Osteoarthritis (OA) is a significant cause of disability. Considering the increasing
diffusion of the viscosupplementation (VS) with hyaluronic acid (HA), the International
Symposium Intra Articular Treatment (ISIAT) appointed a Technical Expert Panel (TEP)
to identify the criteria for successful VS with a specific HA in OA; this through
a systematic literature review (SLR), performed following the PRISMA guidelines interrogating
Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature
(CINAHL), Grey Matters and American College of Rheumatology (ACR/EULAR) databases
and the opinion of international experts. The research included only studies on adults
and humans without limitations of language or time of publication. Researchers extracted
both quantitative and qualitative data from each study. Mixed Methods Appraisal Tool
(MMAT) was used to perform quality analysis for the level of evidence. The SLR retrieved
385 papers, 25 of which were suitable for the analysis. The TEP focused on the different
formulations of the product Sinovial (R) [HA 0.8%, HA 1.6%, HA 2%, 800-1200 kDa, HA
3.2% (1400-2100 kDa/65-110 kDa)]. The choice was due to the vast amount of evidence
available. The TEP weighed the evidence in two rounds of a Delphi survey; the results,
and any disagreement, were discussed in a final session. Three domains were considered:
1) the patients' characteristics associated with the best results; 2) the contraindications
and the conditions linked to increased risk of failure; 3) the clinical conditions
in which VS is considered appropriate. The TEP concluded that VS with HA is safe and
effective in the treatment of knee and hip OA of grades I to III and that it is possible
to undertake VS in other situations (eg grade IV Kellgren-Lawrence - KL); a comprehensive
examination of the patient should be performed before the procedure.
