Skip to main content
SpringerLink
Log in

Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians

  • Review
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Osteoarthritis (OA) constitutes a growing public health burden and the most common cause of disability in the United States. Non-pharmacologic modalities and conservative pharmacologic therapies are recommended for the initial treatment of OA, including acetaminophen, and topical and oral non-steroidal anti-inflammatory drugs. However, safety concerns continue to mount regarding the use of these treatments and none have been shown to impact disease progression. Viscosupplementation with injections of hyaluronans (HAs) are indicated when non-pharmacologic and simple analgesics have failed to relieve symptoms (e.g., pain, stiffness) associated with knee OA. This review evaluates literature focusing on the efficacy and/or safety of HA injections in treating OA of the knee and in other joints, including the hip, shoulder, and ankle.

Methods

Relevant literature on intra-articular (IA) HA injections as a treatment for OA pain in the knee and other joints was identified through PubMed database searches from inception until January 2013. Search terms included “hyaluronic acid” or “hylan”, and “osteoarthritis”.

Discussion

Current evidence indicates that HA injections are beneficial and safe for patients with OA of the knee. IA injections of HAs treat the symptoms of knee OA and may also have disease-modifying properties, potentially delaying progression of OA. Although traditionally reserved for second-line treatment, evidence suggests that HAs may have value as a first-line therapy in the treatment of knee OA as they have been shown to be more effective in earlier stages and grades of disease, more recently diagnosed OA, and in less severe radiographic OA.

Conclusion

For primary care physicians who treat and care for patients with OA of the knee, IA injection with HAs constitutes a safe and effective treatment that can be routinely administered in the office setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

HA:

Hylan/hyaluronic acid

PBS:

Phosphate buffered saline

References

  1. A National Public Health Agenda for Osteoarthritis. Centers for Disease Control and Prevention. www.cdc.gov/arthritis/docs/OAagenda.pdf (2010). Accessed Aug 24, 2012.

  2. Dillon CF, Rasch EK, Gu Q, Hirsch R. Prevalence of knee osteoarthritis in the United States: arthritis data from the Third National Health and Nutrition Examination Survey 1991–94. J Rheumatol. 2006;33:2271–9.

    PubMed  Google Scholar 

  3. Brzusek D, Petron D. Treating knee osteoarthritis with intra-articular hyaluronans. Curr Med Res Opin. 2008;24:3307–22.

    PubMed  CAS  Google Scholar 

  4. Goldring MB, Otero M. Inflammation in osteoarthritis. Curr Opin Rheumatol. 2011;23:471–8.

    PubMed  CAS  Google Scholar 

  5. Murphy L, Schwartz TA, Helmick CG, et al. Lifetime risk of symptomatic knee osteoarthritis. Arthr Rheum. 2008;59:1207–13.

    Google Scholar 

  6. Hootman JM, Murphy LB, Helmick CG. Arthritis as a potential barrier to physical activity among adults with obesity—United States, 2007–2009. Morb Mortal Wkly Rep. 2011;60:614–5.

    Google Scholar 

  7. Moreland LW. Intra-articular hyaluronan (hyaluronic acid) and hylans for the treatment of osteoarthritis: mechanism of action. Arthr Res Ther. 2003;5:54–67.

    CAS  Google Scholar 

  8. Bagga H, Burkhardt D, Sambrook P, March L. Longterm effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol. 2006;33:946–50.

    PubMed  CAS  Google Scholar 

  9. Balazs EA. Some aspects of the aging and radiation sensitivity of the intercellular matrix with special regard to hyaluronic acid in synovial fluid and vitreous. Aging Connect Skeletal Tissue 1969;107–22.

  10. Felson DT, Gross KD, Nevitt MC, et al. The effects of impaired joint position sense on the development and progression of pain and structural damage in knee osteoarthritis. Arthr Rheum. 2009;61:1070–6.

