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The value of injectable viscoelastic supplements for joints

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Abstract

Intra-articular viscoelastic supplements are commonly administered by musculoskeletal radiologists for the treatment of symptomatic osteoarthritis (OA). This article provides an overview of the putative mechanism of action of the agents, a brief review of the evidence base underlying the practice, a commentary on some of the major society guidelines regarding the treatment, and a description of the adverse events that are associated with intra-articular hyaluronic acid administration.

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References

  1. BMUS: The burden of musculoskeletal diseases in the United States [Internet]. [cited 2022]. Available from: http://www.boneandjointburden.org/

  2. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. 2018;392(10159):1789–858. Available from: https://doi.org/10.1016/S0140-6736(18)32279-7

  3. Cui A, Li H, Wang D, Zhong J, Chen Y, Lu H. Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies. EClinicalMedicine [Internet]. 2020;29–30(100587):100587. Available from: https://doi.org/10.1016/j.eclinm.2020.100587

  4. Doherty E, O’Neill C. Estimating the health-care usage associated with osteoarthritis and rheumatoid arthritis in an older adult population in Ireland. J Public Health (Oxf) [Internet]. 2014;36(3):504–10. Available from: https://doi.org/10.1093/pubmed/fdt097

  5. March LM, Bachmeier CJ. Economics of osteoarthritis: a global perspective. Baillieres Clin Rheumatol [Internet]. 1997;11(4):817–34. Available from: https://doi.org/10.1016/s0950-3579(97)80011-8

  6. Torio CM, Moore BJ. National inpatient hospital costs: the most expensive conditions by payer, 2013. Agency for Healthcare Research and Quality; 2016.

  7. Murphy LB, Cisternas MG, Pasta DJ, Helmick CG, Yelin EH. Medical expenditures and earnings losses among US adults with arthritis in 2013. Arthritis Care Res (Hoboken) [Internet]. 2018;70(6):869–76. Available from: https://doi.org/10.1002/acr.23425

  8. Aceves-Avila FJ, Delgadillo-Ruano MA, Ramos-Remus C, Gómez-Vargas A, Gutiérrez-Ureña S. The first descriptions of therapeutic arthrocentesis: a historical note. Rheumatology (Oxford) [Internet]. 2003;42(1):180–3. Available from: https://doi.org/10.1093/rheumatology/keg001

  9. Hollander JL. The local effects of compound F (hydrocortisone) injected into joints. Bull Rheum Dis. 1951;2(2):3–4.

    CAS  PubMed  Google Scholar 

  10. Hollander JL, Brown EM Jr, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc [Internet]. 1951;147(17):1629–35. https://doi.org/10.1001/jama.1951.03670340019005.

    Article  CAS  PubMed  Google Scholar 

  11. Hollander JL. Intra-articular hydrocortisone in arthritis and allied conditions; a summary of two years’ clinical experience. J Bone Joint Surg Am. 1953;35(4):983–90.

    Article  PubMed  Google Scholar 

  12. Volpi N, Schiller J, Stern R, Soltes L. Role, metabolism, chemical modifications and applications of hyaluronan. Curr Med Chem [Internet]. 2009;16(14):1718–45. https://doi.org/10.2174/092986709788186138.

    Article  CAS  PubMed  Google Scholar 

  13. Schiraldi C, La A, De M. 2010. Biotechnological production and application of hyaluronan. In: Biopolymers. Sciyo

  14. Cowman MK, Lee H-G, Schwertfeger KL, McCarthy JB, Turley EA. The content and size of hyaluronan in biological fluids and tissues. Front Immunol [Internet]. 2015;6:261. https://doi.org/10.3389/fimmu.2015.00261.

    Article  CAS  PubMed  Google Scholar 

  15. Gupta RC, Lall R, Srivastava A, Sinha A. Hyaluronic acid: molecular mechanisms and therapeutic trajectory. Front Vet Sci [Internet]. 2019;6:192. https://doi.org/10.3389/fvets.2019.00192.

