Meta-analysis of Viscosupplementation for Knee Osteoarthritis Reveals Little Benefit

In the study outlined below, handling alongside viscosupplementation (typically diverse forms of hyaluronic acid) was studied inward over 12,500 patients.  This is an injection therapy used inward patients alongside articulatio genus osteoarthritis.  It is commonly reserved for patients that neglect other forms of treatment.  Here is the determination of this study of studies:  "In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events."

Clearly, the information shows this handling does non render transformative value.  We withdraw ameliorate options for patients alongside mild to moderate articulatio genus osteoarthritis.  Biologic therapies such every bit platelet rich plasma and autologous stalk cells are evolving only nonetheless withdraw significantly ameliorate studies to endure used for articulatio genus osteoarthritis widely.  

It is oft NOT discussed only patients alongside articulatio genus osteoarthritis tin hand the axe oft create goodness from weight reduction as well as leg strengthening via an practice wheel program.  Perhaps nosotros should focus on these patient driven solutions first.

AM

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Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review as well as Meta-analysis 

Anne W.S. Rutjes, PhD; Peter Jüni, MD; Bruno R. da Costa, MSc; Sven Trelle, MD; Eveline Nüesch, PhD; as well as Stephan Reichenbach, MD, MScBackground: Viscosupplementation, the intra-articular injection of hyaluronic acid, is widely used for symptomatic articulatio genus osteoarthritis.

Purpose: To assess the benefits as well as risks of viscosupplementation for adults alongside symptomatic articulatio genus osteoarthritis.

Data Sources: MEDLINE (1966 to Jan 2012), EMBASE (1980 to Jan 2012), the Cochrane Central Register of Controlled Trials (1970 to Jan 2012), as well as other sources.

Study Selection: Randomized trials inward whatsoever linguistic communication that compared viscosupplementation alongside sham or nonintervention command inward adults alongside articulatio genus osteoarthritis.

Data Extraction: Primary outcomes were hurting intensity as well as flare-ups. Secondary outcomes included share as well as serious adverse events. Reviewers used duplicate abstractions, assessed study quality, pooled information using a random-effects model, examined funnel plots, as well as explored heterogeneity using meta-regression.

Data Synthesis: Eighty-nine trials involving 12 667 adults met inclusion criteria. Sixty-eight had a sham control, forty had a follow-up duration greater than iii months, as well as 22 used cross-linked forms of hyaluronic acid. Overall, 71 trials (9617 patients) showed that viscosupplementation moderately reduced hurting (effect size, −0.37 [95% CI, −0.46 to −0.28]). There was of import between-trial heterogeneity as well as an asymmetrical funnel plot: Trial size, blinded outcome assessment, as well as publication condition were associated alongside final result size. Five unpublished trials (1149 patients) showed an final result size of −0.03 (CI, −0.14 to 0.09). Eighteen large trials alongside blinded outcome assessment (5094 patients) showed a clinically irrelevant final result size of −0.11 (CI, −0.18 to −0.04). Six trials (811 patients) showed that viscosupplementation increased, although non statistically significantly, the run a jeopardy for flare-ups (relative risk, 1.51 [CI, 0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the run a jeopardy for serious adverse events (relative risk, 1.41 [CI, 1.02 to 1.97]).

Limitations: Trial lineament was to a greater extent than oft than non low. Safety information were oft non reported.

Conclusion: In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events.

Link to Abstract

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PRP beats Placebo for Knee Arthritis

The American Journal of Sports Medicine of late published the results of unopen to other written report supporting the usage of Platelet Rich Plasma for arthritis.  In this really good done study, 2 dissimilar doses of PRP were given to patients too and then compared to a saline injection.  One grouping recieved a unmarried injection of PRP, unopen to other 2 PRP injections spaced three weeks apart too the tertiary grouping a unmarried injection of saline or sterile tabular array salt water.  The tertiary grouping served the placebo control. 