    Google Scholar 

  11. Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthr Care Res (Hoboken). 2012;64:465–74.

    CAS  Google Scholar 

  12. Zhang W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil. 2010;18:476–99.

    PubMed  CAS  Google Scholar 

  13. Altman R, Barkin RL. Topical therapy for osteoarthritis: clinical and pharmacologic perspectives. Postgrad Med. 2009;121:139–47.

    PubMed  Google Scholar 

  14. Altman RD, Fowler PJ. Pharmacologic treatment of knee osteoarthritis in athletic women. Phys Sportsmed. 2011;39:39–44.

    PubMed  Google Scholar 

  15. Schilling A, Corey R, Leonard M, Eghtesad B. Acetaminophen: old drug, new warnings. Cleve Clin J Med. 2010;77:19–27.

    PubMed  Google Scholar 

  16. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal antiinflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115:1634–42.

    PubMed  Google Scholar 

  17. Chou R, Helfand M, Peterson K, Dana T, Roberts C. Drug class review on cyclo-oxygenase (COX)-2 inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs) final report update. Oregon Health and Science University; 2006.

  18. Conaghan PG. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int. 2012;32:1491–502.

    PubMed  CAS  Google Scholar 

  19. FDA acetaminophen announcement. Nevada Department of Health and Human Services. www.medicaid.nv.gov/Downloads/provider/web_announcement_468_20120425.pdf (2012). Accessed Oct 30, 2013.

  20. FDA. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm150314.htm (2005). Accessed Mar 5, 2013.

  21. Avouac J, Gossec L, Dougados M. Efficacy and safety of opioids for osteoarthritis: a meta-analysis of randomized controlled trials. Osteoarthr Cartil. 2007;15:957–65.

    PubMed  CAS  Google Scholar 

  22. Cepeda MS, Camargo F, Zea C, Valencia L. Tramadol for osteoarthritis. Cochrane Database Syst Rev. 2006;3:CD005522.

    PubMed  Google Scholar 

  23. Solomon DH, Rassen JA, Glynn RJ, Lee J, Levin R, Schneeweiss S. The comparative safety of analgesics in older adults with arthritis. Arch Intern Med. 2010;170:1968–76.

    PubMed  Google Scholar 

  24. FDA issues draft guidance on abuse-deterrent opioids. US Food and Drug Administration. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm334785.htm (2013). Accessed Mar 5, 2013.

  25. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2005;2:CD005328.

    PubMed  Google Scholar 

  26. Daly E, Gray A, Barlow D, Mcpherson K, Roche M, Vessey M. Measuring the impact of menopausal symptoms on quality of life. BMJ. 1993;307:836–40.

    PubMed  CAS  Google Scholar 

  27. Balch HW, Gibson JM, El-Ghobarey AF, Bain LS, Lynch MP. Repeated corticosteroid injections into knee joints. Rheumatol Rehabil. 1977;16:137–40.

    PubMed  CAS  Google Scholar 

  28. Tehranzadeh J, Booya F, Root J. Cartilage metabolism in osteoarthritis and the influence of viscosupplementation and steroid: a review. Acta Radiol. 2005;46:288–96.

    PubMed  CAS  Google Scholar 

  29. Synvisc-One® (hylan G-F 20) Prescribing Information. Genzyme Biosurgery. http://synviscone.com/~/media/SynviscOneUS/Files/Synvisc-OnePI-70240104.pdf (2013). Accessed Mar 5, 2013.

  30. Synvisc® (hylan G-F 20) Prescribing Information. Genzyme Biosurgery. http://synviscone.com/~/media/SynviscOneUS/Files/synvisc_PI.pdf (2013). Accessed Mar 5, 2013.

  31. Euflexxa® (1% sodium hyaluronate) Prescribing Information. Ferring Pharmaceuticals. www.euflexxa.com/assets/euflexxa_physician-f87c5c8e9b6f9317c6cfd0b7df1b48c6.pdf (2013). Accessed Mar 5, 2013.

