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Review
. 2011 Jun;19(6):611-9.
doi: 10.1016/j.joca.2010.09.014. Epub 2011 Apr 9.

Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis

R R Bannuru  1 , N S Natov, U R Dasi, C H Schmid, T E McAlindon
Affiliations
Review

Therapeutic trajectory following intra-articular hyaluronic acid injection in knee osteoarthritis--meta-analysis

R R Bannuru et al. Osteoarthritis Cartilage. 2011 Jun.

Abstract

Objective: To evaluate the therapeutic trajectory of intra-articular hyaluronic acid (IAHA) vs placebo for knee osteoarthritis (OA).

Design: Our data sources include Medline, EMBASE, CINAHL, BIOSIS, Web of Science, Google Scholar, Cochrane database; hand searched reviews, manuscripts, and, supplements; author contacts for unpublished data. Randomized trials that reported effects of IAHA vs placebo on knee OA were selected based on inclusion criteria. We computed effect sizes for change from baseline at 4, 8, 12, 16, 20 and 24 weeks, using Bayesian random effects model. We performed multivariate analyses adjusting for correlation between time points. Meta-regressions were performed adjusting for potential confounders.

Results: The 54 eligible trials included 7545 participants. The conduct and quality of these trials varied in number of aspects. The effect size (ES) favored IAHA by week 4 (0.31; 95% CI 0.17, 0.45), reaching peak at week 8 (0.46; 0.28, 0.65), and then trending downwards, with a residual detectable effect at week 24 (0.21; 0.10, 0.31). This therapeutic trajectory was consistent among the subset of high quality trials and on multivariate analysis adjusting for correlation between time points.

Conclusions: Our meta-analysis highlights a therapeutic trajectory of IAHA for knee OA pain over 6 months post-intervention. With this additional perspective, we are able to infer that IAHA is efficacious by 4 weeks, reaches its peak effectiveness at 8 weeks and exerts a residual detectable at 24 weeks. On the other hand, the peak effect size (0.46; 0.28, 0.65), is greater than published effects from other OA analgesics [acetaminophen (ES=0.13; 0.04, 0.22); NSAIDs (ES=0.29; 0.22, 0.35); COX-2 inhibitors (ES=0.44; 0.33, 0.55)]. An effect size above 0.20 is considered to be clinically relevant on an individual patient basis in chronic pain conditions such as knee OA. Thus, its properties could have utility for certain clinical situations, or in combination with other therapies.

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Conflict of interest statement

Conflict of interest

Bannuru RR; Natov NS; Dasi UR; Schmid CH: None

McAlindon TE: received consulting fees from Stryker Biotech, NiCox, Gelita and GlaxoSmithKline and currently has grant funding from the National Institutes of Health.

Figures

Fig. 1.
Fig. 1.
Study flow chart.
Fig. 2.
Fig. 2.
Graph depicting the effect sizes (95% CI) for pain.
See this image and copyright information in PMC

References

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