Latest Hyaluronic Acid Review: Knee Injections Rate Another "Meh"

Hunter DJ. Viscosupplementation for Osteoarthritis of the Knee.N Engl J Med 2015; 372:1040-1047. March 12, 2015. doi: 10.1056/NEJMct1215534

Carla Rothaus. Viscosupplementation. Now@NEJM. March 13, 2015

The good news: At best, intraarticular hyaluronate injected in the knee for osteoarthritis (OA) is modestly effective. The bad news: At worst, it’s indistinguishable from placebo, in some meta-analyses.

The guidelines come to a similar conclusion. Guidelines of the Osteoarthritis Research Society International, American Academy of Orthopedic Surgeons, and American College of Rheumatology (ACR) range from inconclusive at best to not recommended at worst. The ACR conditionally recommends hyaluronate when first-line medications have failed.

In the favorable studies, the effect size is “modest.” In a randomized trial of patients with an average score of 2.3 on the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale, Chevalier et al reported that a hyaluronate derivative led to an improvement of 0.15 points.

In the case vignette [second article above], a 67-year-old woman with OA has a body mass index of 32, and after nine years of occasional naproxen she is becoming more sedentary and finds it more difficult to play golf. A golfing partner recommended hyaluronate.

The specialist advised weight loss and exercise, and recommended against hyaluronate.