Towards reaching consensus on hyaluronic acid efficacy in knee osteoarthritis

  • Larry E. MillerEmail author
Brief Report


Intra-articular injection of hyaluronic acid (HA) is a controversial treatment for knee osteoarthritis (OA). While clinical efficacy of HA relative to saline injections has been demonstrated in many studies, these results are of limited value in real-world clinical practice since saline injection is not a knee OA treatment. Instead, rigorous postmarket comparative studies of HA versus approved knee OA treatments are encouraged. The conduct of such studies is particularly important given the paucity and heterogeneous nature of current evidence regarding nonsurgical knee OA treatment.

Key Points

Societal guidelines recommend nonsteroidal anti-inflammatory drugs and corticosteroid injections, but not hyaluronic acid injections, for knee osteoarthritis (OA) despite inconsistent supportive data.

This article encourages rigorous comparative post-approval studies to clarify the role of nonsurgical treatments used in clinical practice for knee OA.


Corticosteroid Injection Nonsteroidal anti-inflammatory drugs Viscosupplementation 



No funds were received for this work.

Compliance with ethical standards

Conflict of interest

The author has previously received personal fees from DePuy Synthes, OrthogenRx, and OsteoArthritis Centers of America and has previously published manuscripts related to hyaluronic acid efficacy in knee osteoarthritis.

Ethical standards

The manuscript does not contain clinical studies or patient data.


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Copyright information

© International League of Associations for Rheumatology (ILAR) 2019

Authors and Affiliations

  1. 1.Miller Scientific ConsultingAshevilleUSA

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