Selçuk Yılmaz1, Mehmet Kurt1, Ahmet Fevzi Kekeç2, Ahmet Yıldırım3

1Department of Orthopedics and Traumatology, Kütahya Health Sciences University, Faculty of Medicine, Kütahya, Türkiye
2Department of Orthopedics and Traumatology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Türkiye
3Department of Orthopedics and Traumatology, University of Health Sciences, Konya Health Application and Research Center, Konya, Türkiye

Keywords: Conservative treatment, gonarthrosis, hyaluronic acid, viscosupplementation.


Objectives: The study aimed to compare the outcomes of single-dose cross-linked hyaluronic acid and the linear regimen of three doses of HA knee injections among patients with gonarthrosis.

Patients and methods: This single-center, retrospective study was conducted with 60 patients (47 females, 13 males; mean age: 57.9±4.29 years; range, 50 to 65 years) with Kellgren-Lawrence Grade 2 or 3 gonarthrosis between February 2020 and February 2022. Patients were either subjected to intra-articular cross-linked hyaluronic acid (n=30) or linear hyaluronic acid (n=30) injection treatments. Comprehensive assessments of the patients were conducted prior to the injections, as well as at three and six months after injection. The two injection groups were compared regarding the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Oxford Knee Score.

Results: Both injections showed a statistically significant improvement from baseline in both WOMAC and Oxford Knee Score at three and six months (p<0.001). There was no notable distinction in the alteration of WOMAC knee scores between the two injection types. However, a notable discrepancy was observed in the elevation of Oxford Knee Score among patients who received cross-linked knee injections compared to those who underwent linear hyaluronic acid knee injections, signifying a significant increase in the former group (p<0.001).

Conclusion: The advantage of a single-dose administration of cross-linked HA knee injections, as opposed to the three-dose regimen required for linear hyaluronic acid, translates into reduced time and cost for the injection process. Moreover, this approach minimizes injection-associated discomfort for patients due to the singular dose administration.

Citation: Yılmaz S, Kurt M, Kekeç AF, Yıldırım A. Effectiveness of gonarthrosis treatment via intra-articular injections of linear vs. cross-linked hyaluronic acids. Jt Dis Relat Surg 2024;35(1):138-145. doi: 10.52312/jdrs.2023.1403.

Ethics Committee Approval

The study protocol was approved by the Kütahya University of Health Sciences NonInterventional Clinical Research Ethics Committee (date: August 16, 2023. No: 2023/09-35). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Idea/concept, design, interpretation, writing the article: S.Y., A.F.K.; Data collection: S.Y., M.K.; Analysis: S.Y.,M.K.,A.F.K.; Literature review, final approval: S.Y., A.Y. Critical review, materials: A.F.K., S.Y., A.Y.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.