Health Problem: Osteoarthritis (OA) is a painful condition in which the cartilage between the bones degenerates, no longer providing a smooth, gliding surface for motion or adequate cushioning. Because OA damages the cartilage and may ultimately damage the bone, it disrupts how components work together, resulting in pain, swelling, inflammation, muscle weakness, impaired quality of life (QOL), and reduced function. The knee is commonly afflicted by OA.

Technology Description: Hyaluronic acid (HA) is a component of synovial fluid, which lubricates the joint and absorbs shock. HA production is generally reduced and may be of poorer quality in patients with OA, which may exacerbate inflammation. Intra-articular (IA) injection of HA (IA-HA) aims to replace depleted or poor-quality HA in the joint.

Controversy: Despite a large evidence base, the efficacy of IA-HA for knee OA remains controversial and mechanisms of action remain poorly understood. Systematic reviews published prior to 2015, in particular, have drawn conflicting conclusions. Furthermore, studies and recent systematic reviews have generally found that while IA-HA confers benefits for knee OA, IA administration of saline (IA-S), which is often used as a placebo/sham control, is also associated with pain relief.

Key Questions:

For adults with knee OA:

  • What is the efficacy of IA-HA compared with IA-S and IA injections of corticosteroids (IA-CS)?
  • How do the efficacy of different IA-HA products compare with each other?
  • What is the safety of IA-HA compared with IA-S and IA-CS?
  • How do the safety of different IA-HA products compare with each other?
  • Have definitive patient selection criteria been established for IA-HA for knee OA?

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