Abstract
OBJECTIVE: Viscosupplementation (VS) by intra-articular injections of hyaluronic acid (HA) is a commonly used treatment of knee osteoarthritis. However, there are no clear recommendations for its use in clinical situations not usually addressed in therapeutic guidelines. DESIGN: Members of the European Viscosupplementation Consensus Group (EUROVISCO), made up of rheumatologists, orthopedic surgeons, and rehabilitation physicians from seven European countries, were asked to make a therapeutic decision on 30 clinical scenarios based on their clinical experience and data from the literature, using the Delphi method. For each scenario, the strength of agreement and the level of consensus were calculated by the chairman of the group. RESULTS: The expert panel reached consensus on 18 of the 30 clinical scenarios proposed. According to the experts, the factors that most influence the decision to use VS with HA to treat knee osteoarthritis are the nature and severity of symptoms, the presence of comorbidity, the absence of therapeutic alternatives, and the patient's refusal to undergo knee arthroplasty. Obesity and an advanced radiological degree of osteoarthritis have been identified as the two main factors for poor response to VS with HA and should be considered before any decision is made to viscosupplement. CONCLUSION: This set of recommendations, based on common clinical scenarios, is intended to help practitioners make decisions about HA VS in patients with osteoarthritis of the knee.