Overview

• Hyaluronic acid injections for knee and hip osteoarthritis were rated a negative self‑pay service, with the Medizinischer Dienst saying they offer no meaningful benefit and may cause harm.
• The review analyzed 25 methodologically convincing knee studies with 9,423 patients and five hip studies with 591 patients, finding no effect for hips and only a clinically negligible effect for knees versus placebo.
• Reported adverse events range from swelling and temporary pain to serious complications such as joint inflammation and heart problems.
• Patients typically pay €220–€300 per treatment cycle, sometimes €500 or more, within an IGeL market where statutory insured people spend at least €2.4 billion annually, including about €397 million in orthopedics.
• Across 60 IGeL services assessed since 2012, 31 were judged negative, 26 unclear due to insufficient evidence, and only three tended positive, prompting calls to ban same‑day sales and require impartial in‑practice information.