Viscosupplementation for OA of the Knee?

NEJM weighs weak evidence of benefit against small risk of viscosupplementation for osteoarthritic knees and recommends against it.

Hunter DJ, Thienpont E, Gladstone S, Zeng C, et al. Correspondence: Viscosupplementation for Osteoarthritis of the Knee. N Engl J Med. 2015; 372:2569-2570 June 25, 2015 DOI: 10.1056/NEJMc1505801

In March, a vignette in The New England Journal of Medicine considered viscosupplementation for osteoarthritis of the knee, weighed the weak evidence of benefit against the 1%-3% incidence of non-septic inflammation and swelling, and recommended against it. (See Latest Hyaluronic Acid Review: Knee Injections Rate Another "Meh.")

In this week’s letters, a knee surgeon defends viscosupplementation and a family doctor criticizes it, citing 3 cases of infection.

A Chinese group reports their favorable experience with sodium hyaluronate, which is popular in China. “A high-quality, multiple-center, large-sample, randomized, controlled trial is about to begin in China,” they write.

David Hunter remains skeptical, until he sees the data. He gives the additional example of arthroscopy for knee osteoarthritis. (See Thumbs Down on Arthroscopic Knee Surgery.) Diet and exercise is safe and effective, and recommended in most guidelines, he reiterates.