Injecting hyaluronic acid should no longer be recommended as a treatment for knee osteoarthritis because there is no evidence that it benefits patients, according to an analysis published today.
International research published in today’s edition of The BMJ reviewed existing studies from the past 50 years to evaluate how effective and safe the procedure, known as viscosupplementation, is for pain and function in patients with knee osteoarthritis.
The researchers identified 169 trials involving 21,163 patients with knee osteoarthritis that compared viscosupplementation with placebo treatment or no treatment.
The main analysis of this review, which included a subset of 24 large trials of higher methodological quality involving 8,997 randomised patients, found that viscosupplementation led to a small reduction in pain compared with placebo, but the difference was “clinically irrelevant”.
Since 2009, trials have demonstrated that viscosupplementation and placebo treatment have had the same clinical result in terms of pain reduction, while 15 large trials on 6,462 randomised participants found the injection was linked to a 49% higher risk of serious adverse events than placebo.
Based on the analysis of studies between 2009 and 2021 alone, more than 12,000 patients were unnecessarily subjected to these injections in viscosupplementation trials, say the researchers.
While the team says their study has some limitations – it represents summary estimates, does not necessarily exclude the possibility that selected patient populations could benefit from viscosupplementation, and they examined adverse events that emerged rather than adverse events directly related to treatment – they scrutinised the largest collection of randomised trials on viscosupplementation reported to date.
“There is strong, conclusive evidence that among patients with knee osteoarthritis, viscosupplementation, compared with placebo, is associated with a clinically irrelevant reduction in pain intensity and with an increased risk of serious adverse events,” they write.
“The findings do not support broad use of viscosupplementation for the treatment of knee osteoarthritis.”
Pereira PV, Jüni P, Saadat P et al. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. BMJ 7 July 2022; doi: 10.1136/bmj-2022-069722
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