December 29, 2015
Hyaluronic Acid Injections for Knee Osteoarthritis?
Allan S. Brett, MD reviewing Jevsevar D et al. J Bone Joint Surg Am 2015 Dec 16.A meta-analysis suggests that this commonly used intervention is largely ineffective.Patients with knee osteoarthritis often are treated with viscosupplementation (intra-articular injections of hyaluronic acid [HA]). HA injections are expensive, and their efficacy is controversial. In this meta-analysis, researchers identified randomized trials of viscosupplementation that had at least 4 weeks of follow-up and at least 30 patients per treatment group; trials were included if either the WOMAC osteoarthritis index or a visual analog pain scale was used to assess outcomes. The minimum important differences for pain and function are 8 points on the 100-point WOMAC scale, and 20 mm on a 100-mm visual analog scale.
Nineteen trials met inclusion criteria. In double-blind, sham-controlled trials, HA reduced mean pain scores and function scores significantly, compared with placebo, but the treatment effects were only 29% of the minimum important difference for pain, and only 48% of the minimum important difference for function. In contrast, in nonblinded trials that compared HA with usual care, the treatment effect exceeded the minimum important differences for both pain and function.
Comment
This meta-analysis strongly suggests that a placebo effect is largely responsible for the purported benefit of HA injections for knee osteoarthritis, because clinically important improvement was not observed in double-blind trials. Several of the authors of this analysis are employed by the American Academy of Orthopaedic Surgeons (AAOS), whose 2013 AAOS guideline on knee osteoarthritis recommends against the use of HA injections (J Am Acad Orthop Surg 2013; 21:571).
Editor Disclosures at Time of Publication
Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose
Citation(s):
Jevsevar D et al.
Viscosupplementation for osteoarthritis of the knee: A systematic review of the evidence. J Bone Joint Surg Am 2015 Dec 16; 97:2047. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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