Viscosupplementation in Degenerative Joint Disease: Current Evidence, Indications, and Clinical Outcomes

Intra-articular hyaluronic acid (IA-HA), or viscosupplementation, remains a subject of ongoing debate in the non-surgical management of knee osteoarthritis. Despite conflicting clinical guidelines, its use continues to grow due to a favorable safety profile and its role in addressing the “treatment gap” for patients with Kellgren-Lawrence grades II and III. This structured narrative review identifies and synthesizes evidence from PubMed, Scopus, and recent clinical guidelines (2006-2026) to explore the physiological role of IA-HA, emphasizing its rheological properties and the dual mechanism of viscosupplementation and viscoinduction. We evaluate current clinical evidence, acknowledging the inherent heterogeneity of reported outcomes while discussing the potential for symptomatic relief that may, in selected populations, extend beyond the traditional six-month window. Furthermore, this work addresses the social and economic relevance of IA-HA, specifically its opioid-sparing benefits amidst the global opioid crisis and its potential to delay total knee arthroplasty (TKA). By refining patient selection and understanding the impact of molecular weight and combination therapies, clinicians can optimize outcomes. This review provides an evidence-based framework for integrating IA-HA into a multimodal joint preservation strategy to improve quality of life and reduce the global burden of degenerative joint disease.