Differentiating factors of intra-articular injectables have a meaningful impact on knee osteoarthritis outcomes: a netwo
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Differentiating factors of intra‑articular injectables have a meaningful impact on knee osteoarthritis outcomes: a network meta‑analysis Mark Phillips1,2 · Christopher Vannabouathong3 · Tahira Devji1 · Rahil Patel4 · Zoya Gomes4 · Ashaka Patel4 · Mykaelah Dixon4 · Mohit Bhandari1,2 Received: 29 May 2019 / Accepted: 17 October 2019 © The Author(s) 2020
Abstract Purpose There are a number of developments in intra-articular therapies that have been determined to be differentiating factors within the classes of treatments. This study evaluated the efficacy and safety of intra-articular treatments of primary knee osteoarthritis in the short term (3 months follow-up), using a network meta-analysis design, while taking within-class differentiating factors into consideration. Methods A literature search of MEDLINE (through OVID), EMBASE (through OVID), Cochrane Central Register of Controlled Trials for all trials comparing intra-articular therapies was conducted on November 12, 2018. The treatments assessed were high molecular weight and low molecular weight hyaluronic acid injections, extended-release corticosteroids, standard-release corticosteroids, platelet-rich plasma, and saline. A frequentist network meta-analysis was conducted for each outcome. Results Sixty-four articles (9710 patients) met the inclusion criteria. High molecular weight hyaluronic acid (− 0.53, 95% CI − 0.81 to − 0.25) and PRP (− 0.79, 95% CI − 1.32 to − 0.26) were the only treatments with a confidence interval that lay completely above the MID threshold; however, PRP results varied within sensitivity analyses. For the function analysis, high molecular weight hyaluronic acid (SMD − 0.76, 95% CI − 1.30 to − 0.22) was the only treatment with a confidence interval entirely above the MID. Extended-release corticosteroid demonstrated a possible benefit in functional improvement (SMD − 0.98, 95% CI − 1.79 to − 0.17) compared to that of standard-release corticosteroid (SMD − 0.14, 95% CI − 0.72 to 0.44). Conclusion High molecular weight HA was the only treatment to surpass the MID for both pain and function outcomes. Extended-release corticosteroids may provide additional clinical benefit over standard-release corticosteroids. Platelet-rich plasma demonstrated possibly beneficial results; however, wide confidence intervals and sensitivity analyses made the conclusions of efficacy uncertain. Level of evidence Level 1. Systematic review of level 1 evidence.
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00167-019-05763-1) contains supplementary material, which is available to authorized users. * Mark Phillips [email protected] 1
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
2
Division of Orthopaedic Surgery, Centre for Evidence‑Based Orthopaedics, McMaster University, Hamilton, ON, Canada
3
OrthoEvidence Inc., Burlington, ON, Canada
4
Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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