The Role of Intra-articular Hyaluronic Acid in Symptomatic Osteoarthritis of the Knee

Abstract

A 62-year-old female nursing supervisor with a history of diabetes mellitus (hemoglobin A1C score: 7.8) presents to your office with a 5þ-year history of right knee pain. She does not report any traumatic events or injuries and states that her right knee is progressively getting more painful with walking and especially when descending stairs. She has participated in both land-based and aquatic therapy in the past with limited improvement. She also reports that she received an ultrasound-guided intra-articular corticosteroid injection 8 weeks ago with tremendous improvement in her pain and function, but now the pain has returned. Examination reveals that she is obese, with a body mass index (BMI) of 34.5, and that she has moderate tenderness over the medial and lateral right knee joint lines. Her range of motion is normal with minimal swelling around the knee joint. Her right knee radiograph reveals Kellgren-Lawrence grade 3 osteoarthritis (OA). She has recently read the guidelines for treating knee OA put forth by the American Academy of Orthopaedic Surgeons (AAOS), in which viscosupplementation is no longer recommended. However, she has many family members and friends who received “Synvisc” in the past and experienced significant improvement in pain and function, and she would like to try this treatment option. Drs Thiru Annaswamy and Erika Gosai will argue that, despite the new AAOS guidelines, viscosupplementation should be offered to the patient to treat the symptoms caused by knee degenerative joint disease. Dr David Jevsevar will argue that there is very little evidence that viscosupplementation is effective for knee OA and that either alternative conservative treatments or surgery should be recommended.