Intra-articular hyaluronic acid (viscosupplementation) for osteoarthritis: is it effective?

Viscosupplementation with intra-articular hyaluronic acid derivatives and cross-linked polymers of hyaluronic acid is increasingly used to treat symptomatic osteoarthritis in the knee, hip and other joints. Most guidelines conditionally recommend against its use to treat knee osteoarthritis, and strongly or conditionally recommend against its use for other joints, indicating a large evidence-to-practice gap. Conclusive evidence from randomised placebo-controlled trials indicates that intra-articular hyaluronic acid provides no important benefits for people with knee (and other joints) osteoarthritis, and may have potentially serious harms including septic arthritis and severe inflammatory joint and cutaneous reactions. Use of computed tomography scans to guide hyaluronic acid injection exposes the patient to unnecessary radiation and has an unwarranted financial and environmental cost. When the topic arises in clinical practice, prescribers should use a shared decision-making approach that includes an explanation as to why hyaluronic acid injection is not recommended care for osteoarthritis and offer alternatives, taking into consideration the patient's values and preferences.