The Effects of Hyaluronic Acid on Gait Parameters in Patients with Knee Osteoarthritis: A Systematic Literature Review

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and in this context, gait analysis could provide an objective assessment of walking patterns to identify any deficits. This systematic review investigates the short and long-term effects of intra-articular HA injections on gait kinematics, pain and activities of daily living (ADL), investigating the correlation between outcomes. Materials and Methods: The review followed PRISMA guidelines. The PICO model included patients with radiographic knee osteoarthritis who received intra-articular HA injections, comparing them to healthy controls or those receiving corticosteroids or placebo. Outcomes included gait kinetics and functional scales at baseline and during follow-ups. Results: From 342 identified articles, 13 were included, comprising a total of 321 patients. The gait analysis utilized optoelectronic systems, inertial sensors, and electromyographic sensors pre- and post-HA treatment. Clinical parameters were assessed using the Visual Analogue Scale, WOMAC OA, Knee Society Score, Lequesne Score, and SF-36. The data showed significant improvement in speed (p = 0.001) and step cadence (p < 0.005) 30 days post-treatment and improvements in knee adduction moment (p < 0.001) and sagittal ground reaction force vectors (p < 0.01) up to six months post-treatment. Pain reduction and improvements in VAS (p < 0.001) and Lequesne score (p < 0.001) were observed in short-term follow-ups. Conclusions: Our study suggests an improvement in pain and knee function after hyaluronic acid injection. Moreover, gait analysis is an important tool for objectively assessing deficits and developing personalized rehabilitation programs. Furthermore, combining infiltrative treatment with rehabilitation could extend the effects of hyaluronic acid and improve results.