    Article  PubMed  Google Scholar 

  16. Snetkov P, Zakharova K, Morozkina S, Olekhnovich R, Uspenskaya M. Hyaluronic acid: The influence of molecular weight on structural physical physico-chemical and degradable properties of biopolymer. Polymers Basel [Internet]. 2020;12(8):1800. https://doi.org/10.3390/polym12081800.

    Article  CAS  PubMed  Google Scholar 

  17. Fallacara A, Baldini E, Manfredini S, Vertuani S. Hyaluronic acid in the third millennium. Polymers Basel [Internet]. 2018;10(7):701. https://doi.org/10.3390/polym10070701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Cowman MK, Matsuoka S. Experimental approaches to hyaluronan structure. Carbohydr Res [Internet]. 2005;340(5):791–809. https://doi.org/10.1016/j.carres.2005.01.022.

    Article  CAS  PubMed  Google Scholar 

  19. O’neill PL, Stachowiak G. The inverse thixotropic behaviour of synovial fluid. J Orthop Rheumatol. 1996;9(4):222–8.

    Google Scholar 

  20. Davies DV. Synovial fluid as a lubricant. Fed Proc. 1966;25(3):1069–76.

    CAS  PubMed  Google Scholar 

  21. Oates KMN, Krause WE, Colby RH. 2001 Using rheology to probe the mechanism of joint lubrication: polyelectrolyte/protein interactions in synovial fluid. Mater Res Soc Symp Proc [Internet].711(FF4.7.1). Available from: https://doi.org/10.1557/proc-711-ff4.7.1

  22. Anadere I, Chmiel H, Laschner W. Viscoelasticity of “normal” and pathological synovial fluid. Biorheology [Internet]. 1979;16(3):179–84. https://doi.org/10.3233/bir-1979-16306.

    Article  CAS  PubMed  Google Scholar 

  23. Dahl LB, Dahl IM, Engström-Laurent A, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid from patients with rheumatoid arthritis and other arthropathies. Ann Rheum Dis [Internet]. 1985;44(12):817–22. https://doi.org/10.1136/ard.44.12.817.

    Article  CAS  PubMed  Google Scholar 

  24. Stafford CT, Niedermeier W, Holley HL, Pigman W. Studies on the concentration and intrinsic viscosity of hyaluronic acid in synovial fluids of patients with rheumatic diseases. Ann Rheum Dis [Internet]. 1964;23(2):152–7. https://doi.org/10.1136/ard.23.2.152.

    Article  CAS  PubMed  Google Scholar 

  25. Yamada H, Morita M, Henmi O, Miyauchi S, Yoshida Y, Kikuchi T, et al. Hyaluronan in synovial fluid of patients with loose total hip prosthesis Comparison with hyaluronan in patients with hip osteoarthritis and idiopathic osteonecrosis of femoral head. Arch Orthop Trauma Surg [Internet]. 2000;120(9):521–4. https://doi.org/10.1007/s004029900131.

    Article  CAS  PubMed  Google Scholar 

  26. Conrozier T, Chevalier X. Long-term experience with hylan GF-20 in the treatment of knee osteoarthritis. Expert Opin Pharmacother [Internet]. 2008;9(10):1797–804. https://doi.org/10.1517/14656566.9.10.1797.

    Article  CAS  PubMed  Google Scholar 

  27. Gomis A, Pawlak M, Balazs EA, Schmidt RF, Belmonte C. Effects of different molecular weight elastoviscous hyaluronan solutions on articular nociceptive afferents. Arthritis Rheum [Internet]. 2004;50(1):314–26. https://doi.org/10.1002/art.11421.

    Article  CAS  PubMed  Google Scholar 

  28. Smith MM, Ghosh P. The synthesis of hyaluronic acid by human synovial fibroblasts is influenced by the nature of the hyaluronate in the extracellular environment. Rheumatol Int [Internet]. 1987;7(3):113–22. https://doi.org/10.1007/bf00270463.

