Hyaluronic Acid vs. Steroid Injection for Knee Osteoarthritis

Summary and Comment |
June 9, 2016

Hyaluronic Acid vs. Steroid Injection for Knee Osteoarthritis

  1. Allan S. Brett, MD

In a randomized trial, researchers found no difference between the two interventions.

  1. Allan S. Brett, MD

A recent meta-analysis suggested that the efficacy of intra-articular injections of hyaluronic acid for knee osteoarthritis is marginal at best; many patients report improvement, but placebo effects account for much of that improvement (NEJM JW Gen Med Jan 15 2016 and J Bone Joint Surg Am 2015; 97:2047). In this double-blind, randomized trial, 110 patients with painful knee osteoarthritis each received a single injection of either hyaluronic acid (hylan G-F 20; Synvisc) or the corticosteroid triamcinolone acetonide.

Compared with baseline, symptoms improved in both groups through 6 months of follow-up. At 2 weeks, the extent of improvement in pain and function was significantly greater with triamcinolone than with hyaluronic acid, but differences between the two groups were not significant for the rest of the follow-up period.


Because patients often get several injections of hyaluronic acid at weekly intervals, some people might argue that this study's use of only one injection was unfair. However, at least one other study has suggested that three hyaluronic acid injections are no better than one. An editorialist criticizes the widespread use of hyaluronic acid injections, noting that its cost is extraordinary (from US$250 to $1000 per dose, compared with a few dollars for a corticosteroid dose). The American Academy of Orthopedic Surgeons advises against the use of hyaluronic acid injections for knee osteoarthritis (J Am Acad Orthop Surg 2013; 21:571).

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose


Reader Comments (1)

Thomas G Smith MD Physician, Family Medicine/General Practice, Single Specialty, Small group in Small town, Michigan

I am under the assumption that corticosteroids weaken cartilage in the long run and hasten the next step to joint replacement. Can this cohort be followed for this outcome?

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