From the Guidelines
Knee replacement surgery is generally recommended over hyaluronic acid injections for patients with severe osteoarthritis who have failed conservative treatments and have significant pain and disability, as it offers a more permanent solution with improved quality of life and durability, as supported by the most recent and highest quality study 1.
Comparison of Treatments
- Hyaluronic acid injections are typically recommended for mild to moderate osteoarthritis, providing temporary relief and delaying surgery.
- Knee replacement surgery is generally reserved for severe osteoarthritis, offering a more permanent solution with 15-20 years of durability.
Considerations for Treatment Choice
- Osteoarthritis severity: patients with severe osteoarthritis are more likely to benefit from knee replacement surgery.
- Patient age: younger patients may try injections first to postpone surgery until absolutely necessary.
- Overall health: patients with significant comorbidities may need to delay surgery for prehabilitation or other medical reasons.
- Lifestyle goals: patients who are active and want to maintain their lifestyle may prefer knee replacement surgery.
Evidence-Based Recommendations
- The 2023 American College of Rheumatology and American Association of Hip and Knee Surgeons clinical practice guideline conditionally recommends proceeding to total joint arthroplasty (TJA) without delay over delaying surgical treatment for a trial of viscosupplementation injections, as the data on viscosupplementation for patients who are otherwise candidates for TJA were very limited 1.
- The AAOS clinical practice guideline summary also recommends against the routine use of hyaluronic acid in patients with knee osteoarthritis, as the current evidence does not identify the subset of patients who benefit from hyaluronic acid to explain the observed inconsistency in the evidence 1.
From the Research
Hyaluronic Acid vs Knee Replacement
- Hyaluronic acid injections are a non-surgical treatment option for osteoarthritis of the knee, with studies showing a favorable safety profile and efficacy in reducing pain 2, 3.
- Knee replacement, or total knee arthroplasty, is a surgical option for patients with severe osteoarthritis who have not responded to conservative treatments 4, 5, 6.
- The decision between hyaluronic acid injections and knee replacement depends on the severity of the osteoarthritis, patient characteristics, and risk factors 4, 6.
- Hyaluronic acid injections may be considered for patients with mild to moderate osteoarthritis, while knee replacement may be considered for patients with severe osteoarthritis who have not responded to other treatments 5, 6.
- Studies have compared the efficacy of different types of hyaluronic acid injections, including hylan G-F 20 and low molecular weight hyaluronic acids, with some showing a superior effect of hylan G-F 20 in reducing pain 3.
Treatment Options
- Non-surgical treatment options for osteoarthritis of the knee include weight loss, aerobic exercise, osteopathic manipulative treatment, nonsteroidal anti-inflammatory drugs, and corticosteroid injections 6.
- Surgical treatment options for osteoarthritis of the knee include arthroscopy, osteotomy, and knee arthroplasty, with the choice of procedure depending on the location and severity of the osteoarthritis, as well as patient characteristics and risk factors 4.
- Minimally invasive interventional options, such as intra-articular injections and radiofrequency treatment, may also be considered for patients with osteoarthritis of the knee 5.
Safety and Efficacy
- Hyaluronic acid injections have been shown to be safe and effective in reducing pain and improving function in patients with osteoarthritis of the knee 2, 3.
- Knee replacement has been shown to be a safe and effective treatment option for patients with severe osteoarthritis, with high success rates and significant improvements in pain and function 4, 6.
- The safety and efficacy of hyaluronic acid injections and knee replacement may vary depending on the individual patient and the specific treatment protocol used 5, 3.