Viscosupplementation for the treatment of osteoarthritis of the knee

Article


Bellamy, N., Campbell, J., Welch, V., Gee, T. L., Bourne, R. and Wells, G. A.. 2005. "Viscosupplementation for the treatment of osteoarthritis of the knee." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD005321.pub2
Article Title

Viscosupplementation for the treatment of osteoarthritis of the knee

ERA Journal ID15305
Article CategoryArticle
AuthorsBellamy, N. (Author), Campbell, J. (Author), Welch, V. (Author), Gee, T. L. (Author), Bourne, R. (Author) and Wells, G. A. (Author)
Journal TitleCochrane Database of Systematic Reviews
Year2005
Place of PublicationUnited Kingdom
ISSN1469-493X
Digital Object Identifier (DOI)https://doi.org/10.1002/14651858.CD005321.pub2
Web Address (URL)http://www2.cochrane.org/reviews/em/ab005321.html
Abstract

Osteoarthritis (OA) is the most prevalent chronic joint disorder worldwide and is associated with significant pain and disability. OBJECTIVES: To assess the effects of viscosupplementation in the treatment of OA of the knee. The products were hyaluronan and hylan derivatives (Adant, Arthrum H, Artz (Artzal, Supartz), BioHy (Arthrease), Durolane, Fermathron, Go-On, Hyalgan, Hylan G-F 20 (Synvisc Hylan G-F 20), NRD-101, Orthovisc, Ostenil, Replasyn, SLM-10, Suplasyn, Synject and Zeel compositum). SEARCH STRATEGY: MEDLINE, EMBASE, PREMEDLINE, Current Contents up to July 2003, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Specialised journals and reference lists of identified randomised controlled trials (RCTs) and pertinent review articles up to April 2004 were handsearched. SELECTION CRITERIA: RCTs of viscosupplementation for the treatment of people with a diagnosis of OA of the knee were eligible. Single and double-blinded studies, placebo-based and comparative studies were eligible. At least one of the four OMERACT III core set outcome measures had to be reported (Bellamy 1997). DATA COLLECTION AND ANALYSIS: Each trial was assessed independently by two reviewers (NB, JC) for its methodological quality using a validated tool. All data were extracted by one reviewer (JC) and verified by a second reviewer (VR). Continuous outcome measures were analysed as weighted mean differences (WMD) with 95% confidence intervals (CI). Dichotomous outcomes were analyzed by relative risk (RR). MAIN RESULTS: Sixty-three trials with a median quality score of 3 (range 1 to 5) were identified. Follow-up periods varied between day of last injection and one year. Thirty-seven trials included comparisons of hyaluronan/hylan and placebo, nine trials included comparisons of intra-articular (IA) corticosteroids, and five trials included comparisons of nonsteroidal anti-inflammatory drugs (NSAIDs). The pooled analyses of the effects of viscosupplements against 'placebo' controls generally supported the efficacy of this class of intervention. In these same analyses, differential efficacy effects were observed for different products on different variables and at different timepoints. Of note is the 5 to 13 week post injection period which showed a percent improvement from baseline of 11 to 54% for pain and 9 to 15% for function. In general, comparable efficacy was noted against NSAIDs and longer-term benefits were noted in comparisons against IA corticosteroids. In general, few adverse events were reported in the hyaluronan/hylan trials included in these analyses. AUTHORS' CONCLUSIONS: Based on the aforementioned analyses, viscosupplementation is an effective treatment for OA of the knee with beneficial effects: on pain, function and patient global assessment; and at different post injection periods but especially at the 5 to 13 week post injection period. It is of note that based on non-randomised groups, the magnitude of the clinical effect, as expressed by the WMD and standardised mean difference (SMD) from the RevMan 4.1 output, is different for different products, comparisons, timepoints, variables and trial designs. However, there are few randomised head-to-head comparisons of different viscosupplements and readers should be cautious, therefore, in drawing conclusions regarding the relative value of different products. The clinical effect for some products, against placebo, on some variables at some timepoints is in the moderate to large effect-size range. Readers should refer to relevant tables to review specific detail given the heterogeneity in effects across the product class and some discrepancies observed between the RevMan 4.1 analyses and the original publications. Overall, the analyses performed are positive for the HA class and particularly positive for some products with respect to certain variables and timepoints, such as pain on weight bearing at 5 to 13 weeks postinjection.In general, sample-size restrictions preclude any definitive comment on the safety of the HA class of products; however, within the constraints of the trial designs employed no major safety issues were detected. In some analyses viscosupplements were comparable in efficacy to systemic forms of active intervention, with more local reactions but fewer systemic adverse events.In other analyses HA products had more prolonged effects than IA corticosteroids. Overall, the aforementioned analyses support the use of the HA class of products in the treatment of knee OA.

