54 patients with moderate to severe knee osteoarthritis (OA) were randomized to receive transcutaneous electric nerve stimulation (TENS) with silver spike electrodes (SSP) or intra-articular hyaluronic acid injections, in order to compare the success of each treatment over 3 months post-treatment. Patients were assessed for pain using the visual analog scale (VAS) and for functional disability using the Lequesne index. The study found that TENS treatment for knee OA achieved superior scores for pain at the 2 week follow-up, and for functional disability at the 2 week and final 3 month follow-ups. The TENS groups also displayed superiority for the secondary assessments of range of knee motion (ROM), walking, patient-global assessment, and disability.