Expert consensus on hyaluronic acid injections for knee osteoarthritis: a patient-centered approach

Hyaluronic acid (HA) is a linear polysaccharide which occurs naturally as a constituent of synovial fluid. The HA concentration in the joint decreases inexorably during the progression of knee osteoarthritis (OA) and so, for nearly five decades, HA has been trialled and used in the treatment of knee OA. There are strong data from clinical trials, meta-analyses and umbrella reviews to support the use of intra-articular hyaluronic acid (IAHA) in the treatment of patients with knee OA, though not in patients with acute, active OA experiencing a flare. The majority of the literature suggests that IAHA has a positive safety profile despite a few meta-analyses suggesting an increased risk of serious adverse effects. Further qualitative analysis integrating patient preferences for multi-modal and/or non-surgical management is required in order to further explore these findings. IAHA has been combined with a number of additional agents, including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations. These show variable performance beyond the baseline effect of their constituents. It is crucial to consider the patient’s preference when considering treatments for knee OA. Specific to IAHA, patients seek minimally invasive, lower-risk, and non-steroidal options with at least moderate efficacy and advantageous safety profiles. Hyaluronic acid is a naturally occurring constituent of synovial fluid and there are strong studies supporting its use in the treatment of osteoarthritis (outside the context of disease flares). The majority of literature supports a highly advantageous safety profile for hyaluronic acid in terms of adverse effect profile. Intra-articular hyaluronic acid (IAHA) can be injected in combination with other agents; including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations, which show potential efficacy beyond their constituents alone.

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Publication Details

Journal
Aging Clinical and Experimental Research
Published
2026-04-01
DOI
https://doi.org/10.1007/s40520-026-03366-8
Primary Topic
Proteoglycans and glycosaminoglycans research
Type
article
Field-Weighted Citation Impact
0.00

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article

Expert consensus on hyaluronic acid injections for knee osteoarthritis: a patient-centered approach

Ralf Schmidmaier, L. Zakraoui, Olivier Bruyère, Jordi Monfort Faure et al.
Aging Clinical and Experimental Research
Proteoglycans and glycosaminoglycans research
article

Expert consensus on hyaluronic acid injections for knee osteoarthritis: a patient-centered approach

Ralf Schmidmaier, L. Zakraoui, Olivier Bruyère, Jordi Monfort Faure, Patrick Ammann, Régis Radermecker, AA Kurth, Stuart Silverman, Angie Botto‐van Bemden, Julien Wegrzyn, Daniel Messina, Gun-il IM, Radmila Matijević, Nansa Burlet, Majed S. Alokail, M L Brandi, Nasser Al-Daghri, E. M. Dennison, Emmanuel Maheu, Cyrus Cooper, Nicholas Fuggle, René Rizzoli, François Rannou, Francis Berenbaum, Roland Chapurlat, Ali Mobasheri, Alberto Migliore, Jean-Yves Reginster, Nicholas C Harvey
article en

Abstract

Hyaluronic acid (HA) is a linear polysaccharide which occurs naturally as a constituent of synovial fluid. The HA concentration in the joint decreases inexorably during the progression of knee osteoarthritis (OA) and so, for nearly five decades, HA has been trialled and used in the treatment of knee OA. There are strong data from clinical trials, meta-analyses and umbrella reviews to support the use of intra-articular hyaluronic acid (IAHA) in the treatment of patients with knee OA, though not in patients with acute, active OA experiencing a flare. The majority of the literature suggests that IAHA has a positive safety profile despite a few meta-analyses suggesting an increased risk of serious adverse effects. Further qualitative analysis integrating patient preferences for multi-modal and/or non-surgical management is required in order to further explore these findings. IAHA has been combined with a number of additional agents, including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations. These show variable performance beyond the baseline effect of their constituents. It is crucial to consider the patient’s preference when considering treatments for knee OA. Specific to IAHA, patients seek minimally invasive, lower-risk, and non-steroidal options with at least moderate efficacy and advantageous safety profiles. Hyaluronic acid is a naturally occurring constituent of synovial fluid and there are strong studies supporting its use in the treatment of osteoarthritis (outside the context of disease flares). The majority of literature supports a highly advantageous safety profile for hyaluronic acid in terms of adverse effect profile. Intra-articular hyaluronic acid (IAHA) can be injected in combination with other agents; including mannitol, sorbitol, chondroitin sulphate, tranexamic acid, polynucleotides and hybrid IAHA formulations, which show potential efficacy beyond their constituents alone.

Aging Clinical and Experimental ResearchVol. 38(1)
Université Claude Bernard Lyon 1 (FR), Goethe University Frankfurt (DE), Cedars-Sinai Medical Center (US), Universität für Weiterbildung Krems (AT), Vita-Salute San Raffaele University (IT), Inserm (FR), University of Liège (BE), Sun Yat-sen University (CN), Universitat Pompeu Fabra (ES), University of Novi Sad (RS), Université Paris Cité (FR), Universidad de Buenos Aires (AR), King Saud University (SA), Centre Hospitalier Universitaire Vaudois (CH), LMU Klinikum (DE), Sorbonne Université (FR), University of Oxford (GB), University Foundation (BE), Sorbonne Paris Cité (FR), Hôpital Cochin (FR), Assistance Publique – Hôpitaux de Paris (FR), State Research Institute Centre for Innovative Medicine (LT), Hôpital Saint-Antoine (FR), University Hospital of Geneva (CH), Dongguk University Ilsan Hospital (KR), Fatebenefratelli Hospital (IT), Hôpital Orthopédique de la Suisse Romande (CH), NIHR Southampton Biomedical Research Centre (GB), Hôpital Edouard Herriot (FR), The First Affiliated Hospital, Sun Yat-sen University (CN), Paris Cardiovascular Research Center (FR), Centre Hospitalier Universitaire de Liège (BE), Centre de Recherche Saint-Antoine (FR), Oxford BioMedica (United Kingdom) (GB), MRC Lifecourse Epidemiology Unit (GB), Pankey Institute (US), University of Southampton (GB), Oulu University of Applied Sciences (FI), Tunis El Manar University (TN), Ludwig-Maximilians-Universität München (DE), University of Oulu (FI)
King Saud University, Oulun Yliopisto
Good health and well-being
Openalex Percentile: Top 28%
Proteoglycans and glycosaminoglycans research
DOIOpen Access PDFOpenAlex
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