Predictors of Clinical Benefit with Intra-articular Hyaluronic Acid in
Patients with Knee Osteoarthritis - A Narrative Review

Xavier      Chevalier; Brendan      Sheehan

doi:10.2174/0115733971274662240108074038

Abstract

Background: There is conflicting evidence regarding the efficacy of viscosupplementation with intra-articular hyaluronic acid injections in knee osteoarthritis. One possible explanation for the inconsistent findings on its efficacy is that only certain subpopulations of patients benefit from this therapy.

Objective: The purpose of this narrative review is to succinctly summarize the existing data on the predictive factors of clinical response to intra-articular hyaluronic acid to identify the patient profile most likely to benefit from this therapy.

Methods: For this narrative review, a PubMed search was conducted in January 2023, with no date limits, to identify publications reporting predictive factors of response to viscosupplementation using the following terms: hyaluronic acid OR viscosupplem* AND osteoarthritis AND knee AND predict*. Searches were limited to randomized controlled trials, systematic reviews and meta- analyses, or observational studies written in English. Other relevant references were identified by searching the references of retrieved articles.

Results: The disease severity was found to reliably predict response to intra-articular hyaluronic acid injections; patients with less severe disease consistently had a more robust therapeutic response than those with more severe disease. Other clinical variables such as level of baseline pain did not reliably predict response. Body mass index, and possibly age, may also be independent predictors of the response.

Conclusion: A review of the existing literature suggests that patients with less severe clinical symptoms and radiological findings, who are younger, and with a lower or normal body mass index are the best candidates for intra-articular hyaluronic acid therapy.

Keywords: Osteoarthritis, intra-articular hyaluronic acid, viscosupplementation, body mass index, disease severity, intra-articular hyaluronic acid injections.

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[1]
Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015–2040. Arthritis Rheumatol  2016; 68(7): 1582-7.
 [http://dx.doi.org/10.1002/art.39692] [PMID: 27015600]

[2]
Rosen J, Avram V, Fierlinger A, Niazi F, Sancheti P, Bedi A. Clinicians’ perspectives on the use of intra-articular hyaluronic acid as a treatment for knee osteoarthritis: A North American, multidisciplinary survey. Clin Med Insights Arthritis Musculoskelet Disord  2016; 9: CMAMD.S34496.
 [http://dx.doi.org/10.4137/CMAMD.S34496] [PMID: 26917981]

[3]
Bannuru RR, Osani MC, Vaysbrot EE, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage  2019; 27(11): 1578-89.
 [http://dx.doi.org/10.1016/j.joca.2019.06.011] [PMID: 31278997]

[4]
Trojian TH, Concoff AL, Joy SM, Hatzenbuehler JR, Saulsberry WJ, Coleman CI. AMSSM scientific statement concerning viscosupplementation injections for knee osteoarthritis. Clin J Sport Med  2016; 26(1): 1-11.
 [http://dx.doi.org/10.1097/JSM.0000000000000274] [PMID: 26562453]

[5]
Rillo O, Riera H, Acosta C, et al. PANLAR consensus recommendations for the management in osteoarthritis of hand, hip, and knee. J Clin Rheumatol  2016; 22(7): 345-54.
 [http://dx.doi.org/10.1097/RHU.0000000000000449] [PMID: 27660931]

[6]
Bruyère O, Cooper C, Pelletier JP, et al. An algorithm recommendation for the management of knee osteoarthritis in Europe and internationally: A report from a task force of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Semin Arthritis Rheum  2014; 44(3): 253-63.
 [http://dx.doi.org/10.1016/j.semarthrit.2014.05.014] [PMID: 24953861]

[7]
Bruyère O, Honvo G, Veronese N, et al. An updated algorithm recommendation for the management of knee osteoarthritis from the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum  2019; 49(3): 337-50.
 [http://dx.doi.org/10.1016/j.semarthrit.2019.04.008] [PMID: 31126594]

[8]
American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the knee (Non-Arthroplasty) evidence-based clinical practice Guideline.   Available from: https://aaos.org/quality/quality-programs/lower-extremity-programs/osteoarthritis-of-the-knee/

