Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug;12(4):695-708.
doi: 10.1007/s40744-025-00780-8. Epub 2025 Jul 2.

The Efficacy and Safety of Single Injections of Hybrid HA in the Treatment of Symptomatic Knee Osteoarthritis: A Case Series

Marcin E Domzalski  1   2 , Klaudia Marchewa  3
Affiliations

The Efficacy and Safety of Single Injections of Hybrid HA in the Treatment of Symptomatic Knee Osteoarthritis: A Case Series

Marcin E Domzalski et al. Rheumatol Ther. 2025 Aug.

Abstract

Introduction: The prevalence of knee osteoarthritis (OA) is rising worldwide, leading to disability and a reduced quality of life, particularly in elderly patients. While there are several treatment options, there is little consensus in the scientific community over which methods are most effective. Viscosupplementation with hyaluronic acid (HA) has been found to reduce pain in patients with knee OA over a period of up to 6 months, with little to no side effects. The aim of this prospective open-label, uncontrolled, observational, single-site study was to assess the efficacy and safety of a single hybrid HA injection over a period of 6 months in subpopulations of patients with low to severe symptomatic knee OA in everyday clinical practice.

Methods: Fifty patients who met the inclusion criteria participated in the study. A single intra-articular ultrasound-guided injection of hybrid HA (Sinovial®) was administered. Patients submitted Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaires at 28, 42, 84, and 168 days post-treatment.

Results: VAS scores measured at rest and when walking indicate an improvement during follow-up, particularly at 28 and 42 days, compared to baseline. Similarly, the most notable improvement of the WOMAC score was observed within the first 42 days after injection. While decrease in pain and joint function improvement were not as pronounced at the end of follow-up, they were still statistically better than at baseline. Overall patient satisfaction was high.

Conclusion: Treatment with a single injection of hybrid HA was demonstrated to be safe and effective in patients with varying degrees of knee OA. Patients with medial knee OA responded better to treatment than patients with patellofemoral OA, which provides information on which types of patients are best suited to this intervention.

Trial registration: ClinicalTrials.gov identifier, NCT06652893. Retrospectively registered October 10, 2024.

Keywords: Hybrid HA; Osteoarthritis; VAS; Viscosupplementation; WOMAC.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of Interest: Marcin E. Domzalski and Klaudia Marchewa declare that they have no competing interests. Ethical Approval: The study was performed in accordance with the ethical guidelines of the Declaration of Helsinki and was approved by the Local Bioethics Committee in Lodz, Poland. Collected information and data were managed according to the guidelines of Good Clinical Practice (GCP). All participants signed an informed consent form at the time of enrollment to collect clinical data. All patients also gave their consent to the use of patient reported outcomes (PROs). The study was registered on ClinicalTrials.gov with NCT06652893.

Figures

Fig. 1
Fig. 1
Study design and patient disposition. n number of patients
Fig. 2
Fig. 2
VAS results for pain at rest. VAS Visual Analog Scale, SE standard error, SD standard deviation
Fig. 3
Fig. 3
VAS results for pain at walking. VAS Visual Analog Scale, SE standard error, SD standard deviation
Fig. 4
Fig. 4
Results of the WOMAC score. WOMAC Western Ontario and McMaster Universities Arthritis Index, SD standard deviation
Fig. 5
Fig. 5
Results of the WOMAC subscales. WOMAC Western Ontario and McMaster Universities Arthritis Index. Overall—total WOMAC, Difficulty-Physical Function subscale
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Geng R, Li J, Yu C, et al. Knee osteoarthritis: current status and research progress in treatment (Review). Exp Ther Med. 2023;26:481. - PMC - PubMed
    1. Katz JN, Arant KR, Loeser RF. Diagnosis and treatment of hip and knee osteoarthritis: a review. JAMA. 2021;325:568–78. - PMC - PubMed
    1. Long H, Liu Q, Yin H, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the global burden of disease study 2019. A&R. 2022;74(7):1172–83. 10.1002/art.42089. - PMC - PubMed
    1. Kucharz EJ, Szántó S, Ivanova Goycheva M, et al. Endorsement by Central European experts of the revised ESCEO algorithm for the management of knee osteoarthritis. Rheumatol Int. 2019;39:1117–23. - PubMed
    1. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl. 1993;39:3–9. - PubMed

Associated data

LinkOut - more resources