A Systematic Review of Intra-Articular Hyaluronic Acid, Corticosteroids, and Platelet Rich Plasma Injections on Gait Biomechanics in Knee Osteoarthritis

Authors

  • Hamidreza Aslani Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran. / Shahid Beheshti University of Medical Sciences, Tehran, Iran.
  • Fateme Mirzaee Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran.
  • Fatemeh Bahramian Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran.
  • Atefeh Aboutorabi Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
  • Alireza Jalali Health Systems Engineering Research Center, Milad Hospital, Tehran, Iran.
  • Bahareh Ahmadinejad Sport Medicine and Knee Research Center, Milad Hospital, Tehran, Iran. / Health Systems Engineering Research Center, Milad Hospital, Tehran, Iran.

Keywords:

Corticosteroid, Hyaluronic Acid, Knee injury, Osteoarthritis, Platelet Rich Plasma

Abstract

The purpose of this systematic review was to assess the consequences of injections of corticosteroid (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP) on gait metrics in patients with osteoarthritis (OA). We examined through the Cochrane library, SCOPUS, Web of Science, and PubMed to find pertinent publications that evaluated the effects of CS, HA, and PRP injections on gait parameters in patients with OA of the knee. Utilizing the Physiotherapy Evidence Database (PEDro) scale, quality evaluation was put into practice. A total of 15 publications with 11 randomized control trials based studies describing results for 1160 participants were published. The combined data for velocity showed a significant change with HA injection (SMD: 0.28 95% CI 0.04 to 0.53). In comparison to the control group, the HA injection group's stride length was longer, however the disparity was not statistically significant (SMD: 0.16 95% CI -0.09 to 0.4). No statistically significant differences were observed between the HA and control groups for the other variables. Results demonstrated a significant increase in knee range of motion after CS injection compared to placebo control (MD= 1.70 95% CI -0.03° to 3.37°) and without intervention. There is insufficient data to conclude that PRP and CS have a greater therapeutic advantage than one another in terms of participants' gait. Nonetheless, no intervention is supported by available data, HA is still thought to be more effective than a placebo. To find out how well therapeutic injections affect patients with knee OA's function and gait, more research is needed.

Downloads

Download data is not yet available.

References

Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. Eclinical Medicine 2020; 29-30:100587. doi:10.1016/j.eclinm.2020.100587

Sharma L. Osteoarthritis of the Knee. N Engl J Med 2021; 384:51-9. doi: 10.1056/NEJMcp1903768

Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73:1323-30. doi:10.1136/annrheumdis-2013-204763

Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev 1988; 10:1-2.8. doi:10.1093/oxfordjournals.epirev.a036019

Heiden TL, Lloyd DG, Ackland TR. Knee joint kinematics, kinetics and muscle co-contraction in knee osteoarth-ritis patient gait. Clin Biomech (Bristol, Avon) 2009; 24:833-41. doi:10.1016/j.clinbiomech.2009.08.005

Zeni JA Jr, Higginson JS. Differences in gait parameters between healthy subjects and persons with moderate and severe knee osteoarthritis: a result of altered walking speed? Clin Biomech (Bristol, Avon) 2009; 24:372-8. doi:10.1016/j.clinbiomech.2009.02.001

Nie Y, Wang H, Xu B, Zhou Z, Shen B, Pei F. The Relation-ship between knee adduction moment and knee osteoarthritis symptoms according to static alignment and pelvic drop. Biomed Res Int 2019; 26:7603249. doi:10.1155/2019/7603249

Robon MJ, Perell KL, Fang M, Guererro E. The relation-ship between ankle plantar flexor muscle moments and knee compressive forces in subjects with and without pain. Clin Biomech (Bristol, Avon) 2000; 15:522-7. doi:10.1016/s0268-0033(00)00007-3

Nguyen C, Lefevre-Colau MM, Poiraudeau S, Rannou F. Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review. Ann Phys Rehabil Med 2016; 59:190-5. doi:10.1016/j.rehab.2016.02.010

Xing D, Wang B, Liu Q, Ke Y, Xu Y, Li Z, et al. Intra-articular hyaluronic acid in treating knee osteoarthritis: a prisma-compliant systematic review of overlapping meta-analysis. Sci Rep 2016; 6:32790. doi:10.1038/srep32790

Juni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev 2015; 22:CD005328. doi:10.1002/14651858.CD005328.pub3

Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ 2005; 172:1039-43. doi:10.1503/cmaj.1041203

Meheux CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD. Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy 2016; 32:495-505. doi:10.1016/j.arthro.2015.08.005

Laudy AB, Bakker EW, Rekers M, Moen MH. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med 2015; 49:657-72. doi:10.1136/bjsports-2014-094036

Maher CG, Sherrington C, Herbert RD, Moseley AM, Elk-ins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 2003; 83:713-21.

Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, et al. Platelet-rich plasma intra-articular Knee Injections Show No Superiority Versus viscosupplementation: a randomized controlled trial. Am J Sports Med 2015; 43:1575-82.

doi:10.1177/0363546515582027

Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-articular, single-shot hylan g-f 20 hyaluronic acid injection compared with corticosteroid in knee osteoarthritis: a double-blind, randomized controlled trial. J Bone Joint Surg Am 2016; 98:885-92. doi:10.2106/JBJS.15.00544

Decaria J, Petrella R, Petrella R, Wolfe D, Chesworth BM, Montero-Odasso M. Effect of intra-articular hyaluronic acid on gait variability in older adults with knee osteoarthritis. J Am Geriatr Soc 2011; 59:949-51. doi:10.1111/j.1532-5415.2011.03375.x

DeCaria JE, Montero-Odasso M, Wolfe D, Cheswrth BM, Petrella RJ. The effect of intra-articular hyaluronic acid treatment on gait velocity in older knee osteoarthritis patients: a randomized, controlled study. Arch Gerontol Geriatr 2012; 55:310-5.

doi:10.1016/j.archger.2011.11.007

Huang TL, Chang CC, Lee CH, Chen SC, Lai CH, Tsai CL. Intra-articular injections of sodium hyaluronate (Hyalgan®) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the Asian population. BMC Musculoskelet Disord 2011; 12:221. doi:10.1186/1471-2474-12-221

Petrella RJ, DiSilvestro MD, Hildebrand C. Effects of hyaluronate sodium on pain and physical functioning in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled clinical trial. Arch Intern Med 2002; 162:292-8. doi:10.1001/archinte.162.3.292

Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoar-thritis of the knee. J Rheumatol 2006; 33:951-6.

Raynauld JP, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoar-thritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2003; 48:370-7. doi:10.1002/art.10777

Skwara A, Peterlein CD, Tibesku CO, Rosenbum D, Fuchs Winkelmann S. Changes of gait patterns and muscle activity after intraarticular treatment of patients with osteoarthritis of the knee: a prospective, randomised, doubleblind study. Knee 2009; 16:466-72. doi:10.1016/j.knee.2009.03.003

Forogh B, Mianehsaz E, Shoaee S, Ahadi T, Raissi GR, Sajadi S. Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoart-hritis: a double-blind randomized clinical trial. J Sports Med Phys Fitness 2016; 56:901-8

Tang AC, Tang SF, Hong WH, Chen HC. Kinetics features changes before and after intra-articular hyaluronic acid injections in patients with knee osteoarthritis. Clin Neurol Neurosurg 2015; 129:S21-6. doi:10.1016/S0303-8467(15)30007-X

Lester DK, Zhang K. Gait analysis of knee arthritis trea-ted with hyaluronic acid. J Arthroplasty 2010; 25:1290-4. doi:10.1016/j.arth.2009.09.001

Skwara A, Ponelis R, Tibesku CO, Rosenbaum D, Fuchs-Winkelmann S. Gait patterns after intraarticular treatment of patients with osteoarthritis of the knee--hyaluronan versus triamcinolone: a prospective, randomized, doubleblind, monocentric study. Eur J Med Res 2009; 14:157-64. doi:10.1186/2047-783x-14-4-157

Yavuzer G, Sonel B, Süldür N, Ergin S. Effects of intra-articular hylan G-F 20 injections on clinical and biomechanical characteristics of the knee in osteoarth-ritis. Int J Rehabil Res 2005; 28:371-4. doi:10.1097/00004356-200512000-00013

