Intra-articular injections of hyaluronic acid (viscosupplementation) in the haemophilic knee.

Intra-articular injections (IAIs) of hyaluronic acid, also called viscosupplementation, can be used for the treatment of radiological haemophilic arthropathy of the knee, that is when mild-to-moderate degenerative changes can be visualized on plain radiographs. This article aims to define the efficacy of IAIs of hyaluronic acid in the treatment of radiological haemophilic arthropathy of the knee. A review of recent literature on the topic has been performed. The literature seems to support the use of hyaluronic acid in the treatment of knee osteoarthritis, because it diminishes pain and improves disability, generally within 1 week and for up to 3-12 months (but especially at the 5-13-week postinjection period). There are only five reports in the literature on the efficacy of knee viscosupplementation in haemophilia, all of them with a low level of evidence. The five studies dealing with viscosupplementation in haemophilia recommend it for haemophilic arthropathy of the knee as a way of delaying the need of operative treatment when noninvasive medical therapy (relative rest, oral anti-inflammatory drugs, oral analgesics and physical therapy) has failed. The short-lived improvement afforded by viscosupplementation does not, however, seem to warrant its use in haemophilic patients given the risks and the cost involved. Further trials are required to ascertain whether viscosupplementation should be indicated in painful radiological haemophilic arthropathy of the knee.