    Article  PubMed  Google Scholar 

  29. Altman RD, Manjoo A, Fierlinger A, Niazi F, Nicholls M. The mechanism of action for hyaluronic acid treatment in the osteoarthritic knee a systematic review. BMC Musculoskelet Disord [Internet]. 2015;16(1):321. https://doi.org/10.1186/s12891-015-0775-z.

    Article  CAS  PubMed  Google Scholar 

  30. Yasuda T. Progress of research in osteoarthritis. Pharmacological effects of hyaluronan. Clin Calcium [Internet]. 2009;19(11):1644–52. Available from: CliCa091116441652

  31. Alpert S. Hyalgan FDA approval order [Internet]. accessdata.fda.gov. 1997 [cited 2022 Apr 10]. Available from: https://www.accessdata.fda.gov/cdrh_docs/pdf/P950027a.pdf

  32. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. 2006 Viscosupplementation for the treatment of osteoarthritis of the knee. Cochrane Database Syst Rev [Internet] 2014(2):CD005321.https://doi.org/10.1002/14651858.CD005321.pub2

  33. Bannuru RR, Vaysbrot EE, Sullivan MC, McAlindon TE. Relative efficacy of hyaluronic acid in comparison with NSAIDs for knee osteoarthritis a systematic review and meta-analysis. Semin Arthritis Rheum [Internet]. 2014;43(5):593–9. https://doi.org/10.1016/j.semarthrit.2013.10.002.

    Article  CAS  PubMed  Google Scholar 

  34. Zhang H-F, Wang C-G, Li H, Huang Y-T, Li Z-J. Intra-articular platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis a meta-analysis. Drug Des Devel Ther [Internet]. 2018;12:445–53. https://doi.org/10.2147/DDDT.S156724.

    Article  CAS  PubMed  Google Scholar 

  35. Han Y, Huang H, Pan J, Lin J, Zeng L, Liang G, et al. Meta-analysis comparing platelet-rich plasma vs hyaluronic acid injection in patients with knee osteoarthritis. Pain Med [Internet]. 2019;20(7):1418–29. https://doi.org/10.1093/pm/pnz011.

    Article  PubMed  Google Scholar 

  36. Chen Z, Wang C, You D, Zhao S, Zhu Z, Xu M. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis a meta-analysis A meta-analysis. Medicine Baltimore [Internet]. 2020;99(11):19388. https://doi.org/10.1097/MD.0000000000019388.

    Article  CAS  Google Scholar 

  37. Tan J, Chen H, Zhao L, Huang W. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis a meta-analysis of 26 randomized controlled trials. Arthroscopy [Internet]. 2021;37(1):309–25. https://doi.org/10.1016/j.arthro.2020.07.011.

    Article  PubMed  Google Scholar 

  38. Tang JZ, Nie MJ, Zhao JZ, Zhang GC, Zhang Q, Wang B. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis. J Orthop Surg Res [Internet]. 2020;15(1):403. https://doi.org/10.1186/s13018-020-01919-9.

    Article  PubMed  Google Scholar 

  39. Gong H, Li K, Xie R, Du G, Li L, Wang S, et al. Clinical therapy of platelet-rich plasma vs hyaluronic acid injections in patients with knee osteoarthritis a systematic review and meta-analysis of randomized double-blind controlled trials. Medicine Baltimore [Internet]. 2021;100(12):e25168. https://doi.org/10.1097/MD.0000000000025168.

    Article  PubMed  Google Scholar 

  40. Zhao D, Pan J-K, Yang W-Y, Han Y-H, Zeng L-F, Liang G-H, et al. Intra-articular injections of platelet-rich plasma, adipose mesenchymal stem cells, and bone marrow mesenchymal stem cells associated with better outcomes than hyaluronic acid and saline in knee osteoarthritis a systematic review and network meta-analysis. Arthroscopy [Internet]. 2021;37(7):2298–314. https://doi.org/10.1016/j.arthro.2021.02.045.

