Health technology reviews

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Hyaluronic acid/viscosupplementation

Status: Decision completed

View findings and decision

Policy context

The Health Technology Assessment program reviewed Hyaluronic Acid/Viscosupplementation for Osteoarthritis of the Knee in 2010. This topic was selected for re-review based on a recent systematic review and meta-analysis (Rutjes 2012) that could change the previous determination.

Hyaluronic acid preparations have been approved by the Food and Drug Administration (FDA) for treatment of pain associated with OA of the knee in patients who have not had an adequate response to nonpharmacological, conservative treatment and simple analgesics. No new indications have been approved since the 2010 report.

Primary criteria ranking

  • Safety =    Medium
  • Efficacy = Medium
  • Cost =      Medium

Assessment timeline

  • Draft Key Questions Published: March 21, 2013
  • Public Comment Period: March 21 - April 8, 2013
  • Draft Report Published: August 5, 2013
  • Public Comment Period: August 5 - September 4, 2013
  • Final Report Published: October 15, 2013
  • HTCC Public Meeting: November 15, 2013


Osteoarthritis (OA) is the most common form of chronic articular disease, and the most commonly affected joint is the knee. Conservative management generally requires a combination of both nonpharmacological and pharmacological therapies. Viscosupplementation, which involves an injection of hyaluronic acid, provides an alternative to NSAIDs and corticosteroid injection, both of which have potential undesirable side effects and/or other drawbacks. Hyaluronic acid is a normal component of synovial fluid and cartilage that acts as both a joint lubricant and a shock absorber. The concentration and molecular weight of endogenous hyaluronic acid are reduced in patients with osteoarthritic joints.