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. 2023 Dec;14(4):424-432.
doi: 10.1177/19476035231154530. Epub 2023 Jun 14.

Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties

Eric Ferkel  1 , Ajay Manjoo  2 , Damion Martins  3 , Mohit Bhandari  2 , Paul Sethi  4 , Mathew Nicholls  5
Affiliations

Intra-articular Hyaluronic Acid Treatments for Knee Osteoarthritis: A Systematic Review of Product Properties

Eric Ferkel et al. Cartilage. 2023 Dec.

Abstract

Introduction: There are many intra-articular hyaluronic acid (IA-HA) products on the market that have known intrinsic differences in molecular size, source, and structure. The current review summarizes existing evidence describing and assessing these differences, while also identifying whether these differences have an impact on clinical outcomes.

Methods: This systematic review summarized all literature that specifically addresses IA-HA product differences. Included studies summarized basic science and mechanism of action comparisons of IA-HA product differences, or systematic reviews that assess differences in clinical outcomes between IA-HA product differences.

Results: A total of 20 investigations assessed basic science differences between IA-HA products, while 20 investigations provided assessments of the clinical outcome differences between IA-HA product characteristics. The published basic science literature provided a differentiation between low molecular weight (LMW) and high molecular weight (HMW) HA with regard to changes within the synovial fluid, driven by the interactions that these molecules have with receptors in the joint space. These differences in receptor interaction manifest within clinical outcomes, as meta-analyses comparing pain relief after IA-HA suggest that pain reduction is superior in patients who receive HMW HA as opposed to LMW HA.

Conclusion: This review highlights differences between IA-HA characteristics, and how important the molecular weight, derivation of the product, and structure are to variances in reported clinical outcomes to treat osteoarthritis (OA) of the knee. HMW IA-HAs have shown greater efficacy compared to the alternative of LMW products, while avian-derived and cross-linked products have potentially demonstrated an increase in inflammatory events over non-avian-derived, non-cross-linked HAs.

Keywords: diagnosis; hyaluronic acid; joint involved; knee; osteoarthritis.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: EF serves as a consultant for Arthrex and Ferring. MN, AM, and DM have nothing to disclose. MB serves as a consultant for Sanofi Aventis, Smith and Nephew, and AgNovos Healthcare. PS serves as a consultant for Arthrex and Pacira.

Figures

Figure 1.
Figure 1.
Article screening process.
Figure 2.
Figure 2.
Histogram of IA-HA (intra-articular hyaluronic acid) product difference publications per year.
See this image and copyright information in PMC

References

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