Intra-articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: A randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy

Abstract

Objective - To determine the safety and efficacy of intra-articular injections of hyaluronan in the treatment of osteoarthritis of the knee. Methods - A randomised double-blind placebo-controlled trial was carried out on 91 patients with radiologically confirmed osteoarthritis of the knee who were recruited from the outpatient clinics. Results - It was found that weekly intraarticular injections of 20 mg of hyaluronan of M(r) = 750000 (Hyalgan) in 2 ml of buffered saline performed no better than the inert vehicle alone over a five week period. The principal side effects of a transient increase in pain and swelling in the affected knee was observed in 47% of the treatment group compared with 22% of the placebo group. A few patients with radiologically mild disease treated with Hyalgan appeared to experience medium to long-term symptomatic improvement over matched placebo controls as judged by a delayed return to previous NSAID therapy or analgesia other than paracetamol. Patient numbers in the survival groups, however, were too small to be meaningful. Conclusion - It is concluded that intraarticular administration of this preparation of 750 kD hyaluronan offers no significant benefit over placebo during a five week treatment period, but incurs a significantly higher morbidity, and therefore has no place in the routine treatment of osteoarthritis.