Original Title: Application 1045

Authors' results and conclusions: Safety - Studies included are limited in their assessment of adverse events. The majority of studies provided very little information on the process for adverse event collection and all but one study failed to include a definition of what was considered an adverse event. Numerous studies were small, some were unblinded and others were of short duration. What is suggested by the available data, however, is that viscosupplementation with hyaluronic acid (HA) compounds has similar incidence of local adverse events (i.e. at the level of the knee) as intra-articular (IA) corticosteroid injections but greater incidence than non-steroidal anti-inflammatory drugs (NSAIDs). Conversely, IA injection of HA produces fewer systemic adverse events (specifically gastrointestinal upset) than NSAID treatment. Studies showed that viscosupplementation with hylan G-F 20 produces a similar incidence of local adverse events as injection with lower molecular weight HA. Effectiveness - From the limited evidence, HA was found to be as effective as, but no more effective than, 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, IA corticosteroids for alleviating night, rest and touch pain, but found to show 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. Treatment with hylan G-F 20 alone is, with one exception, no more effective in improving outcomes measures of pain, global assessment, physical function or stiffness than treatment with NSAIDs.

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

Project Status: Completed

URL for project: https://www.msac.gov.au/applications/1045

Year Published: 2003

URL for published report: https://www.msac.gov.au/sites/default/files/documents/1045-Assessment-Report.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Adelaide Health Technology Assessment

Contact Address: School of Public Health, Mail Drop 545, University of Adelaide, Adelaide SA 5005, AUSTRALIA, Tel: +61 8 8313 4617

Contact Name: ahta@adelaide.edu.au

Contact Email: ahta@adelaide.edu.au

Copyright: <p>Adelaide Health Technology Assessment (AHTA) on behalf of NICS</p>