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In the U.S., for every 7 patients with knee osteoarthritis, 1 receives an intra-articular injection of a hyaluronic acid derivative (viscosupplementation) as first-line treatment. However, the evidence supporting this treatment is controversial, and most clinical guidelines discourage its use (NEJM JW Gen Med Jul 1 2022 and J Bone Joint Surg Am 2022; 104:43). In a meta-analysis, researchers combined data from 24 large, randomized trials in which a total of 9000 patients with knee osteoarthritis were randomized to viscosupplementation or to placebo or no treatment.
At a median 13 weeks after the last injection, patients randomized to viscosupplementation had small, statistically significant — but not clinically important — reductions in pain …