Purpose
To conduct a systematic review of overlapping meta-analyses comparing treatment of
knee osteoarthritis (OA) with intra-articular viscosupplementation (intra-articular
hyaluronic acid [IA-HA]) versus oral nonsteroidal anti-inflammatory drugs (NSAIDs),
intra-articular corticosteroids (IA-corticosteroids), intra-articular platelet-rich
plasma (IA-PRP), or intra-articular placebo (IA-placebo) to determine which meta-analyses
provide the best current evidence and identify potential causes of discordance.
Methods
Literature searches were performed for meta-analyses examining use of IA-HA versus
NSAIDs, IA-corticosteroids, IA-PRP, or IA-placebo. Clinical data were extracted, and
meta-analysis quality was assessed. The Jadad algorithm was applied to determine which
meta-analyses provided the highest level of evidence.
Results
Fourteen meta-analyses met the eligibility criteria and ranged in quality from Level
I to IV evidence. In studies reporting patient numbers, there were a total of 20,049
patients: 13,698 receiving IA-HA, 355 receiving NSAIDs, 294 receiving IA-corticosteroids,
and 5,702 receiving IA-placebo. Ten studies examined the effects of IA-HA versus IA-placebo;
of these, 5 found that IA-HA improved pain and 4 found that IA-HA improved function.
No clinically relevant differences in the efficacy of IA-HA versus NSAIDs regarding
pain and function were found. Regarding IA-HA versus IA-PRP, IA-HA improved knee function
at 2 and 6 months after injection but the effects were less robust than those of IA-PRP.
Regarding IA-HA versus IA-corticosteroids, the positive effects of IA-HA were greater
at 5 to 13 weeks and persisted for up to 26 weeks. After application of the Jadad
algorithm, 2 concordant high-quality meta-analyses were selected and both showed that
IA-HA provided clinically relevant improvements in pain and function compared with
IA-placebo.
Conclusions
This systematic review of overlapping meta-analyses comparing IA-HA with other nonoperative
treatment modalities for knee OA shows that the current highest level of evidence
suggests that IA-HA is a viable option for knee OA. Its use results in improvements
in knee pain and function that can persist for up to 26 weeks. IA-HA has a good safety
profile, and its use should be considered in patients with early knee OA.
Level of Evidence
Level IV, systematic review of Level I to IV studies.
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Article info
Publication history
Published online: May 18, 2015
Accepted:
March 19,
2015
Received:
December 10,
2014
Footnotes
See commentary on page 2046
The authors report the following potential conflict of interest or source of funding: B.R.B. receives support from Arthrex, Ossur, Linvatec, and Smith & Nephew. B.J.C. receives support from Arthrex, DJ Orthopaedics, Johnson & Johnson, Regentis, Zimmer, and Smith & Nephew. N.N.V. receives support from Minivasive, Smith & Nephew, Arthrosurface, Omeros, Arthrex, Athletico, ConMed Linvatec, Miomed, and Mitek.
Identification
Copyright
© 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
