Evaluation of Effectiveness of Combined Intra-Articular Injection of Ozone and High Molecular Weight Hyaluronic Acid in Patients With Knee Osteoarthritis

Osteoarthritis is one of the major causes of disability and a source of social cost in the elderly. Its prevalence is increasing due to ageing and increasing obese population. The knee is one of the most common joints to be affected by osteoarthritis and it can lead to serious effects on one’s mobility, quality of life and livelihood. One of non-surgical treatments is intra-articular injection. Injection of both ozone and hyaluronic acid into knee joint are common methods for treatment of knee osteoarthritis. The aim of this study was to evaluate reduction of pain and improvement of function in patients who received combination of intra-articular injection of high molecular weight hyaluronic acid and ozone. In this retrospective case series study data of patients with knee osteoarthritis who underwent intra-articular injection of high molecular weight hyaluronic acid with ozone were evaluated. Participants had fulfilled Western Ontario and McMaster Universities Arthritis Index (WOMAC) short form questionnaire before, three days, one month and six months after the intra-articular injection. Pain reduction and function improvement factors were assessed according to the WOMAC short form questionnaire. A total of 65 patients were evaluated in this study. There was significant decrease in the total score of WOMAC SF (stiffness and function) in all three follow-ups (P<0.001). Also, patients who had more severe pain before the injection benefited more from the intra-articular injection. Our study showed that the effectiveness of intra-articular injection of high molecular weight hyaluronic acid with ozone does not depend on the age, sex and BMI of patients. Injection of high molecular weight hyaluronic acid and ozone into the joint cause to significant improvement in patient’s knee pain and function. It is recommended that the combination of high molecular weight hyaluronic acid and ozone be considered as an effective treatment in the process of these patients.