Authors' objectives:

This review aims to provide a systematic review of literature on intra-articular viscosupplementation for treatment of osteoarthritis (OA) of the knee.

Authors' results and conclusions: From the limited evidence available, Hyalgan(R) (a hyaluronic acid or HA) was found to as effective as, but no more effective than, non-steroidal anti-inflammatory drugs (NSAIDs) at improving patient perceived pain scores, physical function, patient global assessment or stiffness scores. HA was found to be as effective as, but no more effective than, intra-articular (IA) corticosteroids for alleviating night, rest and touch pain but showed a trend for reduced risk of pain under load. HA improved physical functioning and patient global assessment scores in comparison to IA corticosteroids. Results of stiffness scores and analgesic use when comparing HA to IA corticosteroids were inconclusive and contradictory. Overall, hylan G-F 20 was associated with some level of improvement in measures such as mean pain scores at 26 weeks when blinding was instituted and only in combination with NSAID therapy. However, this result is found in a single study of relatively small size. Therefore, treatment with hylan G-F 20 alone is, with one exception, no more effective in improving outcome measures of pain, global assessment, physical function or stiffness than treatment with NSAIDs. Comparison with a lower molecular weight HA is inconclusive due to poor data reporting. The combination of hylan G-F 20 with appropriate care has produced significant improvements in pain, global assessment, physical function and stiffness compared to appropriate care alone. However, these results are questionable due to potential bias inherent in the study design.

Authors' recommendations: MSAC recommended that on the strength of evidence pertaining to intra-articular viscosupplementation for treatment of osteoarthritis of the knee public funding should not be supported for this procedure.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.msac.gov.au/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Medical Services Advisory Committee

Contact Address: MSAC (MDP 107), GPO Box 9848, Canberra, ACT 2601, Australia. Tel: +61 2 6289 6811; Fax: +61 2 6289 8799.

Contact Name: msac.secretariat@health.gov.au

Contact Email: msac.secretariat@health.gov.au

Copyright: Medical Services Advisory Committee (MSAC)