Intraarticular Injection of Botox and Hyaluronic Acid in Knee Osteoarthritis

Inclusion Criteria: * Age ≥ 50 years. * Both genders. * Chronic knee osteoarthritis (KOA) according to American College of Rheumatology criteria for the diagnosis of knee osteoarthritis. * Third or fourth grade Kellgren and Lawrence system for classification of osteoarthritis based on radiological data, it is a common method of classifying the severity of osteoarthritis (OA) using five grades according to the following sites and projections. Exclusion Criteria: * History of intra-articular injection within the last 6 months, * History of surgery on the knee joint or major trauma to the lower limb causing fracture. * Body mass index (BMI) more than 40 kg/m2. * Medical conditions affecting the joint or lower extremity function such as severe osteoporosis, rheumatoid arthritis, collagen vascular diseases, and gout. * Diabetic patient. * Any contraindication to intra-articular injections for instance immunodeficiency, coagulation defect or anticoagulation therapy taking or skin infection at the site of injection. * Hypersensitivity to Botulinum toxin or hyaluronic acid.