  32. Hyalgan® (sodium hyaluronate) Prescribing Information. Sanofi-aventis. www.hyalgan.com/download/hyalgan_pi.pdf (2013). Accessed Mar 5, 2013.

  33. Supartz® (sodium hyaluronate) Prescribing Information. Seikagaku Corporation. http://supartzprofessional.com/docs/PackageInsert.pdf (2013). Accessed Mar 5, 2013.

  34. Orthovisc® (sodium hyaluronate) Prescribing Information. Anika Pharmaceuticals. www.orthoviscline.com/sites/default/files/file/Orthovisc_Package_Insert.pdf (2013). Accessed Mar 5, 2013.

  35. Gel-One® (cross-linked hyaluronate) Prescribing Information. Seikagaku Corporation. www.zimmer.com/content/pdf/en-US/Gel-One_Pkg_Insert_Final.pdf (2013). Accessed Mar 5, 2013.

  36. Rutjes AW, Juni P, da Costa BR, Trelle S, Nuesch E, Reichenbach S. Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis. Ann Intern Med. 2012;157:180–91.

    PubMed  Google Scholar 

  37. Bannuru RR, Natov NS, Dasi UR, Schmid CH, McAlindon TE. Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis—meta-analysis. Osteoarthr Cartil. 2011;19:611–9.

    PubMed  CAS  Google Scholar 

  38. Goldberg VM, Goldberg L. Intra-articular hyaluronans: the treatment of knee pain in osteoarthritis. J Pain Res. 2010;3:51–6.

    PubMed  CAS  Google Scholar 

  39. Grecomoro G, La Sala F, Francavilla G. Rheologic changes in the synovial fluid of patients with gonarthritis induced by intraarticular infiltration of hyaluronic acid. Int J Tissue React. 2001;23:67–71.

    PubMed  CAS  Google Scholar 

  40. Wang Y, Hall S, Hanna F, et al. Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskelet Disord. 2011;12:195.

    PubMed  Google Scholar 

  41. Creamer P, Sharif M, George E, et al. Intra-articular hyaluronic acid in osteoarthritis of the knee: an investigation into mechanisms of action. Osteoarthr Cartil. 1994;2:133–40.

    PubMed  CAS  Google Scholar 

  42. Scale D, Wobig M, Wolpert W. Viscosupplementation of osteoarthritic knees with hylan: a treatment schedule study. Curr Ther Res. 1994;55:220–32.

    Google Scholar 

  43. Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther. 1998;20:410–23.

    PubMed  CAS  Google Scholar 

  44. Karlsson J, Sjogren LS, Lohmander LS. Comparison of two hyaluronan drugs and placebo in patients with knee osteoarthritis. A controlled, randomized, double-blind, parallel-design multicentre study. Rheumatology. 2002;41:1240–8.

    PubMed  CAS  Google Scholar 

  45. Grecomoro G, Martorana U, Di Marco C. Intra-articular treatment with sodium hyaluronate in gonarthrosis: a controlled clinical trial versus placebo. Pharmatherapeutica. 1987;5:137–41.

    PubMed  CAS  Google Scholar 

  46. Dixon AS, Jacoby RK, Berry H, Hamilton EBD. Clinical trial of intra-articular injection of sodium hyaluronate in patients with osteoarthritis of the knee. Curr Med Res Opin. 1988;11:205–13.

    PubMed  CAS  Google Scholar 

  47. Dougados M, Nguyen M, Listrat V, Amor B. High molecular weight sodium hyaluronate (hyalectin) in osteoarthritis of the knee: a 1 year placebo-controlled trial. Osteoarthr Cartil. 1993;1:97–103.

    PubMed  CAS  Google Scholar 

  48. Altman RD, Moskowitz R. Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol. 1998;25:2203–12.

    PubMed  CAS  Google Scholar 

  49. Puhl W, Bernau A, Greiling H, et al. Intra-articular sodium hyaluronate in osteoarthritis of the knee: a multicenter, double-blind study. Osteoarthr Cartil. 1993;1:233–41.

