Medial Knee Joint Loading Increases in Those Who Respond to Hyaluronan Injection for Medial Knee Osteoarthritis

Knee osteoarthritis (OA) is a cause of decline in function and the medial compartment is often affected. Intraarticular injection of hyaluronic acid (HA) is indicated as a symptom modifying treatment with at least 6 months passing between consecutive injection series. The effects of HA injection on gait variables have not been extensively examined. Therefore, our objective was to investigate the effects of HA injection on gait in people with medial knee OA. Twenty-seven subjects were included; each was tested prior to treatment (baseline), no later than 3 weeks following the last injection (post-HA), and again 5 months after treatment ended (follow-up). Responder criteria were defined to identify responders and non-responders. Subjects underwent 3D gait analysis, muscle activity was sampled, and co-contraction indices were calculated. Responders experienced increased peak knee adduction moments post-HA, whereas non-responders did not. Improved self-report scores were associated with increased knee adduction moments and increased medial co-contraction. Pain relief may result in higher loading onto the already vulnerable medial compartment due to changes in lower limb mechanics and muscle activation patterns. Eventually this may result in a more rapid progression of joint deterioration. (C) 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 27:1420-1425, 2009