Statistically pregnant improvements inward hurting too component were noted inward the PRP groups inside 2-3 weeks too lasted vi months.  The saline treated grouping noted worsening of symptoms.  There were no pregnant differences betwixt the 2 PRP groups alongside both showing improvement. 

Overall, this prospective, randomized trial adds to the mounting evidence that specific forms of PRP tin live helpful for patients alongside human knee osteoarthritis.  See abstract below for details. 

The usage of PRP for human knee osteoarthritis is apace evolving.  There are at in ane trial 37 articles on PubMed discussing that specific topic.  (Link to abstracts)  Over the class of 2013, to a greater extent than presentations too papers volition assist clarify the role of PRP for this really mutual problem.

AM
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Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis: Influenza A virus subtype H5N1 Prospective, Double-Blind, Randomized Trial.

Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A.
Am J Sports Med. 2013 January 8. [Epub ahead of print]
SourceDepartment of Orthopaedics, Post Graduate Institute of Medical Education too Research, Chandigarh, India.

BACKGROUND:Specific increment factors accept been proposed equally therapeutic proteins for cartilage repair. HYPOTHESIS:Platelet-rich plasma (PRP) provides symptomatic relief inward early on osteoarthritis (OA) of the knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A full of 78 patients (156 knees) alongside bilateral OA were divided randomly into three groups. Group Influenza A virus subtype H5N1 (52 knees) received a unmarried injection of PRP, grouping B (50 knees) received 2 injections of PRP three weeks apart, too grouping C (46 knees) received a unmarried injection of normal saline. White blood jail cellular telephone (WBC)-filtered PRP alongside a platelet count three times that of baseline (PRP type 4B) was administered inward all. All the groups were homogeneous too comparable inward baseline characteristics. Clinical outcome was evaluated using the Western Ontario too McMaster Universities Arthritis Index (WOMAC) questionnaire earlier handling too at vi weeks, three months, too vi months after treatment. They were too evaluated for hurting past times a visual analog scale, too overall satisfaction alongside the physical care for too complications were noted. RESULTS:Statistically pregnant improvement inward all WOMAC parameters was noted inward groups Influenza A virus subtype H5N1 too B inside 2 to three weeks too lasting until the concluding follow-up at vi months, alongside slight worsening at the 6-month follow-up. The hateful WOMAC scores (pain, stiffness, physical function, too full score) for grouping Influenza A virus subtype H5N1 at baseline were 10.18, 3.12, 36.56, too 49.86, respectively, too at concluding follow-up were 5.00, 2.10, 20.08, too 27.18, respectively, showing pregnant improvement. Similar improvement was noted inward grouping B (mean WOMAC scores at baseline: 10.62, 3.50, 39.10, too 53.20, respectively; hateful WOMAC scores at concluding follow-up: 6.18, 1.88, 22.40, too 30.48, respectively). In grouping C, the hateful WOMAC scores deteriorated from baseline (9.04, 2.70, 33.80, too 45.54, respectively) to concluding follow-up (10.87, 2.76, 39.46, too 53.09, respectively). The three groups were compared alongside each other, too no improvement was noted inward grouping C equally compared alongside groups Influenza A virus subtype H5N1 too B (P < .001). There was no divergence betwixt groups Influenza A virus subtype H5N1 too B, too at that spot was no influence of age, sex, weight, or torso volume index on the outcome. Knees alongside Ahlback degree 1 fared improve than those alongside degree 2. Mild complications such equally nausea too dizziness, which were of brusk duration, were observed inward vi patients (22.2%) inward grouping Influenza A virus subtype H5N1 too eleven patients (44%) inward grouping B. CONCLUSION:A unmarried dose of WBC-filtered PRP inward concentrations of 10 times the normal total is equally effective equally 2 injections to alleviate symptoms inward early on human knee OA. The results, however, deteriorate after vi months. Both groups treated alongside PRP had improve results than did the grouping injected alongside saline only.




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