    PubMed  CAS  Google Scholar 

  50. Lohmander LS, Dalen N, Englund G, et al. Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double blind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. Ann Rheum Dis. 1996;55:424–31.

    PubMed  CAS  Google Scholar 

  51. Day R, Brooks P, Conaghan PG, Petersen M. A double blind, randomized, multicenter, parallel group study of the effectiveness and tolerance of intraarticular hyaluronan in osteoarthritis of the knee. J Rheumatol. 2004;31:775–82.

    PubMed  CAS  Google Scholar 

  52. Brandt KD, Block JA, Michalski JP, Moreland LW, Caldwell JR, Lavin PT. Efficacy and safety of intraarticular sodium hyaluronate in knee osteoarthritis. ORTHOVISC Study Group. Clin Orthop Relat Res. 2001;385:130–43.

    PubMed  Google Scholar 

  53. Kotevoglu N, Iybozkurt PC, Hz O, Toktas H, Kuran B. A prospective randomized controlled clinical trial comparing the efficacy of different molecular weight hyaluronan solutions in the treatment of knee osteoarthritis. Rheumatol Int. 2006;26:325–30.

    PubMed  CAS  Google Scholar 

  54. Neustadt D, Caldwell J, Bell M, Wade J, Gimbel J. Clinical effects of intraarticular injection of high molecular weight hyaluronan (Orthovisc) in osteoarthritis of the knee: a randomized, controlled, multicenter trial. J Rheumatol. 2005;32:1928–36.

    PubMed  CAS  Google Scholar 

  55. Altman RD, Rosen JE, Bloch DA, Hatoum HT, Korner P. A double-blind, randomized, saline-controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis of the knee, with an open-label safety extension (the FLEXX trial). Semin Arthritis Rheum. 2009;39:1–9.

    PubMed  CAS  Google Scholar 

  56. Tamir E, Robinson D, Koren R, Agar G, Halperin N. Intra-articular hyaluronan injections for the treatment of osteoarthritis of the knee: a randomized, double blind, placebo controlled study. Clin Exp Rheumatol. 2001;19:265–70.

    PubMed  CAS  Google Scholar 

  57. Altman RD, Rosen JE, Bloch DA, Hatoum HT. Safety and efficacy of retreatment with a bioengineered hyaluronate for painful osteoarthritis of the knee: results of the open-label Extension Study of the FLEXX Trial. Osteoarthr Cartil. 2011;19:1169–75.

    PubMed  CAS  Google Scholar 

  58. Chevalier X, Jerosch J, Goupille P, et al. Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial. Ann Rheum Dis. 2010;69:113–9.

    PubMed  CAS  Google Scholar 

  59. Strand V, Baraf HS, Lavin PT, Lim S, Hosokawa H. A multicenter, randomized controlled trial comparing a single intra-articular injection of Gel-200, a new cross-linked formulation of hyaluronic acid, to phosphate buffered saline for treatment of osteoarthritis of the knee. Osteoarthr Cartil. 2012;20:350–6.

    PubMed  CAS  Google Scholar 

  60. Strand V, Barafat HSB, Lavin PT, Lim S, Hosokawa H. Effectiveness and safety of a multicenter extension and retreatment trial of Gel-200 in patients with knee osteoarthritis. Cartilage. 2012;3:297–304.

    Google Scholar 

  61. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Viscosupplementation for the treatment of osteoarthritis of the knee (review). Cochrane Database Syst Rev 2006;(2):CD005321.

  62. Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2004;86-A:538–45.

    PubMed  Google Scholar 

  63. Lo GH, LaValley M, McAlindon T, Felson DT. Intra-articular hyaluronic acid in treatment of knee osteoarthritis: a meta-analysis. JAMA. 2003;290:3115–21.

