Viscosupplementation for Osteoarthritis of the Knee

  title={Viscosupplementation for Osteoarthritis of the Knee},
  author={Anne W.S. Rutjes and Peter J{\"u}ni and Bruno R. da Costa and Sven Trelle and Eveline N{\"u}esch and Stephan Reichenbach},
  journal={Annals of Internal Medicine},
  pages={180 - 191}
BACKGROUND Viscosupplementation, the intra-articular injection of hyaluronic acid, is widely used for symptomatic knee osteoarthritis. [] Key MethodDATA SOURCES MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), the Cochrane Central Register of Controlled Trials (1970 to January 2012), and other sources. STUDY SELECTION Randomized trials in any language that compared viscosupplementation with sham or nonintervention control in adults with knee osteoarthritis.
Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence.
The most consistent finding was that double-blinded, sham-controlled trials had much smaller treatment effects than trials that were not sufficiently blinded (p < 0.05), and the overall effect was greater but was biased toward stronger treatment effects because of the influence of nonblinded or improperly blinded trials.
A Search for Factors that Predict the Efficacy of Viscosupplementation in Knee Osteoarthritis
Factors that predict clinical response to a single intra-articular injection of Hylan GF-20 did not confirm previous predictors of response to hyaluronate injections, and the need for prospective studies to answer this question was highlighted.
Hyaluronic acid injection therapy for osteoarthritis of the knee: concordant efficacy and conflicting serious adverse events in two systematic reviews
Trials show a small but significant effect of HA on function on which recent systematic reviews agree, but lack of AE synthesis standardization leads to opposite conclusions about the balance of benefits and harms.
Intra-articular hyaluronic acid and corticosteroids in the treatment of knee osteoarthritis: A meta-analysis
A meta-analysis highlights a therapeutic trajectory for intra-articular HA in knee OA pain, as compared with CS, over six months post-intervention; however, in the long term, HA was found to have an enhanced effect.
Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis
Strong conclusive evidence indicates that viscosupplementation leads to a small reduction in knee osteoarthritis pain compared with placebo, but the difference is less than the minimal clinically important between group difference.
Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians
Evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA.


Hyaluronic acid injections relieve knee pain.
Intra-articular viscosupplementation was moderately effective in relieving knee pain in patients with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not at 15 to 22 weeks.
Viscosupplementation for the treatment of osteoarthritis of the knee.
The pooled analyses of the effects of viscosupplementation against 'placebo' controls generally supported the efficacy of this class of intervention and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products.
Hylan versus hyaluronic acid for osteoarthritis of the knee: a systematic review and meta-analysis.
Given the likely lack of a superior effectiveness of hylan over hyaluronic acids and the increased risk of local adverse events associated with hylan, the use of intraarticular hylan in patients with knee osteoarthritis in clinical research or practice is discouraged.
Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis
Background: Osteoarthritis of the knee affects up to 10% of the elderly population. The condition is frequently treated by intra-articular injection of hyaluronic acid. We performed a systematic
Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis.
It is suggested that the highest-molecular-weight hyaluronic acid may be more efficacious in treating knee OA, but heterogeneity of these studies limits definitive conclusions.
The effect of viscosupplementation on neuromuscular control of the knee in patients with osteoarthritis.
It was demonstrated that intraarticular injection of hyaluronan in patients with knee OA led to a short-term increase in proprioception and isokinetic muscle force, and also significant improvements in the functional conditions of patients.
Intra-articular hyaluronan injections for the treatment of osteoarthritis of the knee: a randomized, double blind, placebo controlled study.
The results through week 20 indicate that BioHy provides relief for osteoarthritic patients without causing adverse effects, although the study was not sufficiently powered to obtain statistically significant differences between the treatment groups.