Abstract
PurposeThere are a number of developments in intra-articular therapies that have been determined to be differentiating factors within the classes of treatments. This study evaluated the efficacy and safety of intra-articular treatments of primary knee osteoarthritis in the short term (3 months follow-up), using a network meta-analysis design, while taking within-class differentiating factors into consideration.MethodsA literature search of MEDLINE (through OVID), EMBASE (through OVID), Cochrane Central Register of Controlled Trials for all trials comparing intra-articular therapies was conducted on November 12, 2018. The treatments assessed were high molecular weight and low molecular weight hyaluronic acid injections, extended-release corticosteroids, standard-release corticosteroids, platelet-rich plasma, and saline. A frequentist network meta-analysis was conducted for each outcome.ResultsSixty-four articles (9710 patients) met the inclusion criteria. High molecular weight hyaluronic acid (− 0.53, 95% CI − 0.81 to − 0.25) and PRP (− 0.79, 95% CI − 1.32 to − 0.26) were the only treatments with a confidence interval that lay completely above the MID threshold; however, PRP results varied within sensitivity analyses. For the function analysis, high molecular weight hyaluronic acid (SMD − 0.76, 95% CI − 1.30 to − 0.22) was the only treatment with a confidence interval entirely above the MID. Extended-release corticosteroid demonstrated a possible benefit in functional improvement (SMD − 0.98, 95% CI − 1.79 to − 0.17) compared to that of standard-release corticosteroid (SMD − 0.14, 95% CI − 0.72 to 0.44).ConclusionHigh molecular weight HA was the only treatment to surpass the MID for both pain and function outcomes. Extended-release corticosteroids may provide additional clinical benefit over standard-release corticosteroids. Platelet-rich plasma demonstrated possibly beneficial results; however, wide confidence intervals and sensitivity analyses made the conclusions of efficacy uncertain.Level of evidenceLevel 1. Systematic review of level 1 evidence.
Highlights
Knee osteoarthritis (OA) is a common disease associated with progressive deterioration of the cartilage and narrowing of the joint space
Studies were included if: (1) one or more of the following IA-treatments are evaluated: corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP); (2) comparator was a placebo control or another eligible intervention; (3) primary or secondary outcome was pain measured at 3 ± 1 months, function measured at 3 ± 1 months, or treatment-related adverse effects; (4) the study was in English; (5) the study included only adults
The Cochrane Risk of Bias assessment demonstrated that allocation sequence generation and allocation concealment were the most frequent categories in which studies may be at risk of bias, while blinding was typically adequate within many of the included studies
Summary
Knee osteoarthritis (OA) is a common disease associated with progressive deterioration of the cartilage and narrowing of the joint space. A large proportion of knee OA patients reside in the mild-to-moderate stages of knee OA, where non-surgical intervention is needed to provide pain relief and limit functional impairment [13]. Many randomized clinical trials (RCTs) and meta-analyses have been published comparing various knee OA treatments to determine the effectiveness and safety of these interventions [6]. PRP has shown evidence of effectiveness and safety in a small number of studies, yet previous meta-analyses have demonstrated large amounts of imprecision regarding the estimates of PRP’s true effects [15]. Recent evidence exploring differentiating factors within classes of therapies has demonstrated improved efficacy by molecular weight (MW), and delivery mechanisms, such as microsphere technology [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
