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Review
. 2023 Apr 4:39:18-29.
doi: 10.1016/j.jor.2023.03.015. eCollection 2023 May.

Funding has no effect on studies evaluating viscosupplementation for knee osteoarthritis: A systematic review of bibliometrics and conflicts of interest

Garrhett Glenn Via  1 , David Anthony Brueggeman  1 , Joseph Gabriel Lyons  1 , Timothy Charles Frommeyer  1 , Andrew William Froehle  1 , Anil Bangalore Krishnamurthy  1
Affiliations
Review

Funding has no effect on studies evaluating viscosupplementation for knee osteoarthritis: A systematic review of bibliometrics and conflicts of interest

Garrhett Glenn Via et al. J Orthop. .

Abstract

Background: Viscosupplementation for knee osteoarthritis (OA) may raise concerns regarding conflicts of interest (COI). Evidence of inconclusive study results and publication bias in previous studies has led to concern that financial COI have influenced viscosupplementation outcomes. It is critical to ensure that clinical practice is guided by informed decision making and evidence-based medicine.

Methods: A systematic review was conducted following PRISMA guidelines. PubMed, MEDLINE, and Web of Science databases were searched for articles pertaining to hyaluronic acid (or similarly derived) injections to native knees with primary OA only. Bibliometric data, financial COI, and study outcomes were assessed.

Results: 67 studies met inclusion criteria for analysis, 53 of which (79.1%) presented Level I evidence, and 21 of which (31.3%) reported at least one author with COI. All studies reporting COI also disclosed industry funding. There were no relationships between reported COI and study outcomes (Χ 2 = 0.31, P = 0.577), levels of evidence (Χ 2 = 3.48, P = 0.176), or relative citation ratio (RCR) (S = 743, P = 0.591). Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors (IF) (reporting COI: IF = 3.5 ± 2.0; no COI: IF = 1.8 ± 1.1; S = 950, P < 0.001). Study outcomes were not related to the probability of being published in an open access journal (Χ 2 = 0.01, P = 0.960), nor to level of evidence (Χ 2 = 2.67, P = 0.263), RCR (S = 618, P = 0.835), or IF (S = 563, P = 0.655).

Conclusions: Investigator COIs (and commercial funding of studies) have not significantly influenced the frequency of favorable outcomes or study level of evidence regarding contemporary viscosupplementation for the treatment of knee OA. Studies reporting COIs/industry funding tended to be published in journals with significantly higher impact factors. Results overwhelmingly supported using viscosupplementation to treat knee OA.

Level of evidence: Level V Systematic Review.

Keywords: Conflict of interest; Funding; Hyaluronic acid; Knee osteoarthritis; Viscosupplementation.

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Conflict of interest statement

The authors have no relevant financial or non-financial interests to declare.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for viscosupplementation in primary knee OA.
See this image and copyright information in PMC

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