Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: a systematic review and network meta-analysis

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Abstract

Objective

There are many injectable treatments for knee osteoarthritis with different characteristics and effects, the aim is to understand which one can lead to better and safer results.

Methods

The PRISMA principles were followed when doing the literature search. Web of Science databases, Embase, the Cochrane Library, PubMed, and the Wanfang database were searched to identified randomized controlled trials that assessed the efficacy of corticosteroids (CSC), platelet-rich plasma (PRP), hyaluronic acid (HA), and combination therapy in treating KOA. Risk of bias was assessed using the relevant Cochrane tools (version 1.0). The outcome measure included the visual analog scale (VAS) score, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, and treatment-related adverse events. The network meta-analysis was performed using STATA17 software and a Bayesian stratified random effects model.

Results

Network meta-analysis using the Bayesian random-effects model revealed 35 studies with 3104 participants. PRP showed the best WOMAC score at a 3-month follow-up, followed by PRP + HA, HA, placebo, and CSC; PRP + HA scored the highest VAS, followed by PRP, CSC, HA, and placebo. PRP, CSC, HA, and placebo had the highest WOMAC scores six months following treatment; PRP + HA showed the best VAS scores. PRP showed the best WOMAC score at 12 months, followed by PRP + HA, HA, placebo, and CSC; The best VAS score was obtained with PRP, followed by PRP + HA, HA, and CSC. No therapy demonstrated a rise in adverse events linked to the treatment in terms of safety.

Conclusions

The current study found that PRP and PRP + HA were the most successful in improving function and alleviating pain after 3, 6, and 12 months of follow-up. CSC, HA, PRP, and combination therapy did not result in an increase in the incidence of treatment-related side events as compared to placebo.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-023-06925-6.

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Most cited references 43

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The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

Brian Hutton, Georgia Salanti, Deborah M Caldwell … (2016)

The PRISMA statement is a reporting guideline designed to improve the completeness of reporting of systematic reviews and meta-analyses. Authors have used this guideline worldwide to prepare their reviews for publication. In the past, these reports typically compared 2 treatment alternatives. With the evolution of systematic reviews that compare multiple treatments, some of them only indirectly, authors face novel challenges for conducting and reporting their reviews. This extension of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement was developed specifically to improve the reporting of systematic reviews incorporating network meta-analyses. A group of experts participated in a systematic review, Delphi survey, and face-to-face discussion and consensus meeting to establish new checklist items for this extension statement. Current PRISMA items were also clarified. A modified, 32-item PRISMA extension checklist was developed to address what the group considered to be immediately relevant to the reporting of network meta-analyses. This document presents the extension and provides examples of good reporting, as well as elaborations regarding the rationale for new checklist items and the modification of previously existing items from the PRISMA statement. It also highlights educational information related to key considerations in the practice of network meta-analysis. The target audience includes authors and readers of network meta-analyses, as well as journal editors and peer reviewers.

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OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

R.R. Bannuru, M.C. Osani, E.E. Vaysbrot … (2019)

To update and expand upon prior Osteoarthritis Research Society International (OARSI) guidelines by developing patient-focused treatment recommendations for individuals with Knee, Hip, and Polyarticular osteoarthritis (OA) that are derived from expert consensus and based on objective review of high-quality meta-analytic data.

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The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

Marita Cross, Emma Smith, Damian Hoy … (2014)

To estimate the global burden of hip and knee osteoarthritis (OA) as part of the Global Burden of Disease 2010 study and to explore how the burden of hip and knee OA compares with other conditions. Systematic reviews were conducted to source age-specific and sex-specific epidemiological data for hip and knee OA prevalence, incidence and mortality risk. The prevalence and incidence of symptomatic, radiographic and self-reported hip or knee OA were included. Three levels of severity were defined to derive disability weights (DWs) and severity distribution (proportion with mild, moderate and severe OA). The prevalence by country and region was multiplied by the severity distribution and the appropriate disability weight to calculate years of life lived with disability (YLDs). As there are no deaths directly attributed to OA, YLDs equate disability-adjusted life years (DALYs). Globally, of the 291 conditions, hip and knee OA was ranked as the 11th highest contributor to global disability and 38th highest in DALYs. The global age-standardised prevalence of knee OA was 3.8% (95% uncertainty interval (UI) 3.6% to 4.1%) and hip OA was 0.85% (95% UI 0.74% to 1.02%), with no discernible change from 1990 to 2010. Prevalence was higher in females than males. YLDs for hip and knee OA increased from 10.5 million in 1990 (0.42% of total DALYs) to 17.1 million in 2010 (0.69% of total DALYs). Hip and knee OA is one of the leading causes of global disability. Methodological issues within this study make it highly likely that the real burden of OA has been underestimated. With the aging and increasing obesity of the world's population, health professions need to prepare for a large increase in the demand for health services to treat hip and knee OA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Author and article information

Contributors

Xihua Yang: yangxihua@126.com

Zhi Tian: drtianzh@sxmu.edu.cn

Journal

Journal ID (nlm-ta): BMC Musculoskelet Disord

Journal ID (iso-abbrev): BMC Musculoskelet Disord

Title: BMC Musculoskeletal Disorders

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2474

Publication date (Electronic): 30 November 2023

Publication date PMC-release: 30 November 2023

Publication date Collection: 2023

Volume: 24

Electronic Location Identifier: 926

Affiliations

[1 ]Second Clinical Medical College, Shanxi Medical University, ( https://ror.org/0265d1010) 382 Wuyi Road, Taiyuan, Shanxi 030001 PR China

[2 ]Department of Orthopedics, Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, The Second Hospital of Shanxi Medical University, ( https://ror.org/03tn5kh37) 382 Wuyi Road, Taiyuan, Shanxi 030001 PR China

[3 ]Department of Orthopedics, JinZhong Hospital Affiliated to Shanxi Medical University, ( https://ror.org/0265d1010) 689 Huitong South Road, Jinzhong, Shanxi 030600 PR China

[4 ]GRID grid.263452.4, ISNI 0000 0004 1798 4018, Xihua Yang Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Cancer Hospital Affiliated to Shanxi Medical University, ; Taiyuan, Shanxi 030013 PR China

[5 ]Orthopedics Department, First Hospital of Shanxi Medical University, ( https://ror.org/02vzqaq35) Taiyuan, Shanxi 030001 PR China

[6 ]Taiyuan Hand Surgery Hospital, Taiyuan, Shanxi 030001 PR China

Article

Publisher ID: 6925

DOI: 10.1186/s12891-023-06925-6

PMC ID: 10687893

PubMed ID: 38037038

SO-VID: 2afabbdf-b63c-415a-a5e7-e631c4bd8a13

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 6 June 2023

Date accepted : 26 September 2023

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100004480, Natural Science Foundation of Shanxi Province;

Award ID: 20210302124410; 201901D111373; 201903D321156

Funded by: The Second Hospital of Shanxi Medical University, and four research funding projects within the hospital

Award ID: 2020001-10

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: knee osteoarthritis,corticosteroids,hyaluronic acid,platelet-rich plasma,meta-analysis

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: knee osteoarthritis, corticosteroids, hyaluronic acid, platelet-rich plasma, meta-analysis

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A commentary on ‘A model-based quantitative analysis of efficacy and associated factors of platelet rich plasma treatment for osteoarthritis’
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Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: a systematic review and network meta-analysis

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Abstract

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Supplementary Information

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Orthopedics

Most cited references 43

The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations.

OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis

The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study.

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