What is the evidence for viscosupplementation injection in treating osteoarthritis of the knee?
AMSTAR Rating
Summary
Patient Population:
Average age of trial participants: 50-72 years (mean=63). Proportion of female participants ranged from 27-100%. There were 71 studies identified for inclusion in the analysis of the primary outcome (pain). 6 trials were unpublished.
Intervention:
Injection of hyaluronic acid was used in osteoarthritic knees. Cross-linked preparations were assessed in 18 trials, non-cross-linked in 67. Low molecular weight was evaluated in 43% of trials, moderate in 19% and high in 19%. 5 trials examined several different weights.
Comparison:
Viscosupplementation injection was compared to sham and/or placebo trials. No trials compared different viscosupplementation injections against one another, or different quantities/injection numbers against one another.
Outcome:
- Pain: viscosupplementation vs. placebo – non-significant difference in favour of injection (ES=-0.37; 95% CI 0.46 to -0.28) with a moderate degree of heterogeneity (and an asymmetrical funnel plot).
- Function: viscosupplementation vs. placebo – non-significant difference in favour of injection (ES=-0.33; 95% CI -0.43,-0.22).
- Safety: 6 trials reported outcomes of flare-ups that could contribute to pooled analysis. Treatment was associated with increased but non-significant risk for the outcome of flare-ups (RR=1.51, 95% CI 0.84, 2.72).
Guideline Recommendations
| Source | Recommendation |
|---|---|
| AAOS | Strong recommendation against |
| NICE | Not recommended |
| ACR (2019) | Conditionally Against |
Outcomes Assessed
- Benefit
- Harm
- Inconclusive
Viscosupplementation vs. Placebo
Pain
Function
Safety
