The effectiveness of hyaluronic acid intra-articular injections in managing osteoarthritic knee pain

Ann R Coll Surg Engl. 2013 Nov;95(8):545-51. doi: 10.1308/rcsann.2013.95.8.545.


Introduction: Knee osteoarthritis (OA) is a common and progressive joint disease. Treatment options for knee OA vary from simple analgesia in mild cases to knee replacement for advanced disease. Knee pain due to moderate OA can be targeted with intra-articular injections. Steroid injections have been used widely in managing acute flare-ups of the disease. In recent years, viscosupplementation has been used as a therapeutic modality for the management of knee OA. The principle of viscosupplementation is based on the physiological properties of the hyaluronic acid (HA) in the synovial joint. Despite a sound principle and promising in vitro studies, clinical studies have been less conclusive on the effectiveness of HA in managing osteoarthritic knee pain. The aim of this systematic review was to assess the effectiveness of HA intra-articular injections in the management of osteoarthritic knee pain.

Methods: A systematic review of the literature was performed using MEDLINE®, Embase™ and CINAHL® (Cumulative Index to Nursing and Allied Health Literature). The databases were searched for randomised controlled trials available on the effectiveness of HA intra-articular injections in managing osteoarthritic knee pain.

Results: The search yielded 188 studies. Of these, 14 met the eligibility criteria and were reviewed in chronological order.

Conclusions: HA intra-articular injections have a modest effect on early to moderate knee OA. The effect peaks at around 6-8 weeks following administration, with a doubtful effect at 6 months.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Epidemiologic Methods
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Injections, Intra-Articular
  • Musculoskeletal Pain / prevention & control*
  • Osteoarthritis, Knee / drug therapy*
  • Pain Measurement
  • Treatment Outcome
  • Viscosupplements / administration & dosage*


  • Viscosupplements
  • Hyaluronic Acid