    PubMed  CAS  Google Scholar 

  64. Colen S, van den Bekerom MP, Mulier M, Haverkamp D. Hyaluronic acid in the treatment of knee osteoarthritis: a systematic review and meta-analysis with emphasis on the efficacy of different products. Biodrugs. 2012;26:257–68.

    PubMed  CAS  Google Scholar 

  65. Arrich J, Piribauer F, Mad P, Schmid D, Klaushofer K, Mullner M. Intra-articular hyaluronic acid for the treatment of osteoarthritis of the knee: systematic review and meta-analysis. CMAJ. 2005;172:1039–43.

    PubMed  Google Scholar 

  66. Campbell J, Bellamy N, Gee T. Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hylan in osteoarthritis of the knee. Osteoarthr Cartil. 2007;15:1424–36.

    PubMed  CAS  Google Scholar 

  67. Raman R, Dutta A, Day N, Sharma HK, Shaw CJ, Johnson GV. Efficacy of Hylan G-F 20 and sodium hyaluronate in the treatment of osteoarthritis of the knee—a prospective randomized clinical trial. Knee. 2008;15:318–24.

    PubMed  CAS  Google Scholar 

  68. Karatosun V, Unver B, Gocen Z, Sen A. Comparison of two hyaluronan drugs in patients with advanced osteoarthritis of the knee. A prospective, randomized, double-blind study with long term follow-up. Clin Exp Rheumatol. 2005;23:213–8.

    PubMed  CAS  Google Scholar 

  69. Juni P, Reichenbach S, Trelle S, et al. Efficacy and safety of intraarticular hylan or hyaluronic acids for osteoarthritis of the knee: a randomized controlled trial. Arthr Rheum. 2007;56:3610–9.

    CAS  Google Scholar 

  70. Kirchner M, Marshall D. A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee. Osteoarthr Cartil. 2006;14:154–62.

    PubMed  CAS  Google Scholar 

  71. Maheu E, Zaim M, Appelboom T, et al. Comparative efficacy and safety of two different molecular weight (MW) hyaluronans F60027 and Hylan G-F20 in symptomatic osteoarthritis of the knee (KOA). Results of a non inferiority, prospective, randomized, controlled trial. Clin Exp Rheumatol. 2011;29:527–35.

    PubMed  CAS  Google Scholar 

  72. Briggs KK, Matheny LM, Steadman JR. Can hylan G-F 20 with corticosteroid meet the expectations of osteoarthritis patients? Am J Orthop (Belle Mead NJ). 2012;41:311–5.

    Google Scholar 

  73. Whitman C, Allen D, Comadoll JL, Thomason HC, Oweida SJ. A retrospective study of SUPARTZ® and repeat treatment for osteoarthritis pain in the knee. J Manag Care Med. 2010;13:43–7.

    Google Scholar 

  74. Kotz R, Kolarz G. Intra-articular hyaluronic acid: duration of effect and results of repeated treatment cycles. Am J Orthop. 1999;28(Suppl 11):5–7.

    PubMed  CAS  Google Scholar 

  75. Raynauld JP, Goldsmith CH, Bellamy N, et al. Effectiveness and safety of repeat courses of hylan G-F 20 in patients with knee osteoarthritis. Osteoarthr Cartil. 2005;13:111–9.

    PubMed  CAS  Google Scholar 

  76. Scali JJ. Intra-articular hyaluronic acid in the treatment of osteoarthritis of the knee: a long-term study. Eur J Rheumatol Inflamm. 1995;15:57–62.

    Google Scholar 

  77. Waddell DD, Cefalu CA, Bricker DC. A second course of hylan G-F 20 for the treatment of osteoarthritic knee pain: 12-month patient follow-up. J Knee Surg. 2005;18:7–15.

    PubMed  Google Scholar 

  78. Waddell DD. The tolerability of viscosupplementation: low incidence and clinical management of local adverse events. Curr Med Res Opin. 2003;19:575–80.

