Hyaluronic acid/viscosupplementation

Hyaluronic acid/ Viscosupplementation for osteoarthritis of the knee was first reviewed by the HTA program in 2010.

  • In 2013, the HCA director selected hyaluronic acid/ viscosupplementation for rereview based on a systematic review and meta-analysis (Rutjes 2012) that could change the original coverage determination.
  • A rereview of hyaluronic acid/ viscosupplementation was completed later in 2013.
  • In 2022, the HCA director selected hyaluronic acid for rereview for osteoarthritis treatment based on published evidence that could change the original coverage determination.

Status: Review in progress

Policy context

Hyaluronic acid preparations have been approved by the Food and Drug Administration (FDA) for treatment of pain associated with osteoarthritis (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
Documents (all assessments)

Assessment (2022)

Assessment (2013)

Assessment (2010)

Assessment timeline (2022)

  • Draft key questions published: October 13, 2022
  • Public comment period: October 13 to 27, 2022
  • Final key questions published: November 29, 2022
  • Draft report published: TBD
  • Public comment period: TBD
  • Final report published: TBD
  • HTCC public meeting: TBD


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.