In patients suffering knee osteoarthritis pain, above all treatment involves physical exercises and analgesics, chiefly paracetamol. Intra-articular hyaluronic acid injections are sometimes offered, but there is no proof of their efficacy.

A study published in 2012 reviewed the trials comparing intra-articular hyaluronic acid injections with a placebo or with no treatment in around 12,500 patients suffering from knee pain.

The analgesic effect of the intra-articular hyaluronic acid injections seems low and of dubious clinical benefit. The results were identical whether the duration of monitoring was 3, 6 or over 6 months, irrespective of the number of injections or the type of substance injected. Another review of trials yielded similar findings.

Local reactions following intra-articular injections, such as prolonged pain or knee effusion, were reported during trials involving a total of over 800 patients.

Hospitalisations, loss of mobility and the occurrence of other severe events following intra-articular injection of hyaluronic acid were reported by more than 3500 patients.

In 2013, in patients suffering from knee pain, it is better to avoid intra-articular hyaluronic acid injections. Its adverse effects outweigh its analgesic benefit, which is at best modest.

©Prescrire 1 October 2013

"Intra-articular hyaluronic acid injection: not for gonarthrosis" Prescrire Int 2013; 22 (142): 248-249. (Pdf, subscribers only).