AAOS Weighs in Against Hyaluronic Acid for Knee OA


In a new revision of its 2009 guidelines on knee osteoarthritis, the American Academy of Orthopaedic Surgeons reverses a formerly noncommital stance on intra-articular hyaluronic acid injections, now deeming the weight of evidence insufficient to support their efficacy.

The American Academy of Orthopaedic Surgeons this week revised its 2009 clinical practice guideline on osteoarthritis (OA) of the knee, among other changes reversing its stand on the use of intra-articular hyaluronic acid (HA). The earlier guideline was inconclusive on the question.

Of 14 studies assessing HA injections for knee OA, although a few showed positive results, the conclusion of an Academy meta-analysis was that the treatment "did not meet the minimum clinically important improvement thresholds," said David S. Jevsevar, MD, MBA, chair of the committee that oversees the guidelines process.

AAOS also reduced the recommended daily dosage of acetaminophen for knee OA from 4,000 mg to 3,000 mg, consistent with a 2009 change in FDA recommendations.

AAOS recommends intra-articular steroid injections for short-term pain relief, and advises patients with knee OA to lose weight and increase low-impact aerobic exercise.

The revised guideline continues to recommend against arthroscopic saline lavage, and does not recommend glucosamine and/or chondroitin, acupuncture, or wedge insoles for patients with knee OA. Lacking sufficient evidence, AAOS does not judge either for or against the effectiveness of bracing, growth factor injections, or platelet-rich plasma.

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