hyaluronic acid in osteoarthritis of the knee

Last reviewed 01/2018

  • there is evidence that the beneficial effect is as least as good as achieved with NSAIDs but without the gastrointestinal side effects (1)
    • Huskisson and Donnelly, in a randomised, placebo, controlled trial of treatment of osteoarthritis of the knee, have shown that a course of 5 weekly hyaluronic acid injections can improve knee function for 4 months and reduce pain on walking for 6 months (1)
  • a more recent meta-analysis (2):
    • confirmed the therapeutic efficacy and safety of intra-articular injection of hyaluronic acid for the treatment of osteoarthritis of the knee
  • NICE however state that intra-articular hyaluronan injections are not recommended for the treatment of osteoarthritis (3)


  • a study compared intra-articular hylan versus hyaluronic acid for osteoarthritis (4)
    • there was no evidence for a difference in efficacy between the two treatments
  • there is evidence that repeated cycles of intra-articular injections of hyaluronic acid not only improve knee osteoarthritis symptoms during the in-between cycle period but also exert a marked carry-over effect for at least 1 year after the last cycle (5)