    Article  PubMed  Google Scholar 

  41. Phillips M, Bhandari M, Grant J, Bedi A, Trojian T, Johnson A, et al. A systematic review of current clinical practice guidelines on intra-articular hyaluronic acid corticosteroid and platelet-rich plasma injection for knee osteoarthritis An international perspective. Orthop J Sports Med [Internet]. 2021;9(8):23259671211030270. https://doi.org/10.1177/23259671211030272.

    Article  Google Scholar 

  42. National Collaborating Centre for Chronic Conditions at the Royal College of Physicians. Osteoarthritis: national clinical guideline for care and management in adults. London, England: Royal College of Physicians of London; 2008.

  43. Jevsevar DS. 2013 Treatment of osteoarthritis of the knee evidence based guideline 2nd edition. J Am Acad Orthop Surg [Internet] 21(9):571–6 https://doi.org/10.5435/JAAOS-21-09-571

  44. National Institute for Health and Clinical Excellence (Great Britain). Osteoarthritis: care and management in adults. London, England: National Institute for Health and Clinical Excellence; 2020.

  45. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee [NonArthroplasty] , Evidence-Based Clinical Practice Guideline [Internet]. 2021 Aug. Available from: https://www.aaos.org/oak3cpg Published 08/31/2021

  46. Riley N, Vella-Baldacchino M, Thurley N, Hopewell S, Carr AJ, Dean BJF. Injection therapy for base of thumb osteoarthritis a systematic review and meta-analysis. BMJ Open [Internet]. 2019;9(9):e027507. https://doi.org/10.1136/bmjopen-2018-027507.

    Article  PubMed  Google Scholar 

  47. Trellu S, Dadoun S, Berenbaum F, Fautrel B, Gossec L. Intra-articular injections in thumb osteoarthritis a systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine [Internet]. 2015;82(5):315–9. https://doi.org/10.1016/j.jbspin.2015.02.002.

    Article  PubMed  Google Scholar 

  48. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the Hand, hip, and knee. Arthritis rheumatol [Internet]. 2020;72(2):220–33 https://doi.org/10.1002/art.41142

  49. Lieberman JR, Engstrom SM, Solovyova O, Au C, Grady JJ. Is intra-articular hyaluronic acid effective in treating osteoarthritis of the hip joint? J Arthroplasty [Internet]. 2015;30(3):507–11. https://doi.org/10.1016/j.arth.2013.10.019.

    Article  PubMed  Google Scholar 

  50. Leite VF, DaudAmadera JE, Buehler AM. Viscosupplementation for hip osteoarthritis: a systematic review and meta-analysis of the efficacy on pain and disability, and the occurrence of adverse events. Arch Phys Med Rehabil [Internet]. 2018;99(3):574–83. https://doi.org/10.1016/j.apmr.2017.07.010.

    Article  PubMed  Google Scholar 

  51. Gazendam A, Ekhtiari S, Bozzo A, Phillips M, Bhandari M. Intra-articular saline injection is as effective as corticosteroids platelet-rich plasma and hyaluronic acid for hip osteoarthritis pain a systematic review and network meta-analysis of randomised controlled trials. Br J Sports Med [Internet]. 2021;55(5):256–61. https://doi.org/10.1136/bjsports-2020-102179.

    Article  PubMed  Google Scholar 

  52. Liao Y-Y, Lin T, Zhu H-X, Shi M-M, Yan S-G. Intra-articular viscosupplementation for patients with hip osteoarthritis a meta analysis and systematic review. Med Sci Monit [Internet]. 2019;25:6436–45. https://doi.org/10.12659/MSM.916955.

    Article  PubMed  Google Scholar 

  53. American Academy of Orthopaedic Surgeons. Management of osteoarthritis of the hip evidence-based clinical practice guideline [Internet]. 2017 Mar. Available from: https://www.aaos.org/globalassets/quality-and-practice-resources/osteoarthritis-of-the-hip/oa-hip-cpg_6-11-19.pdf

  54. Sabha M, Hochberg MC. Non-surgical management of hip and knee osteoarthritis; comparison of ACR/AF and OARSI 2019 and VA/DoD 2020 guidelines. Osteoarthritis and Cartilage Open [Internet]. 2022;4(1):100232. https://doi.org/10.1016/j.ocarto.2021.100232.