[9]
Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res  2020; 72(2): 149-62.
 [http://dx.doi.org/10.1002/acr.24131] [PMID: 31908149]

[10]
NICE. Osteoarthritis: care and management.  Available from: https://www.nice.org.uk/guidance/cg177/evidence/full-guideline-pdf-191761311

[11]
VA/DoD Clinical Practice Guidelines. The non-surgical management of hip & knee osteoarthritis (OA) (2020).  Available from: https://www.healthquality.va.gov/guidelines/cd/oa/index.asp

[12]
Altman RD, Rosen JE, Bloch DA, Hatoum HT, Korner P. A double-blind, randomized, saline-controlled study of the efficacy and safety of EUFLEXXA for treatment of painful osteoarthritis of the knee, with an open-label safety extension (the FLEXX trial). Semin Arthritis Rheum  2009; 39(1): 1-9.
 [http://dx.doi.org/10.1016/j.semarthrit.2009.04.001] [PMID: 19539353]

[13]
Perruchet S, Balblanc JC, Rapp C, et al. The Association between radiographic features and the duration of effectiveness of a single injection of extended-release hyaluronic acid (HANOX-M-XL) in patients with knee osteoarthritis: Preliminary results of a prospective trial. Cartilage  2022; 14(2): 19476035221109230.
 [PMID: 36527367]

[14]
Polacco A, Zobel BB, Polacco M, et al. The effect of intra-articular hyaluronic acid (Sinovial(R) One) on knee osteoarthritis: a preliminary study. Eur J Inflamm  2013; 11(3): 847-53.
 [http://dx.doi.org/10.1177/1721727X1301100327]

[15]
Raeissadat SA, Rayegani SM, Hassanabadi H, et al. Knee osteoarthritis injection choices: Platelet- rich plasma (PRP) versus hyaluronic acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord  2015; 8: CMAMD. S17894.
 [http://dx.doi.org/10.4137/CMAMD.S17894] [PMID: 25624776]

[16]
Kon E, Mandelbaum B, Buda R, et al. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: From early degeneration to osteoarthritis. Arthroscopy  2011; 27(11): 1490-501.
 [http://dx.doi.org/10.1016/j.arthro.2011.05.011] [PMID: 21831567]

[17]
Bowman EN, Hallock JD, Throckmorton TW, Azar FM. Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment. Int Orthop  2018; 42(4): 733-40.
 [http://dx.doi.org/10.1007/s00264-017-3731-8] [PMID: 29299652]

[18]
Nicholls M, Shaw P, Niazi F, Bhandari M, Bedi A. The impact of excluding patients with end-stage knee disease in intra-articular hyaluronic acid trials: A systematic review and meta-analysis. Adv Ther  2019; 36(1): 147-61.
 [http://dx.doi.org/10.1007/s12325-018-0847-1] [PMID: 30506407]

[19]
Vincent P, Lucas de Couville T, Thomas T. Intra-articular hyaluronic acid for knee osteoarthritis: A postmarket, open-label, long-term historical control study with analysis detailed per krellgren-lawrence radiologic osteoarthritis scale grade. Curr Ther Res Clin Exp  2020; 92: 100575.
 [http://dx.doi.org/10.1016/j.curtheres.2020.100575] [PMID: 32211082]

[20]
Turajane T, Tanavaree A, Labpiboonpong V, Maungsiri S. Outcomes of intra-articular injection of sodium hyaluronate for the treatment of osteoarthritis of the knee. J Med Assoc Thai  2007; 90(9): 1845-52.
 [PMID: 17957929]

[21]
Guidolin D. Intra-articular 500-730 kDa hyaluronan (Hyalgan®) therapy in the management of osteoarthritis. Can a specific therapeutic profile be defined? Eur Rev Med Pharmacol Sci  2018; 22(14): 4698-719.
 [PMID: 30058706]

[22]
Toh EM, Prasad PS, Teanby D. Correlating the efficacy of knee viscosupplementation with osteoarthritic changes on roentgenological examination. Knee  2002; 9(4): 321-30.
 [http://dx.doi.org/10.1016/S0968-0160(02)00040-6] [PMID: 12424042]

