Abstract
BackgroundKnee osteoarthritis is a common cause of musculoskeletal pain and a leading cause of disability and healthcare economic burden. The optimum treatment for knee osteoarthritis is still inconclusive. A network meta-analysis is required to assess the efficacy and safety of treatments and provide more scientific medical evidence.MethodsRelevant studies were searched through PubMed, Embase, and Cochrane Library electronic databases from the inception to October 2018. Continuous outcomes such as pain, stiffness, physical function and total scores were expressed as the mean differences with 95% credible interval. Surface under the cumulative ranking curve illustrated the rank probability of each therapy under different outcomes.ResultsNineteen studies were included in this study, with a total of 2395 patients. For knee pain, platelet-rich plasma (0.691) was ranked at the first place, followed by hyaluronic acid combined with platelet-rich plasma (0.670) and hyaluronic acid (0.402). In terms of stiffness, hyaluronic acid combined with platelet-rich plasma (0.743) enjoyed the highest value, platelet-rich plasma (0.603) was the next and hyaluronic acid (0.386) was the third. As for physical function, the rank was hyaluronic acid combined with platelet-rich plasma (0.772), platelet-rich plasma (0.608) and hyaluronic acid (0.343). For total scores, the order given by surface under the cumulative ranking was hyaluronic acid combined with platelet-rich plasma (0.765), platelet-rich plasma (0.624) and hyaluronic acid (0.37).ConclusionsHyaluronic acid combined with platelet-rich plasma showed the best efficacy in improving stiffness, physical function, and total scores, while platelet-rich plasma appeared the best in terms of pain reduction.
Highlights
Knee osteoarthritis is a common cause of musculoskeletal pain and a leading cause of disability and healthcare economic burden
We performed the first network meta-analysis (NMA) to evaluate the efficacy and safety of five different treatments for patients with OA, including corticosteroid, hyaluronic acid (HA), platelet-rich plasma (PRP), placebo and HA + PRP, in regard to their performance on pain, stiffness, physical function or total assessed with quantitative scores by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), in order to provide optimal treatments for knee OA patients
These following search terms and their corresponding synonyms were applied for systematic searching: “knee osteoarthritis”, “platelet-rich plasma”, “hyaluronic acid”, “corticosteroid”, “placebo”, and “randomized controlled trial”
Summary
Knee osteoarthritis is a common cause of musculoskeletal pain and a leading cause of disability and healthcare economic burden. Knee osteoarthritis (OA) is a degenerative disease with clinical manifestations, including joint pain, tenderness, joint swelling restricted movement as well as joint deformities and a leading cause of disability and healthcare economic burden [1, 2]. Li et al Eur J Med Res (2020) 25:27 of intra-articular corticosteroid injection are well recognized, while the long-term benefits and the value of repetitive injections are still debatable [11, 12]. Since the elasticity and viscosity of synovial fluid are directly proportional to HA content and integrity, intra-articular injection of HA is a rational approach to the treatment of OA [14]. Beneficial effects on pain, function and patient global assessment have been documented, the real entity of improvement and which of the many available HA products can offer the best results is not clear [16]
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