    Article  PubMed  Google Scholar 

  55. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee hip and polyarticular osteoarthritis. Osteoarthritis Cartilage [Internet]. 2019;27(11):1578–89. https://doi.org/10.1016/j.joca.2019.06.011.

    Article  CAS  PubMed  Google Scholar 

  56. Krishnamurthy A, Lang AE, Pangarkar S, Edison J, Cody J, Sall J. Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense clinical practice guideline: the non-surgical management of hip and knee osteoarthritis. Mayo Clin Proc [Internet]. 2021;96(9):2435–47. https://doi.org/10.1016/j.mayocp.2021.03.017.

    Article  PubMed  Google Scholar 

  57. Zhang B, Thayaparan A, Horner N, Bedi A, Alolabi B, Khan M. Outcomes of hyaluronic acid injections for glenohumeral osteoarthritis a systematic review and meta-analysis. J Shoulder Elbow Surg [Internet]. 2019;28(3):596–606. https://doi.org/10.1016/j.jse.2018.09.011.

    Article  PubMed  Google Scholar 

  58. American Academy of Orthopaedic Surgeons. Management of glenohumeral joint osteoarthritis evidence-based clinical practice guideline [Internet]. 2020 Mar. Available from: https://www.aaos.org/gjocpg

  59. Chang K-V, Hsiao M-Y, Chen W-S, Wang T-G, Chien K-L. Effectiveness of intra-articular hyaluronic acid for ankle osteoarthritis treatment a systematic review and meta-analysis. Arch Phys Med Rehabil [Internet]. 2013;94(5):951–60. https://doi.org/10.1016/j.apmr.2012.10.030.

    Article  PubMed  Google Scholar 

  60. Witteveen AGH, Hofstad CJ, Kerkhoffs GMMJ. 2015 Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database Syst Rev [Internet] (10):CD010643 https://doi.org/10.1002/14651858.CD010643.pub2

  61. Bannuru RR, Osani M, Vaysbrot E, McAlindon TE. 2016 Comparative safety profile of hyaluronic acid products for knee osteoarthritis: a systematic review and network meta-analysis. Osteoarthritis Cartilage [Internet] 24:S527. Available from: https://doi.org/10.1016/j.joca.2016.01.963

  62. Ishikawa M, Yoshioka K, Urano K, Tanaka Y, Hatanaka T, Nii A. Biocompatibility of cross-linked hyaluronate (Gel-200) for the treatment of knee osteoarthritis. Osteoarthritis Cartilage [Internet]. 2014;22(11):1902–9. https://doi.org/10.1016/j.joca.2014.08.002.

    Article  CAS  PubMed  Google Scholar 

  63. Sedrak P, Hache P, Horner NS, Ayeni OR, Adili A, Khan M. Differential characteristics and management of pseudoseptic arthritis following hyaluronic acid injection is a rare complication a systematic review. J ISAKOS [Internet]. 2021;6(2):94–101. https://doi.org/10.1136/jisakos-2020-000438.

    Article  PubMed  Google Scholar 

  64. Strand V, McIntyre LF, Beach WR, Miller LE, Block JE. Safety and efficacy of US-approved viscosupplements for knee osteoarthritis a systematic review and meta-analysis of randomized saline-controlled trials. J Pain Res [Internet]. 2015;8:217–28. https://doi.org/10.2147/JPR.S83076.

    Article  PubMed  Google Scholar 

  65. Bannuru RR, Brodie CR, Sullivan MC, McAlindon TE. Safety of repeated injections of sodium hyaluronate (SUPARTZ) for knee osteoarthritis a systematic review and meta-analysis A systematic review and meta-analysis. Cartilage [Internet]. 2016;7(4):322–32. https://doi.org/10.1177/1947603516642271.

