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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-06-2019 | Knee

Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis

Authors: Christopher Smith, Rahil Patel, Christopher Vannabouathong, Brendan Sales, Alexander Rabinovich, Robert McCormack, Etienne L. Belzile, Mohit Bhandari

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 6/2019

Abstract

Purpose

Intra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) have individually demonstrated efficacy for knee osteoarthritis (OA); however, both treatments are limited by the trajectory of symptom relief. The combination of CS and HA in the management of knee OA may provide improved symptomatic relief for patients who are candidates for intra-articular therapies.

Methods

Electronic databases Medline, EMBASE and Cochrane Library were used to identify relevant publications. Randomized controlled trials (RCT) that evaluated intra-articular injections of combined CS and HA in comparison to HA alone were included. Outcomes eligible for meta-analysis were WOMAC pain, WOMAC total, OMERACT-OARSI responder rate, and treatment-related adverse events. Standardized mean differences (SMD) were calculated for continuous outcomes using an inverse variance method and a random-effects model. Odds ratios (OR) were calculated for dichotomous outcomes using the Mantel–Haenszel method and a random-effects model. Heterogeneity was assessed using the I² statistic.

Results

Eight trials (n = 751 patients) were included. Reduction in WOMAC pain scores at 2–4 weeks favoured the combined CS and HA group compared to HA alone [SMD 0.60, 95% CI (0.23, 0.97); p = 0.002, I² = 75%]. Longer term improvements at 24–26 and 52 weeks WOMAC pain scores also favoured the combined CS and HA group {[SMD 0.25, 95% CI (0.09, 0.41); p = 0.002, I² = 0%] and [SMD 0.39, 95% CI (0.01, 0.77); p = 0.05, I² = 0%]} compared to HA alone, respectively. There were no significant differences in WOMAC total scores, OMERACT-OARSI responder rate, or treatment-related adverse events.

Conclusion

Combined intra-articular injections of CS and HA led to reductions in pain at 2–4, 24–26 and 52 weeks compared to HA injections alone.

Level of evidence

Level II—meta-analysis.

Available only for authorised users

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Title: Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis
Authors: Christopher Smith
Rahil Patel
Christopher Vannabouathong
Brendan Sales
Alexander Rabinovich
Robert McCormack
Etienne L. Belzile
Mohit Bhandari
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 6/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-018-5071-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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