Effects of hydrogen inhalation duration on symptom relief in elderly patients with knee osteoarthritis: A pilot study

doi:10.5312/wjo.v17.i6.121358

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. Jun 18, 2026; 17(6): 121358
Published online Jun 18, 2026. doi: 10.5312/wjo.v17.i6.121358

Effects of hydrogen inhalation duration on symptom relief in elderly patients with knee osteoarthritis: A pilot study

Chen-Hui Wang, Yu-Ru Li, Lei Han, Hong-Qian Wang, Shu-Feng Jia, Xing-Chen Liu, Hao Wu, Fan Wu, Bao-Guo Wang

Chen-Hui Wang, Fan Wu, Bao-Guo Wang, Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, Beijing 100018, China

Chen-Hui Wang, Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

Yu-Ru Li, Lei Han, Hong-Qian Wang, Shu-Feng Jia, Infirmary, Taikang Yanyuan Continuing Care Retirement Community, Beijing 102200, China

Xing-Chen Liu, School of Nursing, Harbin Medical University, Harbin 150076, Heilongjiang Province, China

Hao Wu, Department of Rehabilitation Medicine, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China

Co-corresponding authors: Fan Wu and Bao-Guo Wang.

Author contributions: Wang CH, Wu F and Wang BG designed the research study; Wang CH, Li YR, Han L, Wang HQ, Jia SF and Liu XC performed the research; Wang CH, Wu F and Wang BG analyzed the data and wrote the manuscript; Wang CH, Wu H, Wu F and Wang BG revised the manuscript; and all authors have read and approve the final manuscript. Both Wu F and Wang BG have played important and indispensable roles in the study design, data interpretation and manuscript preparation as the co-corresponding authors. Wang BG applied for and obtained the funds for this research project. Wang BG conceptualized, designed, and supervised the whole process of the project. He searched the literature, revised and submitted the early version of the manuscript with the focus on the association between hydrogen inhalation duration and symptoms relief of KOA. Wu F was instrumental and responsible for data re-analysis and re-interpretation, figure plotting, comprehensive literature search, preparation and submission of the current version of the manuscript with a new focus on plateau effect of hydrogen therapy and its potential underlying mechanism. This collaboration between Wu F and Wang BG is crucial for the publication of this manuscript.

AI contribution statement: ChatGPT was used for translation and language polishing.

Supported by Capital’s Funds for Health Improvement and Research, No. CFH2024-3-8011.

Institutional review board statement: This study has been approved by Ethics Committee of Sanbo Brain Hospital, Capital Medical University (No. SBNK-YJ-2024-009-01).

Informed consent statement: All the subjects and their legal representatives fully understood the purpose, content, protocol and assessment methods of the study and provided informed consent before the start of the study.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: sharing statement: No additional data are available.

Corresponding author: Bao-Guo Wang, MD, Chief Physician, Professor, Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, No. 36 Courtyard, Dongba Middle Road, Chaoyang District, Beijing 100018, China. wangbg@ccmu.edu.cn

Received: March 24, 2026
Revised: April 18, 2026
Accepted: May 13, 2026
Published online: June 18, 2026
Processing time: 86 Days and 23.5 Hours

Abstract

BACKGROUND

Molecular hydrogen, with antioxidant and anti-inflammatory properties, has shown therapeutic potential in knee osteoarthritis (KOA). However, optimal inhalation parameters and the dose-response relationship between hydrogen inhalation duration and symptomatic relief in KOA patients remain uncertain.

AIM

To evaluate the effect of different durations of hydrogen inhalation on KOA symptom relief and explore the dose-response relationship between inhalation duration and symptom relief in elderly KOA patients.

METHODS

In this 12-week pilot study, elderly KOA patients were assigned to either a long-term (LT) or short-term (ST) hydrogen inhalation group based on the median cumulative inhalation duration. Primary outcomes were the changes in the Western Ontario and McMaster Universities Osteoarthritis Index (ΔWOMAC) total and subscale scores. Secondary outcomes included changes in 36-item Short-Form Health Survey scores (ΔSF-36), dose-response analysis between cumulative inhalation duration and ΔWOMAC, and adverse events. Assessments were conducted at baseline and week 12.

RESULTS

A total of 49 patients (mean age 80.1 ± 5.8 years; 77.6% female) were enrolled. At week 12, the LT group showed significantly greater symptom improvement in the ΔWOMAC total score (LT: 28.2 ± 7.0 vs ST: 11.2 ± 4.6, P < 0.001). Multivariable regression confirmed a positive association between cumulative inhalation duration and ΔWOMAC total score (β = 15.176, 95%CI: 12.177-18.176, P < 0.001). ΔSF-36 scores did not differ significantly. Dose-response analysis revealed a logarithmic relationship between inhalation duration and symptom improvement, plateauing after approximately 114 cumulative hours.

CONCLUSION

Our pilot study indicated that LT hydrogen inhalation may provide greater symptom relief in elderly KOA patients than ST exposure. A potential dose-response relationship was observed, with therapeutic benefits suggesting a potential plateau trend around 114 cumulative hours.

Keywords: Hydrogen; Elderly; Osteoarthritis; Dose-response relationship; Non-pharmacological management

Core Tip: This pilot study is the first to demonstrate a dose-response relationship between cumulative hydrogen inhalation duration and symptom relief in elderly patients with knee osteoarthritis. Long-term inhalation (over 30 cumulative hours) provided significantly greater improvements in pain, stiffness, and physical function than short-term inhalation. The therapeutic benefit followed a logarithmic curve, plateauing after approximately 114 cumulative hours, suggesting a potential saturation point for clinical efficacy.