BACKGROUND: Viscosupplementation, the intra-articular injection of hyaluronicacid, is widely used for symptomatic knee osteoarthritis.PURPOSE: To assess the benefits and risks of viscosupplementation for adults withsymptomatic knee osteoarthritis.DATA SOURCES: MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), the Cochrane Central Register of Controlled Trials (1970 to January 2012), and other sources.STUDY SELECTION: Randomized trials in any language that comparedviscosupplementation with sham or nonintervention control in adults with kneeosteoarthritis.DATA EXTRACTION: Primary outcomes were pain intensity and flare-ups. Secondaryoutcomes included function and serious adverse events. Reviewers used duplicateabstractions, assessed study quality, pooled data by using a random-effectsmodel, examined funnel plots, and explored heterogeneity by usingmeta-regression.DATA SYNTHESIS: Eighty-nine trials involving 12 667 adults met inclusioncriteria. Sixty-eight had a sham control, 40 had a follow-up duration greaterthan 3 months, and 22 used cross-linked forms of hyaluronic acid. Overall, 71trials (9617 patients) showed that viscosupplementation moderately reduced pain(effect size, -0.37 [95% CI, -0.46 to -0.28]). There was important between-trial heterogeneity and an asymmetrical funnel plot: Trial size, blinded outcomeassessment, and publication status were associated with effect size. Fiveunpublished trials (1149 patients) showed an effect size of -0.03 (CI, -0.14 to0.09). Eighteen large trials with blinded outcome assessment (5094 patients)showed a clinically irrelevant effect size of -0.11 (CI, -0.18 to -0.04). Sixtrials (811 patients) showed that viscosupplementation increased, although notstatistically significantly, the risk for flare-ups (relative risk, 1.51 [CI,0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the risk for serious adverse events (relative risk, 1.41 [CI, 1.02 to1.97]).LIMITATIONS: Trial quality was generally low. Safety data were often notreported.CONCLUSION: In patients with knee osteoarthritis, viscosupplementation isassociated with a small and clinically irrelevant benefit and an increased riskfor serious adverse events.PRIMARY FUNDING SOURCE: Arco Foundation.
Viscosupplementation for osteoarthritis of the knee: a systematic review and meta-analysis
Rutjes A
;
2012-01-01
Abstract
BACKGROUND: Viscosupplementation, the intra-articular injection of hyaluronicacid, is widely used for symptomatic knee osteoarthritis.PURPOSE: To assess the benefits and risks of viscosupplementation for adults withsymptomatic knee osteoarthritis.DATA SOURCES: MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), the Cochrane Central Register of Controlled Trials (1970 to January 2012), and other sources.STUDY SELECTION: Randomized trials in any language that comparedviscosupplementation with sham or nonintervention control in adults with kneeosteoarthritis.DATA EXTRACTION: Primary outcomes were pain intensity and flare-ups. Secondaryoutcomes included function and serious adverse events. Reviewers used duplicateabstractions, assessed study quality, pooled data by using a random-effectsmodel, examined funnel plots, and explored heterogeneity by usingmeta-regression.DATA SYNTHESIS: Eighty-nine trials involving 12 667 adults met inclusioncriteria. Sixty-eight had a sham control, 40 had a follow-up duration greaterthan 3 months, and 22 used cross-linked forms of hyaluronic acid. Overall, 71trials (9617 patients) showed that viscosupplementation moderately reduced pain(effect size, -0.37 [95% CI, -0.46 to -0.28]). There was important between-trial heterogeneity and an asymmetrical funnel plot: Trial size, blinded outcomeassessment, and publication status were associated with effect size. Fiveunpublished trials (1149 patients) showed an effect size of -0.03 (CI, -0.14 to0.09). Eighteen large trials with blinded outcome assessment (5094 patients)showed a clinically irrelevant effect size of -0.11 (CI, -0.18 to -0.04). Sixtrials (811 patients) showed that viscosupplementation increased, although notstatistically significantly, the risk for flare-ups (relative risk, 1.51 [CI,0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the risk for serious adverse events (relative risk, 1.41 [CI, 1.02 to1.97]).LIMITATIONS: Trial quality was generally low. Safety data were often notreported.CONCLUSION: In patients with knee osteoarthritis, viscosupplementation isassociated with a small and clinically irrelevant benefit and an increased riskfor serious adverse events.PRIMARY FUNDING SOURCE: Arco Foundation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
