Table 1.

Considerations for the use of viscosupplementation in osteoarthritis according to recommendations from the EUROVISCO group [31]

Main items

VS is an effective treatment for mild to moderate knee, hip, ankle, shoulder, and trapeziometacarpal joint OA

VS may also be helpful in advanced stages of knee OA

VS is not an alternative to surgery in advanced hip OA

VS when administered at the early stages of OA may have a chondroprotective effect

Owing to its safety profile, VS should not only be used in patients who have failed to respond adequately to analgesics and NSAIDs

VS is a “positive” indication but not a “lack of anything better” indication

Because hyaluronic acids differ widely from each other, results of clinical trials with a particular VS cannot be extrapolated to others

The dosing regimen must be supported by evidence-based medicine

A good technique of injection and/or the use of imaging guidance may enhance the success of VS

Obesity (BMI > 30) may influence the response of VS in the knee

Joint space narrowing severity may influence the response of viscosupplementation in the knee and hip

Characteristics of pain may influence the response of viscosupplementation in the knee and hip

Appropriateness for the use of viscosupplementation

Patients with symptomatic, mild to moderate knee or hip OA (joint space narrowing grade 0–2, KL score I–III), with normal weight or moderate overweight (BMI < 30), not sufficiently improved by non-pharmacological interventions and analgesics/NSAIDs or with contraindication to analgesics/NSAIDs

EUROVISCO EUROpean VIScosupplementation COnsensus group, HA hyaluronic acid, KL Kellgren–Lawrence, OA osteoarthritis, VS viscosupplementation