Ann Rheum Dis 69:113-119 doi:10.1136/ard.2008.094623
  • Clinical and epidemiological research
  • Extended report

Single, intra-articular treatment with 6 ml hylan G-F 20 in patients with symptomatic primary osteoarthritis of the knee: a randomised, multicentre, double-blind, placebo controlled trial

Open Access
  1. X Chevalier1,
  2. J Jerosch2,
  3. P Goupille3,
  4. N van Dijk4,
  5. F P Luyten5,
  6. D L Scott6,
  7. F Bailleul7,
  8. K Pavelka8
  1. 1
    Hôpital Henri Mondor, Créteil, France
  2. 2
    Klinik für Orthopädie, Neuss, Germany
  3. 3
    University Hospital, INSERM CIC-202, Tours, France
  4. 4
    AMC/UVA, Amsterdam, The Netherlands
  5. 5
    Universitair Ziekenhuis Gasthuisberg, Leuven, Belgium
  6. 6
    Kings College Hospital, London, UK
  7. 7
    Genzyme Biosurgery, Clinical Research Europe, St Germain en Laye, France
  8. 8
    Institute of Rheumatology, Prague, Czech Republic
  1. Correspondence to Professor X Chevalier, Department of Rheumatology, Henri Mondor Hospital, University Paris XII, Bd de Lattre de Tassigny, 94010 Créteil, France; Xavier.Chevalier{at}
  • Accepted 1 March 2009
  • Published Online First 19 March 2009


Objectives: The primary objective was to compare a single, 6 ml, intra-articular injection of hylan G-F 20 with placebo in patients with symptomatic knee osteoarthritis. The safety of a repeat injection of hylan G-F 20 was also assessed.

Methods: Patients with primary osteoarthritis knee pain were randomly assigned to arthrocentesis plus a 6 ml intra-articular injection of either hylan G-F 20 or placebo in a prospective, double-blind (one injector/one blinded observer) study. Results were evaluated at 4, 8, 12, 18 and 26 weeks post-injection. The primary outcome criterion was change from baseline over 26 weeks in Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index A pain. Secondary outcome measures included WOMAC A1 and C, patient global assessment (PGA) and clinical observer global assessment (COGA) and Outcome Measures in Rheumatology, Osteoarthritis Research Society International responder rates. A 4-week, open, repeat treatment phase evaluated safety only.

Results: A total of 253 patients (Kellgren–Lawrence grade II or III) was randomly assigned. Patients receiving hylan G-F 20 experienced statistically significantly greater improvements in WOMAC A pain scores (−0.15, SE 0.076, p = 0.047), and several of the secondary outcome measures (WOMAC A1, PGA and COGA), than patients receiving placebo. There was no difference between the safety results of the two groups. No increased risk of local adverse events was observed in the open, repeat treatment phase.

Conclusions: This placebo-controlled study demonstrated that, in patients with knee osteoarthritis, a single 6 ml intra-articular injection of hylan G-F 20 is safe and effective in providing statistically significant, clinically relevant pain relief over 26 weeks, with a modest difference versus placebo.

Trial registration number: NCT00131352.


  • ▸ Additional supplemental material 1 and 2 is published online only at

  • Funding This manuscript is based upon clinical trial results from a study sponsored by Genzyme Biosurgery.

  • Competing interests Declared. XC, JJ and PG have been reimbursed by Genzyme Biosurgery, the manufacturer of hylan G-F 20, for attending symposia and have also received speaker fees. JJ has received research funds from Genzyme Biosurgery. FB is an employee of Genzyme Biosurgery working in the Clinical Research and Medical Affairs Departments. NvD, FPL, DLS and KP have no conflicts of interest. All authors actively participated in the conduct of this trial and in its analysis and interpretation.

  • Ethics approval Ethics committee approvals were obtained.

  • Patient consent Obtained.

  • Provenance and Peer review Not commissioned; externally peer reviewed.