Management of knee osteoarthritis: knee lavage combined with hylan versus hylan alone

Arch Phys Med Rehabil. 2003 May;84(5):634-7. doi: 10.1016/s0003-9993(02)04811-6.


Objective: To assess the difference in efficacy between knee lavage plus the standard hylan G-F 20 (a derivative of hyaluronan) protocol and the standard hylan G-F 20 as per standard usage protocol alone for the treatment of knee osteoarthritis (OA).

Design: Nonrandomized prospective study in which patients chose their treatment group. Follow-up averaged 1.1 years.

Setting: Faculty practice of a single physician at a major teaching hospital.

Participants: Eighty-one patients with documented knee OA on magnetic resonance imaging.

Interventions: Group 1 (n=44) received a single-needle lavage 1 week before the standard hylan G-F 20 protocol; group 2 (n=37) received the standard hylan G-F 20 protocol alone.

Main outcome measures: Pre- and posttreatment scores on the Lysholm-II Questionnaire and a visual analog scale (VAS) were documented for each patient. The Wilcoxon signed-rank test was used for statistical analysis.

Results: A successful outcome was noted in 79.5% of group 1 patients and in 54% of group 2 patients (P<.05).

Conclusions: In the management of knee OA, the use of knee lavage before viscosupplementation with hylan G-F 20 yields better results than using hylan G-F 20 alone. The presence of radiologic grade IV knee OA or moderate to severe patellofemoral arthritis are negative prognostic factors.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Drug Administration Schedule
  • Exercise Therapy / methods
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / analogs & derivatives
  • Hyaluronic Acid / chemistry
  • Hyaluronic Acid / pharmacology
  • Injections, Intra-Articular
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Molecular Weight
  • Osteoarthritis, Knee / diagnosis
  • Osteoarthritis, Knee / psychology
  • Osteoarthritis, Knee / therapy*
  • Pain Measurement
  • Patient Satisfaction
  • Patient Selection
  • Prognosis
  • Prospective Studies
  • Severity of Illness Index
  • Single-Blind Method
  • Surveys and Questionnaires
  • Therapeutic Irrigation / methods*
  • Treatment Outcome


  • hylan
  • Hyaluronic Acid