Tang SF, Chen CP, Chen MJ, Pei YC, Lau YC, Leong CP. Changes in sagittal ground reaction forces after intra-articular hyaluronate injections for knee osteoarthritis. Arch Phys Med Rehabil 2004; 85:951-5. doi:10.1016/j.apmr.2003.08.095

Milt Miltner O, Schneider U, Siebert CH, Niedhart C, Niethard FU. Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis--a prospective clinical trial. Osteoarthritis Cartilage 2002; 10:680-6. doi:10.1053/joca.2002.0815

Sun J, Liu Y, Yan S, Cao G, Wang S, Lester DK, et al. Clinical gait evaluation of patients with knee osteoarthritis. Gait Posture 2017; 58:319-24. doi:10.1016/j.gaitpost.2017.08.009

Mundermann A, Dyrby CO, Andriachi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum 2005; 52:2835-44. doi:10.1002/art.21262

Bohannon RW, Glenney SS. Minimal clinically important difference for change in comfortable gait speed of adults with pathology: a systematic review. J Eval Clin Pract 2014; 20:295-300.doi:10.1111/jep.12158

Kiss RM. Effect of severity of knee osteoarthritis on the variability of gait parameters. J Electromyogr Kinesiol 2011; 21:695-703. doi:10.1016/j.jelekin.2011.07.011

Kaufman KR, Hughes C, Morrey BF, Morrey M, An KN. Gait characteristics of patients with knee osteoarthritis. J Biomech 2001; 34:907-15. doi:10.1016/s0021-9290(01)00036-7

Hurwitz DE, Ryals AR, Block JA, Sharma L, Schnitzer TJ, Andriacchi TP. Knee pain and joint loading in subjects with osteoarthritis of the knee. J Orthop Res 2000; 18:572-9. doi:10.1002/jor.1100180409

Briem K, Axe MJ, Snyder-Mackler L. Medial knee joint loading increases in those who respond to hyaluronan injection for medial knee osteoarthritis. J Orthop Res 2009; 27:1420-5. doi:10.1002/jor.20899

Monticone M, Frizziero A, Rovere G, Vittadini F, Uliano D, LA Bruna S, et al. Hyaluronic acid intra-articular injection and exercise therapy: effects on pain and disability in subjects affected by lower limb joints osteoarthritis. A systematic review by the Italian Society of Physical and Rehabilitation Medicine (SIMFER). Eur J Phys Rehabil Med 2016; 52:389-99.

Jalalvand A, Anbarian M, Ahanjan S, Hajiloo B, Tayfe Seyedan AA. The effect of knee osteoarthritis on excursions of lower limb joints during gait. Phys Treat 2017; 6:233-41. doi:10.18869/NRIP.PTJ.6.4.233

Aboutorabi A, Arazpour M, Bahramizadeh M, Hutchins SW, Fadayevatan R. The effect of aging on gait parameters in able-bodied older subjects: a literature review. Aging Clin Exp Res 2016; 28:393-405. doi:10.1007/s40520-015-0420-6

Zhang W, Robertson J, Jones AC, Dieppe PA, Doherty M. The placebo effect and its determinants in osteoar-thritis: meta-analysis of randomised controlled trials. Ann Rheum Dis 2008; 67:1716-23. doi:10.1136/ard.2008.092015

Van Tunen JA, Dell'Isola A, Juhl C, Dekker J, Steultjens M, Thorlund JB, et al. Association of malalignment, muscular dysfunction, proprioception, laxity and abnormal joint loading with tibiofemoral knee osteoarthritis - a systematic review and meta-analysis. BMC Musculoskelet Disord 2018; 2819:273. doi:10.1186/s12891-018-2202-8.

Downloads

Published

2025-03-25

How to Cite

Aslani, H., Mirzaee, F., Bahramian, F., Aboutorabi, A., Jalali, A., & Ahmadinejad, B. (2025). A Systematic Review of Intra-Articular Hyaluronic Acid, Corticosteroids, and Platelet Rich Plasma Injections on Gait Biomechanics in Knee Osteoarthritis. Journal of the Dow University of Health Sciences (JDUHS), 4(09). Retrieved from https://jduhs.com/index.php/jduhs/article/view/2006

Issue

Section

Review Article