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Osteoarthritis of the knee: avoid intra-articular hyaluronic acid injections

At best, intra-articular hyaluronic acid injections give modest relief to patients suffering knee osteoarthritis pain, at the price of local reactions and sometimes severe adverse effects.

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).

Download the full review.
Pdf, subscribers only

See also:

Hyaluronate sodium solution
for intra-articular injection
Prescrire Int 1996:
5 (24):105-107).
Pdf, subscribers only