[23]
Pelletier JP, Raynauld JP, Abram F, Dorais M, Delorme P, Martel-Pelletier J. Exploring determinants predicting response to intra-articular hyaluronic acid treatment in symptomatic knee osteoarthritis: 9-year follow-up data from the Osteoarthritis Initiative. Arthritis Res Ther  2018; 20(1): 40.
 [http://dx.doi.org/10.1186/s13075-018-1538-7] [PMID: 29490683]

[24]
Pritzker KPH, Gay S, Jimenez SA, et al. Osteoarthritis cartilage histopathology: Grading and staging. Osteoarthritis Cartilage  2006; 14(1): 13-29.
 [http://dx.doi.org/10.1016/j.joca.2005.07.014] [PMID: 16242352]

[25]
Custers RJH, Creemers LB, Verbout AJ, van Rijen MHP, Dhert WJA, Saris DBF. Reliability, reproducibility and variability of the traditional histologic/histochemical grading system vs the new OARSI osteoarthritis cartilage histopathology assessment system. Osteoarthr Cartil  2007; 15(11): 1241-8.
 [http://dx.doi.org/10.1016/j.joca.2007.04.017] [PMID: 17576080]

[26]
Conrozier T, Eymard F, Afif N, Balblanc JC, Legré-Boyer V, Chevalier X. Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis. Knee  2016; 23(5): 842-8.
 [http://dx.doi.org/10.1016/j.knee.2016.05.015] [PMID: 27353769]

[27]
Eymard F, Chevalier X, Conrozier T. Obesity and radiological severity are associated with viscosupplementation failure in patients with knee osteoarthritis. J Orthop Res  2017; 35(10): 2269-74.
 [http://dx.doi.org/10.1002/jor.23529] [PMID: 28128473]

[28]
Conrozier T, Eymard F, Chouk M, Chevalier X. Impact of obesity, structural severity and their combination on the efficacy of viscosupplementation in patients with knee osteoarthritis. BMC Musculoskelet Disord  2019; 20(1): 376.
 [http://dx.doi.org/10.1186/s12891-019-2748-0] [PMID: 31421686]

[29]
Jubb RW, Piva S, Beinat L, Dacre J, Gishen P. A one-year, randomised, placebo (saline) controlled clinical trial of 500-730 kDa sodium hyaluronate (Hyalgan) on the radiological change in osteoarthritis of the knee. Int J Clin Pract  2003; 57(6): 467-74.
 [http://dx.doi.org/10.1111/j.1742-1241.2003.tb10535.x] [PMID: 12918884]

[30]
Conrozier T, Mathieu P, Schott AM, et al. Factors predicting long-term efficacy of Hylan GF-20 viscosupplementation in knee osteoarthritis. Joint Bone Spine  2003; 70(2): 128-33.
 [http://dx.doi.org/10.1016/S1297-319X(03)00005-8] [PMID: 12713857]

[31]
Kemper F, Gebhardt U, Meng T, Murray C. Tolerability and short-term effectiveness of hylan G-F 20 in 4253 patients with osteoarthritis of the knee in clinical practice. Curr Med Res Opin  2005; 21(8): 1261-9.
 [http://dx.doi.org/10.1185/030079905X56501] [PMID: 16083536]

[32]
Bisicchia S, Bernardi G, Tudisco C. HYADD 4 versus methylprednisolone acetate in symptomatic knee osteoarthritis: A single-centre single blind prospective randomised controlled clinical study with 1-year follow-up. Clin Exp Rheumatol  2016; 34(5): 857-63.
 [PMID: 27244700]

[33]
Altman RD, Farrokhyar F, Fierlinger A, Niazi F, Rosen J. Analysis for prognostic factors from a database for the intra-articular hyaluronic acid (Euflexxa) treatment for osteoarthritis of the knee. Cartilage  2016; 7(3): 229-37.
 [http://dx.doi.org/10.1177/1947603515620890] [PMID: 27375838]