    PubMed  Google Scholar 

  79. Caborn D, Rush J, Lanzer W, Parenti D, Murray C. A randomized, single-blind comparison of the efficacy and tolerability of hylan G-F 20 and triamcinolone hexacetonide in patients with osteoarthritis of the knee. J Rheumatol. 2004;31:333–43.

    PubMed  CAS  Google Scholar 

  80. Spitzer AI, Bockow BI, Brander VA, et al. Hylan G-F 20 improves hip osteoarthritis: a prospective, randomized study. Phys Sportsmed. 2010;38:35–47.

    PubMed  Google Scholar 

  81. Migliore A, Tormenta S, Massafra U, et al. Intra-articular administration of hylan G-F 20 in patients with symptomatic hip osteoarthritis: tolerability and effectiveness in a large cohort study in clinical practice. Curr Med Res Opin. 2008;24:1309–16.

    PubMed  CAS  Google Scholar 

  82. Migliore A, Bizzi E, Massafra U, Bella A. The impact of treatment with hylan G-F 20 on progression to total hip arthroplasty in patients with symptomatic hip OA: a retrospective study. Curr Med Res Opin. 2012;28:755–60.

    PubMed  CAS  Google Scholar 

  83. Qvistgaard E, Christensen R, Torp-Pedersen S, Bliddal H. Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthr Cartil. 2006;14:163–70.

    PubMed  CAS  Google Scholar 

  84. Carpenter B, Motley T. The role of viscosupplementation in the ankle using hylan G-F 20. J Foot Ankle Surg. 2008;47:377–84.

    PubMed  Google Scholar 

  85. Witteveen AG, Giannini S, Guido G, et al. A prospective multi-centre, open study of the safety and efficacy of hylan G-F 20 (Synvisc) in patients with symptomatic ankle (talo-crural) osteoarthritis. Foot Ankle Surg. 2008;14:145–52.

    PubMed  Google Scholar 

  86. Salk RS, Chang TJ, D’Costa WF, Soomekh DJ, Grogan KA. Sodium hyaluronate in the treatment of osteoarthritis of the ankle: a controlled, randomized, double-blind pilot study. J Bone Joint Surg Am. 2006;88:295–302.

    PubMed  Google Scholar 

  87. Cohen MM, Altman RD, Hollstrom R, Hollstrom C, Sun C, Gipson B. Safety and efficacy of intra-articular sodium hyaluronate (Hyalgan) in a randomized, double-blind study for osteoarthritis of the ankle. Foot Ankle Int. 2008;29:657–63.

    PubMed  Google Scholar 

  88. Sun SF, Hsu CW, Sun HP, Chou YJ, Li HJ, Wang JL. The effect of three weekly intra-articular injections of hyaluronate on pain, function, and balance in patients with unilateral ankle arthritis. J Bone Joint Surg Am. 2011;93:1720–6.

    PubMed  Google Scholar 

  89. Witteveen AG, Sierevelt IN, Blankevoort L, Kerkhoffs GM, van Dijk CN. Intra-articular sodium hyaluronate injections in the osteoarthritic ankle joint: effects, safety and dose dependency. Foot Ankle Surg. 2010;16:159–63.

    PubMed  Google Scholar 

  90. Figen Ayhan F, Üstun N. The evaluation of efficacy and tolerability of hylan G-F 20 in bilateral thumb base osteoarthritis: 6 months follow-up. Clin Rheumatol. 2009;28:535–41.

    PubMed  CAS  Google Scholar 

  91. Mandl LA, Hotchkiss RN, Adler RS, et al. Injectable hyaluronan for the treatment of carpometacarpal osteoarthritis: open label pilot trial. Curr Med Res Opin. 2009;25:2103–8.

