The American Journal of Orthopedics : Updates on Intra-Articular Hyaluronic Acid Therapy for Knee Osteoarthritis

The American Journal of Orthopedics : Updates on Intra-Articular Hyaluronic Acid Therapy for Knee Osteoarthritis

OA is the most common arthritis in the United States. Symptomatic treatment remains the standard of care using pharmacologic and non-pharmacologic modalities. Injections with corticosteroids or HAs are used for the treatment of knee OA when oral therapy does not provide adequate symptom control. Joint replacement surgery is reserved for those who fail more conservative therapies, including injections.
HA derivatives have an established track record of efficacy and safety in knee OA. With the exception of Hylan GF-20, a drawback to these injections compared to corticosteroids is the need for multiple weekly injections over 3 to 5 weeks. Preliminary studies of the use of HAs in combination with corticosteroids or injected NSAIDs for knee OA show encouraging results. There appears to be a rapid onset of symptomatic relief with the same durability of response as HA alone with no apparent increase in toxicity with the combination approach. Future studies should examine if HA preparations (except for hylan G-F 20) can provide equal efficacy with compressed dosing schedules compared to traditional multi-week dosing. Additional research will also better define the role combination anti-inflammatory and HA injections for the treatment of OA at the knee and other sites.