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. 2025 May 12;17(5):e83944.
doi: 10.7759/cureus.83944. eCollection 2025 May.

Pain Relief Improves Key Motor Functions in Refractory Advanced Knee Osteoarthritis

Yoshinori Ishii  1 , Hideo Noguchi  2 , Junko Sato  1 , Ikuko Takahashi  1 , Hana Ishii  3 , Ryo Ishii  4 , Kei Ishii  5 , Kai Ishii  1 , Shin-Ichi Toyabe  6 , Taishi Ogawara  7
Affiliations

Pain Relief Improves Key Motor Functions in Refractory Advanced Knee Osteoarthritis

Yoshinori Ishii et al. Cureus. .

Abstract

Background: Advanced knee osteoarthritis (KOA) severely impacts function and quality of life. While pain reduction is thought to improve motor function, the direct relationship remains unclear, especially in refractory cases. This study investigated the impact of pain relief following intra-articular diclofenac-etalhyaluronate (DF-HA) on motor function in advanced KOA patients unresponsive to conventional treatments.

Methods: This retrospective study included 100 knees (82 patients, Kellgren-Lawrence (KL) grade III/ IV) who received DF-HA. Patients were categorized into an Improved Group (IM-G, n= 88 knees) and a Non-Improved Group (Non-IM-G, n= 12 knees) based on visual analog scale (VAS) pain score changes 3-7 days post-injection. Japanese Orthopaedic Association Score for Osteoarthritis of the Knee (JOAS), range of motion (ROM), quadriceps femoris strength (QF), and single-legged stance (SLS) were assessed pre- and post-injection. Non-parametric tests compared changes within and between groups.

Results: In the IM-G, significant improvements were observed in JOAS (p< 0.001), ROM (p< 0.001), QF (p< 0.001), and SLS (p = 0.003). Conversely, the Non-IM-G showed no significant changes in JOAS, ROM, or QF, but a significant improvement in SLS (p = 0.024).

Conclusion: Aggressive pain management with DF-HA significantly improved key motor functions in advanced KOA patients experiencing pain relief. However, balance improvement may involve mechanisms beyond pain reduction. These findings highlight the importance of pain control in improving motor function in refractory KOA.

Keywords: advanced knee osteoarthritis; diclofenac-etalhyaluronate; motor function; pain management; quadriceps femoris strength; range of motion; single-legged-stance.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. The Research Board of Healthcare Corporation Ashinokai, Gyoda, Saitama, Japan issued approval ID number: 2020-10. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Stratification of 100 Knee Joints According to Clinical Response (Pain Relief) to Intra-articular Injection
See this image and copyright information in PMC

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