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Osteoarthritis
Extended report
Hyaluronan for knee osteoarthritis: an updated meta-analysis of trials with low risk of bias
  1. Pascal Richette1,2,
  2. Xavier Chevalier3,
  3. Hang Korng Ea1,2,
  4. Florent Eymard3,
  5. Yves Henrotin4,
  6. Paul Ornetti5,
  7. Jérémie Sellam6,
  8. Michel Cucherat7 and
  9. Marc Marty3
  10. On behalf of the French OsteoArthritis study group
  1. 1Université Paris Diderot, UFR Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisière, Fédération de Rhumatologie, Paris, France
  2. 2Inserm U1132, Hôpital Lariboisière, Paris, France
  3. 3Department of Rheumatology, Henri Mondor Hospital, Creteil, France
  4. 4Cartilage Bone and Cartilage Research Unit, Arthropôle Liège, University of Liège, Institute of Pathology, Liège, Belgium
  5. 5INSERM U1093, Plateforme d'Investigation Technologique, CHU Dijon, Université de Bourgogne, Dijon, France
  6. 6Rheumatology Department, Assistance Publique—Hôpitaux de Paris (AP-HP), DHU i2B, Inserm UMRS_938, UPMC Univ Paris 06, Paris, France
  7. 7UMR 5558; CNRS, 69622 Villeurbanne Cedex, Lyon, France
  1. Correspondence to Professor Pascal Richette; pascal.richette{at}lrb.aphp.fr

Abstract

Background The effectiveness of intra-articular hyaluronic acid (IAHA) injection for knee osteoarthritis (KOA) is debated.

Objectives To evaluate the effect of IAHA for patients with KOA by analysing data from trials of IAHA versus placebo with low risk of bias, to provide the highest level of evidence.

Methods A systematic review and meta-analysis was conducted. Randomised controlled trials (RCTs) with a low risk of bias (adequate randomisation and concealment and double-blind design) that investigated IAHA versus placebo (saline solution) injection were eligible. The primary efficacy measure was pain intensity and secondary outcome function at 3 months. The treatment effect was summarised with the standardised mean difference (SMD) calculated from differences in means of pain and function measures between treatment and control groups at 3 months. Trials were pooled by a random-effects model with DerSimonian and Laird weights. Statistical heterogeneity was explored by a visual exploration of forest plots and the I2 statistic.

Results A total of eight RCTs (2 199 randomised patients) met our inclusion criteria. IAHA significantly reduced the pain intensity (SMD=−0.21, 95% CI (95% CI) −0.32 to −0.10) and improved function (SMD=−0.12, 95% CI −0.22 to −0.02). Trials showed no heterogeneity.

Conclusions This meta-analysis of high-quality trials of IAHA versus placebo shows that IAHA provides a moderate but real benefit for patients with KOA.

  • Osteoarthritis
  • Outcomes research
  • Treatment

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2015-000071

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