[34]
Cole BJ, Karas V, Hussey K, Merkow DB, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: A prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med  2017; 45(2): 339-46.
 [http://dx.doi.org/10.1177/0363546516665809] [PMID: 28146403]

[35]
Kearey P, Popple AE, Warren J, Davis T, Bellamy N. Improvement in condition-specific and generic quality of life outcomes in patients with knee osteoarthritis following single-injection Synvisc: results from the LOBRAS study. Curr Med Res Opin  2017; 33(3): 409-19.
 [http://dx.doi.org/10.1080/03007995.2016.1260533] [PMID: 27848271]

[36]
Wang CT, Lin J, Chang CJ, Lin YT, Hou SM. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. J Bone Joint Surg Am  2004; 86(3): 538-45.
 [http://dx.doi.org/10.2106/00004623-200403000-00012] [PMID: 14996880]

[37]
Uçar D, Dıraçoğlu D, Süleyman T, Çapan N. Intra-articular hyaluronic Acid as treatment in elderly and middle-aged patients with knee osteoarthritis. Open Rheumatol J  2013; 7(1): 38-41.
 [http://dx.doi.org/10.2174/1874312901307010038] [PMID: 23919093]

[38]
Ong K, Lau E, Runa M, Daley W, Altman R. Factors associated with knee arthroplasty in a knee osteoarthritis patient cohort treated with intra-articular injections of hylan G-F 20. J Knee Surg  2021; 34(8): 886-97.
 [http://dx.doi.org/10.1055/s-0039-3402043] [PMID: 31874465]

[39]
Jørgensen A, Stengaard-Pedersen K, Simonsen O, et al. Intra-articular hyaluronan is without clinical effect in knee osteoarthritis: a multicentre, randomised, placebo-controlled, double-blind study of 337 patients followed for 1 year. Ann Rheum Dis  2010; 69(6): 1097.2-102.
 [http://dx.doi.org/10.1136/ard.2009.118042] [PMID: 20447955]

[40]
Newberry SJ, Fitzgerald JD, Maglione MA. Systematic review for effectiveness of hyaluronic acid in the treatment of severe degenerative joint disease (DJD) of the knee. Rockville (MD): Agency for Healthcare Research and Quality (US) 2015.

[41]
Wobig M, Dickhut A, Maier R, Vetter G. Viscosupplementation with Hylan G-F 20: A 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther  1998; 20(3): 410-23.
 [http://dx.doi.org/10.1016/S0149-2918(98)80052-0] [PMID: 9663358]

[42]
Mackowiak J, Jones JT, Dasa V. A comparison of 4-year total medical care costs, adverse outcomes, and opioid/prescription analgesic use for 3 knee osteoarthritis pain treatments: Intra-articular hyaluronic acid, intra-articular corticosteroids, and knee arthroplasty. Semin Arthritis Rheum  2020; 50(6): 1525-34.
 [http://dx.doi.org/10.1016/j.semarthrit.2020.01.003] [PMID: 32088013]

[43]
Waddell D, Rein A, Panarites C, Coleman PM, Weiss C. Cost implications of introducing an alternative treatment for patients with osteoarthritis of the knee in a managed care setting. Am J Manag Care  2001; 7(10): 981-91.
 [PMID: 11669362]

[44]
Waddell DD, Joseph B. Delayed total knee replacement with hylan G-F 20. J Knee Surg  2016; 29(2): 159-68.
 [PMID: 25349988]

[45]
Ong KL, Runa M, Lau E, Altman R. Is intra-articular injection of synvisc associated with a delay to knee arthroplasty in patients with knee osteoarthritis? Cartilage  2019; 10(4): 423-31.
 [http://dx.doi.org/10.1177/1947603518775792] [PMID: 29779404]

[46]
Dasa V, Lim S, Heeckt P. Real-world evidence for safety and effectiveness of repeated courses of hyaluronic acid injections on the time to knee replacement surgery. Am J Orthop  2018; 47(7)
 [http://dx.doi.org/10.12788/ajo.2018.0058] [PMID: 30075038]

