Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis

Bannuru RR, Schmid CH, Kent DM, et al. · Annals of Internal Medicine

IA hyaluronic acid ranked highest for pain (ES 0.63 vs oral placebo), but IA placebo itself outperformed oral placebo — much of every injection's apparent benefit is the needle, not the contents.

Population

137 trials, 33,243 participants with knee OA

Intervention

Network comparison of NSAIDs, acetaminophen, IA corticosteroids, IA hyaluronic acid

Comparator

Oral and intra-articular placebo

Limitations

3-month outcomes only; indirect comparisons; AHRQ-funded. Frequently cited by HA proponents while omitting the IA-placebo finding.