    PubMed  CAS  Google Scholar 

  92. Heyworth BE, Lee JH, Kim PD, Lipton CB, Strauch RJ, Rosenwasser MP. Hylan versus corticosteroid versus placebo for treatment of Basal joint arthritis: a prospective, randomized, double-blinded clinical trial. J Hang Surg Am. 2008;33:40–8.

    Google Scholar 

  93. Stahl S, Karsh-Zafrir I, Ratzon N, Rosenberg N. Comparison of intraarticular injection of depot corticosteroid and hyaluronic acid for treatment of degenerative trapeziometacarpal joints. J Clin Rheumatol. 2005;11:299–302.

    PubMed  Google Scholar 

  94. Schumacher HR, Meador R, Sieck M, Mohammed Y. Pilot investigation of hyaluronate injections for first metacarpal-carpal (MC-C) osteoarthritis. J Clin Rheumatol. 2004;10:59–62.

    PubMed  Google Scholar 

  95. Bjornland T, Gjaerum AA, Moystad A. Osteoarthritis of the temporomandibular joint: an evaluation of the effects and complications of corticosteroid injection compared with injection with sodium hyaluronate. J Oral Rehabil. 2007;34:583–9.

    PubMed  CAS  Google Scholar 

  96. Manfredini D, Bonnini S, Arboretti R, Guarda-Nardini L. Temporomandibular joint osteoarthritis: an open label trial of 76 patients treated with arthrocentesis plus hyaluronic acid injections. Int J Oral Maxillofac Surg. 2009;38:827–34.

    PubMed  CAS  Google Scholar 

  97. Saito S, Furuya T, Kotake S. Therapeutic effects of hyaluronate injections in patients with chronic painful shoulder: a meta-analysis of randomized controlled trials. Arthr Care Res (Hoboken). 2010;62:1009–18.

    CAS  Google Scholar 

  98. Brander VA, Gomberawalla A, Chambers M, Bowen M, Nuber G. Efficacy and safety of hylan G-F 20 for symptomatic glenohumeral osteoarthritis: a prospective, pilot study. PM R. 2010;2:259–67.

    PubMed  Google Scholar 

  99. Merolla G, Sperling JW, Paladini P, Porcellini G. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg. 2011;95:215–24.

    PubMed  Google Scholar 

  100. Silverstein E, Leger R, Shea KP. The use of intra-articular hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med. 2007;35:979–85.

    PubMed  Google Scholar 

  101. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008;90:970–9.

    PubMed  Google Scholar 

  102. Langworthy MJ, Saad A, Langworthy NM. Conservative treatment modalities and outcomes for osteoarthritis: the concomitant pyramid of treatment. Phys Sportsmed. 2010;38:133–45.

    PubMed  Google Scholar 

  103. Raynauld JP, Torrance G, Band P, et al. A prospective, randomized, pragmatic, health outcomes trial evaluating the incorporation of hylan G-F 20 into the treatment paradigm for patients with knee osteoarthritis (Part 1 of 2): clinical results. Osteoarthr Cartil. 2002;10:506–17.

    PubMed  Google Scholar 

  104. Kahan A, Lleu PL, Salin L. Prospective randomized study comparing the medicoeconomic benefits of hylan G-F 20 vs. conventional treatment in knee osteoarthritis. Joint Bone Spine. 2003;70:276–81.

    PubMed  Google Scholar 

  105. Brander VA, Stadler TS. Functional improvement with hylan G-F 20 in patients with knee osteoarthritis. Phys Sportsmed. 2009;37:38–48.

    PubMed  Google Scholar 

  106. Karatosun V, Unver B, Gocen Z, Sen A, Gunal I. Intra-articular hyaluronic acid is compared with progressive knee exercises in osteoarthritis of the knee: a prospective randomized trial with long-term follow-up. Rheumatol Int. 2006;26:277–84.

