Comparing the efficacy of combining ozone therapy with hyaluronic acid versus using hyaluronic acid alone for pain relief in patients with knee osteoarthritis: A randomized clinical trial

BACKGROUND: There is growing interest in the therapeutic application of ozone (OZ) and hyaluronic acid (HA) for individuals suffering from osteoarthritis. This randomized trial aimed to assess the effectiveness of HA versus a mixture of OZ and HA in alleviating pain for patients diagnosed with OA. METHODS: In a double-blind clinical trial, 60 patients diagnosed with OA were randomly divided into two groups: One group was administered four intra-articular (IA) injections of hyaluronic acid (HA) every week (HA group), while the second group received the same frequency of injections but with ozone combined with HA (OZ+HA group). Patients underwent evaluations for pain levels utilizing the Visual Analogue Scale (VAS), assessed their quality of life with support from Health-Related Quality of Life (HRQL) metrics, and analyzed sleep quality using the Pittsburgh Sleep Quality Index (PSQI) at initial assessment and again at 2 weeks, 2 months, and 6 months following the intervention. RESULTS: Results indicated a significant decrease in the VAS-score value for both groups after six months of intervention, with the OZ + HA group experiencing a greater reduction (P < 0.001 for both). The HRQL value changes were significantly more pronounced in the OZ+HA group than in the HA group by the end of the study (P < 0.001). The decrease in the PSQI score in the OZ + HA group following six months of intervention was substantially less compared to the HA group (P < 0.001). CONCLUSION: The combination of ozone and HA appears to have an enhancing effect on analgesic outcomes, sleep, and quality of life, indicating a need for further research.