    Article  CAS  PubMed  Google Scholar 

  66. Honvo G, Reginster J-Y, Rannou F, Rygaert X, Geerinck A, Rabenda V, et al. Safety of intra-articular hyaluronic acid injections in osteoarthritis Outcomes of a systematic review and meta-analysis. Drugs Aging [Internet]. 2019;36(Suppl 1):101–27. https://doi.org/10.1007/s40266-019-00657-w.

    Article  CAS  PubMed  Google Scholar 

  67. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328(7444):869. https://doi.org/10.1136/bmj.38039.573970.7C.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Bellamy N, Campbell J, Robinson V, Gee T, Bourne R, Wells G. Intraarticular corticosteroid for treatment of osteoarthritis of the knee. Cochrane Database Syst Rev. 2006;(2):CD005328. doi: https://doi.org/10.1002/14651858.CD005328.pub2. Update in: Cochrane Database Syst Rev. 2015;10:CD005328

  69. Jüni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, da Costa BR. Intra-articular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015 2015(10):CD005328 https://doi.org/10.1002/14651858.CD005328.pub3.

  70. Concoff A, Sancheti P, Niazi F, Shaw P, Rosen J. The efficacy of multiple versus single hyaluronic acid injections: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2017;18(1):542. https://doi.org/10.1186/s12891-017-1897-2.PMID:29268731;PMCID:PMC5740709.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Nicholls M, Shaw P, Niazi F, Bhandari M, Bedi A. The impact of excluding patients with end-stage knee disease in intra-articular hyaluronic acid trials: a systematic review and meta-analysis. Adv Ther. 2019;36(1):147–61. https://doi.org/10.1007/s12325-018-0847-1.

    Article  CAS  PubMed  Google Scholar 

  72. Vincent P, Lucas de Couville T, Thomas T. Intra-articular hyaluronic acid for knee osteoarthritis: a postmarket, open-label, long-term historical control study with analysis detailed per Krellgren-Lawrence Radiologic Osteoarthritis Scale Grade. Curr Ther Res Clin Exp. 2020;92:100575 https://doi.org/10.1016/j.curtheres.2020.100575

  73. Kubo T, Kumai T, Ikegami H, Kano K, Nishii M, Seo T. Diclofenac-hyaluronate conjugate (diclofenac etalhyaluronate) intra-articular injection for hip, ankle, shoulder, and elbow osteoarthritis: a randomized controlled trial. BMC Musculoskelet Disord [Internet]. 2022;23(1):371. https://doi.org/10.1186/s12891-022-05328-3.

    Article  CAS  PubMed  Google Scholar 

  74. Zhu KY, Acuña AJ, Samuel LT, Grits D, Kamath AF. 2022 Hyaluronic acid injections for knee osteoarthritis: has utilization among medicare beneficiaries changed between 2012 and 2018? J Bone Joint Surg Am 104(10):e43 https://doi.org/10.2106/JBJS.21.00832

  75. Campbell KA, Erickson BJ, Saltzman BM, Mascarenhas R, Bach BR Jr, Cole BJ, et al. Is local viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: a systematic review of overlapping meta-analyses. Arthroscopy [Internet]. 2015;31(10):2036-45.e14. https://doi.org/10.1016/j.arthro.2015.03.030.

    Article  PubMed  Google Scholar 

  76. Kompel AJ, Roemer FW, Murakami AM, Diaz LE, Crema MD, Guermazi A. Intra-articular corticosteroid injections in the hip and knee: perhaps not as safe as we thought? Radiology [Internet]. 2019;293(3):656–63. https://doi.org/10.1148/radiol.2019190341.

    Article  PubMed  Google Scholar 

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Bowden, D.J., Eustace, S.J. & Kavanagh, E.C. The value of injectable viscoelastic supplements for joints. Skeletal Radiol 52, 933–940 (2023). https://doi.org/10.1007/s00256-022-04178-3

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