Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis

Pereira TV, Jüni P, Saadat P, et al. · BMJ

Pain reduction vs placebo of SMD -0.08 (~2 mm on a 100 mm VAS) — far below the minimal clinically important difference — with a 49% higher risk of serious adverse events (RR 1.49). Since 2009 there has been strong evidence of no clinically relevant benefit.

Population

169 trials, 21,163 randomized participants; main pain analysis from 24 large placebo-controlled trials (8,997 participants)

Intervention

Intra-articular hyaluronic acid

Comparator

Placebo or no intervention

Limitations

Some author consulting relationships disclosed; trial-level heterogeneity — but this is the largest and most conservative synthesis available.