Intra-articular Injections of Hyaluronic Acid and Other Drugs in the Knee Joint

Abstract

Degenerative osteoarthritis of the knee (OA) affects 35% of persons older than 65years. If pain persists after non-invasive treatment, some intra-articular drugs can be tried before surgical treatment. The purpose of this article is to review the literature after 2006 with the aim of answering two questions: (1) Are intra-articular injections of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP) effective in painful knee OA? and (2) Which of these drugs is more effective? The search engines were MedLine and the Cochrane Library. The keywords used were: knee, osteoarthritis, and intra-articular injections. Eight hundred and forty-four articles were found but only 142 had been published after 2006. Of those, only 14 were selected and reviewed because they were strictly focused on the topic and the questions of this article. The clinical efficacy of intra-articular injections of HA and CS in patients with knee OA has been demonstrated. Pain reduction after three to five weekly injections of HA lasts between 5 to13 weeks (sometimes up to 1year). Pain reduction is less durable after CS injections (2 to 3weeks). Recent reports indicate that PRP could have a better performance than HA in younger patients. Three to five weekly intra-articular injections of HA are recommendable in patients with knee OA before surgical treatment. CS injections have a very short effect. The efficacy and duration of PRP injections require further studies.