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Knee osteoarthritis: how effective are injections of hyaluronic acid?

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Injections of hyaluronic acid (known as viscosupplementation) to treat osteoarthritis of the knee have virtually no effect on pain and pose risks of adverse effects, according to a study published in July 2022 in the

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Viscosupplementation has been used to treat knee osteoarthritis since the 1970s, but its effectiveness and safety have been questioned for several years.

Osteoarthritis of the knee is a chronic disease that is characterized by inflammation and structural changes in the joints, leading to joint pain and limitations in physical movement. It is one of the main causes of disability in the elderly.

National and international recommendations vary, but most advise against the use of viscosupplementation. In England, the directives of the National Institute for Health and Care Excellence (NICE) advise against its use, but health systems in other countries, including the United States, still offer it to patients. (Arthrosis: hyaluronic acid injections delisted in France)

An international team of researchers therefore set out to review existing studies on the subject conducted over the past 50 years in order to assess the efficacy and safety of viscosupplementation on pain and function in patients with osteoarthritis. of the knee.

They identified 169 trials involving 21,163 patients with knee osteoarthritis that compared viscosupplementation with placebo (dummy) treatment or no treatment.

The main analysis of this review, which included a subset of 24 large trials of higher methodological quality involving 8997 randomized patients, found that viscosupplementation was associated with a small reduction in pain compared to placebo, but the difference was minimal (-2 on a scale of 100) and was described as “clinically irrelevant. »

Their analysis showed that since 2009 there is conclusive evidence that viscosupplementation and placebo treatment have the same clinical outcome in terms of pain reduction, meaning there is no point in doing the injections. .

They also found, from 15 large trials involving 6,462 randomized participants, that viscosupplementation was linked to a 49% increased risk of serious adverse events compared to placebo treatment.

There is strong and conclusive evidence that, in patients with knee osteoarthritis, viscosupplementation, compared to placebo, is associated with a clinically insignificant reduction in pain intensity and an increased risk of adverse events serious“, conclude the authors.

The results do not support a wide use of viscosupplementation for the treatment of knee osteoarthritis.»

In France, intra-articular injections of hyaluronic acid (Durolane, Arthrum, Synvisc-One, Euflexxa) for the treatment of osteoarthritis were dereimbursed in 2017.

For more information on osteoarthritis and its treatment, see the links below.

Psychomedia with sources: BMJ (press release), BMJ (study).
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