Intra-Articular Use of Hyaluronic Acid Preparations in the Treatment of Knee Osteoarthritis
Bibliographic record
Abstract
PURPOSE OF THE STUDY: The knee is the most common peripheral site of osteoarthritis (KOA; knee osteoarthritis). The mainstay of non-operative treatment is education, exercise, weight reduction, and pharmacological therapy. Intra-articular hyaluronic acid (HA) injection is a non-operative treatment option. The aim of our study was to assess the most recent data on the efficacy of intra-articular administration of HA in KOA therapy and to compare it with intra-articular injections of platelet-rich plasma (PRP), corticosteroids (CS) and placebo (saline solution). MATERIAL AND METHODS: The PubMed and Cochrane Library databases were searched for randomized clinical trials (RCTs) conducted between 2012 and 2023 comparing the efficacy of HA with PRP, CS, or placebo. The efficacy was mostly assessed using the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) and VAS (Visual Analogue Scale) for pain. The Rob2 (Risk of Bias 2) tool developed by the Cochrane Collaboration was used to assess the risk of bias. RESULTS: The data pooled from 29 studies (2032 patients treated with HA, 965 with PRP, 376 with CS and 697 with placebo) were analysed. The efficacy was assessed mostly at 1, 3, 6 and 12 months after the administration of the investigated substance. All types of interventions (HA, PRP, CS) were found to have a beneficial effect on the knee affected by KOA, namely through symptom relief. The greatest effect was achieved with PRP, which lasted longer than that of HA or CS. HA offered a moderate relief of symptoms, which was still apparent at 6 months after administration. The administration of CS resulted in a rapid onset of pain relief which was, however, of short duration and started to diminish as early as after the first month of follow-up. In placebo-controlled studies, the follow-up did not exceed 6 months. DISCUSSION AND CONCLUSIONS: Intra-articular administration of HA continues to be the most common intra-articular therapy for patients with KOA. We should therefore take an interest in its outcomes. This intervention is recommended by the OARSI as 1B level treatment. The ACR, on the contrary, has turned from both the HA and PRP. The NICE in its opinion on non-surgical management of KOA also advises against HA. In our study, on the other hand, we concluded that all three active pharmaceutical ingredients (HA, PRP and CS) improved the KOA symptoms, with PRP showing the most significant, longest lasting and most consistent overall beneficial effects. This conclusion does not imply that HA offers no or only negligible effect. The particular size of effect of intra-articular administration of HA depends on a number of circumstances. Further research should therefore be conducted which would look into the HA benefit in relation to the specific patient, KOA phenotype, stage of inflammation, or healing processes.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.003 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".