[47]
Altman R, Lim S, Steen RG, Dasa V. Hyaluronic acid injections are associated with delay of total knee replacement surgery in patients with knee osteoarthritis: Evidence from a large U.S. Health claims database. PLoS One  2015; 10(12): e0145776.
 [http://dx.doi.org/10.1371/journal.pone.0145776] [PMID: 26694145]

[48]
Concoff A, Niazi F, Farrokhyar F, Alyass A, Rosen J, Nicholls M. Delay to TKA and costs associated with knee osteoarthritis care using intra-articular hyaluronic acid: Analysis of an administrative database. Clin Med Insights Arthritis Musculoskelet Disord  2021; 14
 [http://dx.doi.org/10.1177/1179544121994092] [PMID: 33814937]

[49]
Mordin M, Parrish W, Masaquel C, Bisson B, Copley-Merriman C. Intra-articular hyaluronic acid for osteoarthritis of the knee in the United States: A systematic review of economic evaluations. Clin Med Insights Arthritis Musculoskelet Disord  2021; 14
 [http://dx.doi.org/10.1177/11795441211047284] [PMID: 34840501]

[50]
Waddell DD, Bricker DC. Total knee replacement delayed with Hylan G-F 20 use in patients with grade IV osteoarthritis. J Manag Care Pharm  2007; 13(2): 113-21.
 [http://dx.doi.org/10.18553/jmcp.2007.13.2.113] [PMID: 17330972]

[51]
Delbarre A, Amor B, Bardoulat I, Tetafort A, Pelletier-Fleury N. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis – A Cox model analysis. PLoS One  2017; 12(11): e0187227.
 [http://dx.doi.org/10.1371/journal.pone.0187227] [PMID: 29155833]

[52]
Altman R, Fredericson M, Bhattacharyya S, et al. Association between hyaluronic acid injections and time-to-total knee replacement surgery. J Knee Surg  2015; 29(7): 564-70.
 [http://dx.doi.org/10.1055/s-0035-1568992] [PMID: 26641076]

[53]
Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee: A systematic review. BMC Musculoskelet Disord  2015; 16(1): 321.
 [http://dx.doi.org/10.1186/s12891-015-0775-z] [PMID: 26503103]

[54]
Hashizume M, Mihara M. High molecular weight hyaluronic acid inhibits IL-6-induced MMP production from human chondrocytes by up-regulating the ERK inhibitor, MKP-1. Biochem Biophys Res Commun  2010; 403(2): 184-9.
 [http://dx.doi.org/10.1016/j.bbrc.2010.10.135] [PMID: 21059338]

[55]
Julovi SM, Ito H, Nishitani K, Jackson CJ, Nakamura T. Hyaluronan inhibits matrix metalloproteinase-13 in human arthritic chondrocytes via CD44 and P38. J Orthop Res  2011; 29(2): 258-64.
 [http://dx.doi.org/10.1002/jor.21216] [PMID: 20706991]

[56]
Waddell DD, Kolomytkin OV, Dunn S, Marino AA. Hyaluronan suppresses IL-1beta-induced metalloproteinase activity from synovial tissue. Clin Orthop Relat Res  2007; 465(465): 241-8.
 [http://dx.doi.org/10.1097/BLO.0b013e31815873f9] [PMID: 18090474]

[57]
Henrotin Y, Chevalier X, Deberg M, et al. Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO 2 ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: A research study part of the Biovisco study. J Orthop Res  2013; 31(6): 901-7.
 [http://dx.doi.org/10.1002/jor.22297] [PMID: 23423846]

[58]
Hummer CD, Angst F, Ngai W, et al. High molecular weight Intraarticular hyaluronic acid for the treatment of knee osteoarthritis: A network meta-analysis. BMC Musculoskelet Disord  2020; 21(1): 702.
 [http://dx.doi.org/10.1186/s12891-020-03729-w] [PMID: 33097031]

[59]
Donovan RL, Edwards TA, Judge A, Blom AW, Kunutsor SK, Whitehouse MR. Effects of recurrent intra-articular corticosteroid injections for osteoarthritis at 3 months and beyond: A systematic review and meta-analysis in comparison to other injectables. Osteoarthritis Cartilage  2022; 30(12): 1658-69.
 [http://dx.doi.org/10.1016/j.joca.2022.07.011] [PMID: 36108937]

