Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis

Intraarticular injections of hyaluronic acid have been advocated for treatm ent of symptomatic knee osteoarthritis. Appropriate indications and favorab le patient response factors, such as radiographic disease severity and age, are not clearly defined for this therapy. The current review of 80 knees w ith symptomatic osteoarthritis treated with hyaluronic acid revealed that a pproximately 2/3 of treated knees received 2/3 relief of pain. Hyaluronic a cid treatment is not appropriate for all patients with knee osteoarthritis. Overall, less than 50% of treated knees achieved satisfactory results, and only 35% reported increased activity. Twenty-two patients (28% of knees; 2 2 knees) underwent surgery within 7 months of their index injection, sugges ting an inadequate response to treatment. The treatment is not without comp lication because 11 patients (15% of knees; 12 knees) experienced adverse r eactions, including one case of septic arthritis. The authors recommend int raarticular hyaluronic acid only for patients with symptoms and significant surgical risk factors and for patients with mild radiographic disease in w hom conservative treatment has failed (physical therapy, weight loss, nonst eroidal antiinflammatory medication, and intraarticular steroid injection). It is inadvisable to treat patients with a complete collapse of joint spac e or bone loss with intraarticular hyaluronic acid, given their poor clinic al response.