A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective
- PMID: 34485586
- PMCID: PMC8414628
- DOI: 10.1177/23259671211030272
A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective
Abstract
Background: There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management.
Purpose: To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP).
Study design: Systematic review.
Methods: A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time.
Results: The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use.
Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.
Keywords: corticosteroids; hyaluronic acid; injectables; knee; osteoarthritis; platelet-rich plasma.
© The Author(s) 2021.
Conflict of interest statement
One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by a grant from the HA Viscosupplement Coalition. The authors solely hold the right to access and analyze study data and publish this paper without influence from the funder. Global Research Solutions Inc provided medical writing support. M.P. is an employee of Global Research Solutions. M.B. has received grants from Acumed, Bioventus, DJO, Flexion Therapeutics, Sanofi Aventis, Stryker, and Titan Spine and personal fees from AgNovos Healthcare and Pendopharm. J.G. has received research support from JRF Ortho, Arthrex, and Aesculap Biologics; education payments from Pinnacle; consulting fees from JRF Ortho and Ossur; speaking fees from JRF Ortho, ConMed Linvatec, and Vericel; honoraria from JRF Ortho; and hospitality payments from Smith & Nephew. A.B. has received consulting fees from Arthrex and Flexion Therapeutics; speaking fees from Arthrex and Synthes; royalties from Arthrex and Smith & Nephew; and hospitality payments from GE Healthcare. E.S. has received consulting fees from Sanofi Aventis. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
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