    PubMed  CAS  Google Scholar 

  107. Atamaz F, Kirazli Y, Akkoc Y. A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatol Int. 2006;26:873–8.

    PubMed  CAS  Google Scholar 

  108. Lee SC, Rha DW, Chang WH. Rapid analgesic onset of intra-articular hyaluronic acid with ketorolac in osteoarthritis of the knee. J Back Musculoskelet Rehabil. 2011;24:31–8.

    PubMed  Google Scholar 

  109. de Campos GC, Rezende MU, Pailo AF, Frucchi R, Camargo OP. Adding triamcinolone improves viscosupplementation: a randomized clinical trial. Clin Orthop Relat Res. 2013;471:613–20.

    PubMed  Google Scholar 

  110. Neustadt DH. Long-term efficacy and safety of intra-articular sodium hyaluronate (Hyalgan) in patients with osteoarthritis of the knee. Clin Exp Rheumatol. 2003;21:307–11.

    PubMed  CAS  Google Scholar 

  111. Lussier A, Cividino AA, McFarlane CA, Olszynski WP, Potashner WJ, De Medicis R. Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol. 1996;23:1579–85.

    PubMed  CAS  Google Scholar 

  112. Waddell DD, Bricker DC. Hylan G-F 20 tolerability with repeat treatment in a large orthopedic practice: a retrospective review. J Surg Orthop Adv. 2006;15:53–9.

    PubMed  Google Scholar 

  113. Evanich JD, Evanich CJ, Wright MB, Rydlewicz JA. Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis. Clin Orthop Relat Res 2001;390:173-81.

    PubMed  Google Scholar 

  114. Kemper F, Gebhardt U, Meng T, Murray C. Tolerability and short-term effectiveness of hylan G-F 20 in 4253 patients with osteoarthritis of the knee in clinical practice. Curr Med Res Opin. 2005;21:1261–9.

    PubMed  CAS  Google Scholar 

  115. Dickson DJ, Hosie G, English JR. A double-blind, placebo-controlled comparison of hylan G-F 20 against diclofenac in knee osteoarthritis. J Clin Res. 2001;4:41–52.

    Google Scholar 

  116. Kean WF, Rainsford KD, Kean IR. Management of chronic musculoskeletal pain in the elderly: opinions on oral medication use. Inflammopharmacology. 2008;16:53–75.

    PubMed  CAS  Google Scholar 

  117. Lee S, Park D, Chmell SJ. Viscosupplementation with hylan G-F 20 (Synvisc®): pain and mobility observations from 74 consecutive patients. J Knee Surg. 2004;17:73–7.

    PubMed  Google Scholar 

  118. Waddell DD, Bricker D. Clinical experience with the effectiveness and tolerability of hylan G-F 20 in 1047 patients with osteoarthritis of the knee. J Knee Surg. 2006;19:19–27.

    PubMed  Google Scholar 

  119. Bannuru RR, Natov NS, Obadan IE, Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: a systematic review and meta-analysis. Arthr Rheum. 2009;61:1704–11.

    CAS  Google Scholar 

Download references

Acknowledgements

Dr. Reid is the guarantor for this article and takes responsibility for the integrity of the work as a whole. Sanofi (formerly Genzyme Biosurgery) provided support for medical writing services to Nicole Cooper and Susan Bijur, PhD, of Precise Publications, LLC. No other funding or sponsorship was received for this study or publication of this article.

Conflict of interest

Dr. Reid has served as a consultant for Sanofi, Pfizer, and Endo Pharmaceuticals.

Compliance with ethics guidelines

This article does not contain any studies with human or animal subjects performed by the author.

Author information

Authors and Affiliations

  1. Weill Cornell Medical College, 1484–1486 1st Avenue, New York, NY, 10075, USA

    M. Carrington Reid

Authors
  1. M. Carrington Reid
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Carrington Reid.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Reid, M.C. Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians. Adv Ther 30, 967–986 (2013). https://doi.org/10.1007/s12325-013-0068-6

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-013-0068-6

Keywords

Search

Navigation