Product Differences in Intra-Articular Hyaluronic Acids for Osteoarthritis of the Knee

Primary tabs

Product Differences in Intra-Articular Hyaluronic Acids for Osteoarthritis of the Knee

Knee osteoarthritis (OA) is a common, but disabling joint disorder among the elderly population. Gradual onset of knee pain, stiffness and swelling are the typical symptoms of the knee osteoarthritis. Knee osteoarthritis can make the daily life activities to suffer like walking or climbing stairs, thereby affecting the quality of life. Nowadays, it is one of the main causes for the loss of work time and disability in people.

Different types of treatment options are available but are prescribed depending on the severity of the disorder and physician's preference. Among those treatments, intra-articular hyaluronic acid (HA) injection has reported to provide the various biochemical and biological benefits to treat the knee osteoarthritis which includes shock absorption, chondroprotection and exhibits anti-inflammatory effects. However, clarity is needed for the available treatments of intra-articular HA which is to be considered for the therapy for knee OA. A meta-analysis was conducted to check the efficacy and safety of injections of intra-articular hyaluronic acid in knee OA.

Data from Medline, EMBASE and PubMed was selected and the already existing randomized trials of intra-articular injections of HA were analyzed. Out of which, the mean pain score was reported to follow-up for the 26 weeks after the injection. Pooled efficacy and safety results were also recorded for the sub groups of HA product.

In this meta-analysis, a total of 68 studies were included. Favorable results of efficacy were seen in the products with average molecular weight ≥3000 kDa as compare to the products with the higher molecular weight. Products with a molecular weight ≥3000 kDa demonstrated significantly fewer discontinuations due to treatment-related adverse events than did ≤1500 kDa counterparts, while trial discontinuation rates were similar between biological fermentation-derived HA products and avian-derived HA.

After the analysis, it was observed that the results were not sufficient to demonstrate the significant difference in the occurrence of the effusion across different molecular weight of subgroups. However, biologically fermented HA showed a smaller incidence of effusion than avian derived HA. Biologically fermented HA had also demonstrated the fewer acute flare-ups at the injection site than avian derived hyaluronic acid, whereas, the high molecular weight products also demonstrated the highest rate of injection site flare-up.

It was concluded that despite of similarities, intra-articular hyaluronic acid products influenced both efficacy and safety. From the available literature, intra-articular products with molecular weight ≥3000 kDa and derived from the biologically fermented process, relates to the superior efficacy and safety-factors that might influence the selection of intra-articular hyaluronic product for knee OA.


Am J Sports Med

Link to the source:

Original title of article:

Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee.


Altman RD, Bedi A, Karlsson J, Sancheti P, Schemitsch E

Am J Sports Med
Therapeutic, Hyaluronic Acid, Osteoarthritis, Knee, Glycosaminoglycan, Meta-analysis, Efficacy, Safety, Intra-articularly
Log in or register to post comments