Original Title: Infiltrationstherapien bei Osteoarthrose: intraartikuläre Injektionen

Authors' objectives: Osteoarthritis (OA) is a chronic, degenerative joint disease that leads to progressive structural joint damage, pain, stiffness and swelling, and is one of the most common causes of chronic disability in adults. In Austria, according to the 2019 national health survey, 14.2% of people aged over 15 reported having had OA in the previous twelve months, with women (17.7%) affected more often than men (10.7%). Prevalence rises markedly with age. Worldwide, an estimated 595 million people were affected in 2020 (7.6% of the global population), and the number of people with OA in Austria is projected to increase by 38% by 2080, driven mainly by population ageing. This rapid review focuses on knee osteoarthritis (gonarthrosis), hip osteoarthritis (coxarthrosis) and shoulderosteoarthritis (omarthrosis).

Authors' results and conclusions: Ten systematic reviews (published 2021-2026) formed the evidence base for this rapid review: six on knee OA, two on hip OA, and two on OA affecting multiple joints. No systematic review of sufficient methodological quality was identified for shoulder OA. The available evidence indicates that IA hyaluronic acid and corticosteroid injections for knee and hip OA provide, overall, only a limited benefit, which predominantly does not persist in the long term (more than three months beyond treatment), and no systematic review of sufficient quality could be identified for shoulder OA. Findings across the included reviews are heterogeneous and at times contradictory, which complicates a definitive assessment of efficacy and safety. This rapid review has several limitations. It was restricted to systematic reviews and meta-analyses and to publications in German or English from the past five years. Due to the focus on systematic reviews (rather than primary studies), a standardised GRADE assessment of the evidence could not be conducted. The clinical guidelines described in this report were not subjected to a comprehensive, instrument-based quality appraisal (e.g. using AGREE II), although a priori quality criteria were applied in their selection. The included HTA reports were likewise not subjected to an instrument-based quality assessment (using ROBIS). An overlap of the primary studies considered in the included reviews (e.g. via a citation matrix) was not assessed as part of this work. No independent definition and assessment of the minimal clinically important difference (MCID) was undertaken for the reported outcomes, and where available, only the thresholds defined in the included systematic reviews were reported. Finally, an assessment of the trustworthiness or data integrity of the primary studies underlying the included systematic reviews and HTA reports (e.g. using INSPECT-SR) was outside the scope of this rapid review. These limitations should be considered when interpreting the results.

Authors' methods: A systematic literature search was conducted on 26 March 2026 in four databases: Ovid MEDLINE (or PubMed), The Cochrane Library, Epistemonikos, and the INAHTA database. Screening was performed independently by two researchers using Rayyan. Of 824 records identified, 92 publications were selected for full-text assessment. From these, 40 systematic reviews were critically appraised for risk of bias using the ROBIS tool, independently by two reviewers, separately for each joint (seven publications on the hip, 28 on the knee, three on OA of multiple joints, and two on the shoulder). Publications before 2021 were excluded on the assumption that relevant primary studies would be sufficiently captured by more recent reviews. Following the ROBIS assessment, 30 systematic reviews were excluded due to a high risk of bias, leaving ten systematic reviews with low or unclear risk of bias as the evidence base for the results presented below. In addition, evidence-based, recent international clinical guidelines (publication period 2020-2026) were identified through a structured manual search of four databases: TRIP Medical Database, the German Association of the Scientific Medical Societies (AWMF), the Guidelines International Network (G-I-N), and UpToDate. Guidelines were included only if they met pre-specified quality criteria: recommendations based on systematic reviews or the best available evidence as opposed to purely consensus-based recommendations, a stated level of evidence and/or grade of recommendation, and recommendations that were formally and clearly identifiable as such. Identified HTA reports and guidelines were not subjected to a standardised, instrument-based quality appraisal. A separate search for currently ongoing clinical trials was performed in ClinicalTrials.gov on 12 June 2026. Generative AI (Claude Sonnet 5 and Opus 4.8) was used to support selected working steps in the preparation of this rapid review, in particular language editing, formatting, and the drafting of summaries. All content was reviewed and validated by the authors, who bear full responsibility for it. Risk-of-bias assessment, data extraction and narrative synthesis were carried out exclusively by the authors.

Project Status: Completed

URL for project: https://aihta.at/en/programme-lines/information-service-rapid-reviews

Year Published: 2026

URL for published report: https://eprints.aihta.at/1617/1/HTA-Informationsdienst_Rapid_Review_021.pdf

URL for additional information: https://eprints.aihta.at/1617/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Austria

Organisation Name: Austrian Institute for Health Technology Assessment

Contact Address: Josefstaedter Strasse 39, A-1080 Vienna, Austria

Contact Name: office@aihta.at

Contact Email: office@aihta.at