OBJECTIVE: To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in treatment of patients with knee osteoarthritis DESIGN: A prospective randomized controlled trial SETTING: Rehabilitation clinic of a teaching hospital PARTICIPANTS: Fifty patients with knee osteoarthritis (aged 51 to 80 years) were randomly placed into HA group (n = 27) and TENS group (n = 23). INTERVENTIONS: The HA group received intra-articular HA injection into the affected knee once a week for five consecutive weeks, and the TENS group received a 20 minutes session of TENS three times a week for four consecutive weeks. MAIN OUTCOME MEASURES: The primary outcome measures used were visual analog scale (VAS) for pain and Lequesne index. The secondary outcome measures were range of motion (ROM) of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living (ADL). All subjects were assessed at baseline, and at 2-weeks, 2-, and 3-months after the treatments were completed. RESULTS: The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2-weeks follow-up (4.17 +/- 1.98 versus 5.31 +/- 1.78, respectively; p = 0.03). In addition, the TENS group also exhibited a significantly greater improvement in Lequesne index than the HA group at 2-weeks (7.78 +/- 2.08 versus 9.85 +/- 3.54, respectively; p = 0.01) and 3-months follow-up (7.07 +/- 2.85 versus 9.24 +/- 4.04, respectively; p = 0.03). CONCLUSIONS: TENS with silver spike point (SSP) electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving VAS for pain at 2-weeks follow-up as well as Lequesne index at 2-weeks and 3-months follow-up.

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