Study: Injections Ineffective for Knee Arthritis

True or false? That depends….

This article – – discusses the treatment of osteoarthritis with injections of hyaluronic acid, also known as, viscosupplementation.  Arthritis is essentially the wearing down of the cartilage in joints.  Viscosupplementation is a chemical that is injected into the joint that helps recreate normal joint fluid.  The exact mechanism of action is still unknown, but many theories exist.  The article references a newly presented meta-analysis looking at the effectiveness of viscosupplementation.  The review suggests there is minimal benefit to be gained with increased risk of injections. 

Based on my clinical experience, I think this conclusion is sweeping and very general and rather unfair for those patients who have had great responses to this therapy.   I have encountered a number of patients who claim good relief from viscosupplementation.  I have also had patients without good response.  The same can be true of all treatment methods.

Also, to base an individual’s response to treatment off a study may not be fair.  Arthritis affects people in very different ways.  Our ability to cope with pain and limitations of arthritis also varies.  Some individuals have extreme degenerative changes on x-ray, but minimal symptoms of pain.  Others are just the opposite.  Similarly, people respond to treatments vary differently.  Traditional treatments include weight loss, exercise, therapy, bracing, shoe inserts, medications, injections, and surgery.  Not all of these work for everybody.

Certainly, the less severe the arthritis and the symptoms, the more likely any non-operative treatment may help, including viscosupplementation.  For many patients, non-operative treatment is effective and their symptoms never lead to surgery.  For others, non-operative treatment is not effective and they need to pursue orthopedic surgical treatments.  This can include osteotomies, partial joint replacements, and total joint replacements.

In the end, treatment is very individualized.  Sometimes this involves trying different therapies.  Care for arthritic joints is multi-faceted and can be addressed by your orthopedic surgeon.

Written by Dr. Sean Brimacombe

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