The evidence of surgery delay after viscosupplementation is increasing

Osteoarthritis (OA) is a widespread disease throughout the world and prosthetic replacement is considered an effective and definitive treatment. However, some patients do not want or cannot undergo this type of invasive procedure due to the risk of complications. Besides, this kind of surgery is a very expensive treatment for the healthcare system. Real life studies have shown, with growing evidence, that repeated cycles of intra-articular injections of hyaluronic acid (HA) resulted in a significant reduction in pain symptoms as well as an improvement in joint function. Moreover, an important reduction in analgesics consumption was observed. Some studies have shown a delay of total knee replacement (TKR) for up to 2 years. There is minimal data available about the impact of HA injections on the delay of total hip replacement (THR). This review has also evaluated, in addition to clinical research studies, several papers with data from administrative databases suggesting that viscosupplementation possesses the potential to delay or obviate the need for surgery in patients with knee or hip OA. Further studies are necessary to understand the predictors of response, the diversity of response to different HA products, the appropriate dosage and cyclicity in relation to the radiological and clinical stage of the disease