Viscosupplementation Deemed Ineffective for Treating Knee OA
(HealthDay News) – Viscosupplementation for osteoarthritis of the knee results in minimal reduction in pain scores while potentially increasing the risk for flare-ups and serious adverse events, according to research published online June 11 in the Annals of Internal Medicine.
Anne WS Rutjes, PhD, of the University of Bern in Switzerland, and colleagues conducted a systematic review and meta-analysis of 89 randomized trials involving 12,667 patients with osteoarthritis of the knee who received either viscosupplementation or a sham injection or served as a nonintervention control patient. Pain intensity and flare-ups were the primary outcomes; function and serious adverse events were secondary outcomes.
Of the studies included in the review, 40 had a follow-up of three months or longer and 22 used cross-linked forms of hyaluronic acid. A total of 71 trials showed a moderate reduction in pain scores; however, the effect size was associated with trial size, blinded outcome assessment, and publication status. The remaining trials demonstrated a clinically irrelevant effect size. Furthermore, six trials found that viscosupplementation increased the risk for flare-ups (relative risk [RR], 1.51; 95% confidence interval [CI], 0.84–2.72) and 14 trials showed a significantly increased risk for serious adverse events (RR, 1.41; 95% CI, 1.02–1.97).
"We conclude that the benefit of viscosupplementation on pain and function in patients with symptomatic osteoarthritis of the knee is minimal or nonexistent," the authors write. "Because of increased risks for serious adverse events and local adverse events, the administration of these preparations should be discouraged."
One author disclosed board membership related to trials funded by Abbott Vascular, Biosensors, Medtronic, and St. Jude Medical.