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AMSSM Scientific Statement Concerning Viscosupplementation Injections for Knee Osteoarthritis: Importance for
Thomas H Trojian1, Andrew L Concoff, Susan M Joy
1*Division of Sports Medicine, Department of Family, Community and Preventive Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania; †Outpatient Musculoskeletal Rehabilitation, St Jude Medical Center, Fullerton, California; ‡Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; §Maine Medical Center Sports Medicine, Portland, Maine; ¶Hartford Hospital Evidence-Based Practice Center, UCONN School of Pharmacy; and ‖Hartford Hospital Evidence-Based Practice Center, Hartford, Connecticut.
Objective:
Osteoarthritis (OA) is a disabling disease that produces severe morbidity reducing physical activity. Our position statement on treatment of knee OA with viscosupplementation injection [hyaluronic acid (HA)] versus steroid [intra-articular corticosteroid (IAS)] and placebo [intra-articular placebo (IAP)] is based on the evaluation of treatment effect by examining the number of subjects within a treatment arm that met the Outcome Measures in Rheumatoid Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) criteria, which is different and more relevant than methods used in other reviews which examined if the average change across the treatment groups was clinically different.
Data Sources:
We performed a systematic literature search for all relevant articles from 1960 to August 2014 in the MEDLINE, EMBASE, and Cochrane CENTRAL. We performed a network meta-analysis (NMA) of the relevant literature to determine if there is a benefit from HA as compared with IAS and IAP.
Main Results:
Eleven articles met the inclusion criteria from the search strategy. On NMA, those subjects receiving HA were 15% and 11% more likely to respond to treatment by the OMERACT-OARSI criteria than those receiving IAS or IAP, respectively (P < 0.05 for both).
Conclusions:
In light of the aforementioned results of our NMA, the American Medical Society for Sport Medicine recommends the use of HA for the appropriate patients with knee OA.