[60]
Bannuru RR, Natov NS, Obadan 
                IE
              , Price LL, Schmid CH, McAlindon TE. Therapeutic trajectory of hyaluronic acid versus corticosteroids in the treatment of knee osteoarthritis: A systematic review and meta-analysis. Arthritis Care Res  2009; 61(12): 1704-11.
 [http://dx.doi.org/10.1002/art.24925] [PMID: 19950318]

[61]
Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: Perhaps not as safe as we thought? Radiology  2019; 293(3): 656-63.
 [http://dx.doi.org/10.1148/radiol.2019190341] [PMID: 31617798]

[62]
McAlindon TE, LaValley MP, Harvey WF, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis. JAMA  2017; 317(19): 1967-75.
 [http://dx.doi.org/10.1001/jama.2017.5283] [PMID: 28510679]

[63]
Habib G, Khazin F, Chernin M. Continuous blood glucose monitoring in a patient with type 2 diabetes who underwent intraarticular betamethasone injection for knee osteoarthritis. Arthritis Rheumatol  2014; 66(1): 230.
 [http://dx.doi.org/10.1002/art.38209] [PMID: 24449590]

[64]
Habib GS, Bashir M, Jabbour A. Increased blood glucose levels following intra-articular injection of methylprednisolone acetate in patients with controlled diabetes and symptomatic osteoarthritis of the knee. Ann Rheum Dis  2008; 67(12): 1790-1.
 [http://dx.doi.org/10.1136/ard.2008.089722] [PMID: 19005159]

[65]
Habib GS, Miari W. The effect of intra-articular triamcinolone preparations on blood glucose levels in diabetic patients: A controlled study. J Clin Rheumatol  2011; 17(6): 302-5.
 [http://dx.doi.org/10.1097/RHU.0b013e31822acd7c] [PMID: 21869712]

[66]
Navarro-Sarabia F, Coronel P, Collantes E, et al. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: The AMELIA project. Ann Rheum Dis  2011; 70(11): 1957-62.
 [http://dx.doi.org/10.1136/ard.2011.152017] [PMID: 21852252]

[67]
Johnston J, Brown K, Muir J, Sloniewsky MJ. Long-term outcomes of single versus multiple courses of viscosupplementation for osteoarthritic knee pain: Real-world, multi-practice experience over a six-year period. J Pain Res  2021; 14: 2413-21.
 [http://dx.doi.org/10.2147/JPR.S312418] [PMID: 34408486]

[68]
Bhadra AK, Altman R, Dasa V, et al. Appropriate use criteria for hyaluronic acid in the treatment of knee osteoarthritis in the United States. Cartilage  2017; 8(3): 234-54.
 [http://dx.doi.org/10.1177/1947603516662503] [PMID: 28618868]

[69]
Spitzer AI, Bert JM. Letter to the Editor: Compliance with the aaos guidelines for treatment of osteoarthritis of the knee: A survey of the American association of hip and knee surgeons. J Am Acad Orthop Surg  2018; 26(16): e358-9.

[70]
Carlson VR, Ong AC, Orozco FR, Hernandez VH, Lutz RW, Post ZD. Compliance with the AAOS guidelines for treatment of osteoarthritis of the knee: A survey of the american association of hip and knee surgeons. J Am Acad Orthop Surg  2018; 26(3): 103-7.
 [http://dx.doi.org/10.5435/JAAOS-D-17-00164] [PMID: 29283898]

[71]
Conrozier T, Monfort J, Chevalier X, et al. EUROVISCO recommendations for optimizing the clinical results of viscosupplementation in osteoarthritis. Cartilage  2020; 11(1): 47-59.
 [http://dx.doi.org/10.1177/1947603518783455] [PMID: 29926748]

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DOI https://dx.doi.org/10.2174/0115733971274662240108074038	Print ISSN 1573-3971
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Predictors of Clinical Benefit with Intra-articular Hyaluronic Acid in Patients with Knee Osteoarthritis - A Narrative Review

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