks. WOMAC pain decreased
by 0.57 points in hyaluronic acid and corticosteroid vs 0.44 in hyaluronic acid only (P=0.001 for within-group
improvements), and WOMAC function scores improved by 7.07 vs 5.46 points, respectively (both P=0.001
within-group).
Conclusion: Hyaluronic acid and corticosteroid co-injection can be a valuable option for more rapid symptom
relief, while hyaluronic acid alone remains beneficial for longer-term management.

How to cite this: Shahid S, Munshi N, Siddiqui AM, Azmatullah U, Azizi A, Aziz A. Intra-articular Hyaluronic Acid with Versus without Corticosteroids for Knee Osteoarthritis Among Patients Presenting at Dr. Ziauddin Hospital, Karachi, Pakistan: A Retrospective Cohort Study. Life and Science. 2025; 6(4): 448-454. doi: http://doi.org/10.37185/LnS.1.1.982