Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis

Int J Surg. 2017 Mar:39:95-103. doi: 10.1016/j.ijsu.2017.01.087. Epub 2017 Jan 27.


Objective: A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis.

Method: Potential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis.

Results: 12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (p = 0.03) and it shows equal efficacy at 3 months (p = 0.29); HA is more effective than CS at 6 months (p = 0.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (p = 0.29); HA shows greater relative effect than CS at 6 months (p = 0.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (p = 0.58) and proportion of withdrawal for knee pain (p = 0.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (p = 0.73) and 6 months (p = 0.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group.

Conclusion: Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.

Keywords: Corticosteroids; Intraarticular hyaluronic acid; Knee osteoarthritis; Meta-analysis.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage*
  • Female
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Injections, Intra-Articular
  • Knee Joint / drug effects
  • Musculoskeletal Pain / drug therapy*
  • Musculoskeletal Pain / etiology
  • Osteoarthritis, Knee / complications
  • Osteoarthritis, Knee / drug therapy*
  • Pain Measurement
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Viscosupplements / administration & dosage*


  • Adrenal Cortex Hormones
  • Viscosupplements
  • Hyaluronic Acid