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

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.