Keywordsclinical trial; controlled clinical trial; human; knee osteoarthritis; meta analysis; randomized controlled trial; review; drug derivative; hyaluronic acid; hylan
ANZSRC Field of Research 2020320216. Orthopaedics
520399. Clinical and health psychology not elsewhere classified
Public Notes

Files associated with this item cannot be displayed due to copyright restrictions.

Byline AffiliationsUniversity of Queensland
London Health Sciences Centre, Canada
University of Ottawa, Canada
Griffith University
University of Ottawa Heart Institute, Canada
Permalink -

https://research.usq.edu.au/item/9zwq5/viscosupplementation-for-the-treatment-of-osteoarthritis-of-the-knee

  • 2174
    total views
  • 10
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

The methodology of personal projects analysis: four modules and a funnel
Little, Brian R. and Gee, Travis. 2007. "The methodology of personal projects analysis: four modules and a funnel." Little, Brian R., Phillips, Susan D. and Salmela-Aro, Katrina (ed.) Personal project pursuit: goals, action, and human flourishing. Mahwah, NJ, USA. Lawrence Erlbaum Associates, Inc.. pp. 51-93
Intraarticular corticosteroid for treatment of osteoarthritis of the knee
Bellamy, Nicholas, Campbell, Jane, Welch, Vivian, Gee, Travis L., Bourne, Robert and Wells, George A.. 2008. "Intraarticular corticosteroid for treatment of osteoarthritis of the knee." Cochrane Database of Systematic Reviews.
Hylan G-F 20 (Synvisc) versus placebo: Cochrane Review 2005
Bellamy, N., Campbell, J., Gee, T., Robinson, V., Bourne, R. and Wells, G.. 2005. "Hylan G-F 20 (Synvisc) versus placebo: Cochrane Review 2005." van de Putte, L. (ed.) Annual European Congress of Rheumatology - EULAR 2005 . Vienna 08 - 11 Jun 2005 Netherlands.
Class-efficacy of hyaluronan/hylan versus placebo in knee osteoarthritis: A Cochrane Review
Bellamy, N., Campbell, J., Gee, T., Robinson, V., Bourne, R. and Wells, G.. 2005. "Class-efficacy of hyaluronan/hylan versus placebo in knee osteoarthritis: A Cochrane Review." van de Putte, L. (ed.) Annual European Congress of Rheumatology - EULAR 2005 . Vienna 08 - 11 Jun 2005 Nijmegen, Netherlands .
An evaluation of the convergence between three different methods of response status assignment (RSA) based on the WOMAC Osteoarthritis Index
Bellamy, N., Lybrand, S. G. and Gee, T.. 2002. "An evaluation of the convergence between three different methods of response status assignment (RSA) based on the WOMAC Osteoarthritis Index." Diamond, J. (ed.) 66th Annual Scientific Meeting of the American College of Rheumatology. New Orleans, United States 25 - 29 Oct 2002 Hoboken, NJ. United States .
Alcohol ignition interlock programmes for reducing drink driving recidivism (Review)
Willis, Charlene, Lybrand, Sean and Bellamy, Nicholas. 2004. "Alcohol ignition interlock programmes for reducing drink driving recidivism (Review)." Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD004168.pub2
Introduction to reading research
Gee, Travis and Pelling, Nadine. 2007. "Introduction to reading research." Pelling, Nadine, Bowers, Randolph and Armstrong, Philip (ed.) The practice of counselling. Melbourne, Australia. Thomson Learning. pp. 454-486
Diagnosis and treatment: some elementary considerations
Gee, Travis. 2007. "Diagnosis and treatment: some elementary considerations." Pelling, Nadine, Bowers, Randolph and Armstrong, Philip (ed.) The practice of counselling. Melbourne, Australia. Thomson Learning. pp. 136-157
Clinical utility of predictors of return-to-work outcome following work-related musculoskeletal injury
Muenchberger, Heidi, Kendall, Elizabeth, Grimbeek, Peter and Gee, Travis. 2008. "Clinical utility of predictors of return-to-work outcome following work-related musculoskeletal injury." Journal of Occupational Rehabilitation. 18 (2), pp. 190-206. https://doi.org/10.1007/s10926-007-9113-0
Capturing study influence: the concept of 'gravity' in meta-analysis
Gee, Travis. 2005. "Capturing study influence: the concept of 'gravity' in meta-analysis." Counselling, Psychotherapy and Health. 1 (1), pp. 51-75.
Questioning premorbid dissociative symptomatology in dissociative identity disorder - a reply to Gleaves, Hernandez and Warner
Gee, Travis, Allen, Kelly V. and Powell, Russell A.. 2003. "Questioning premorbid dissociative symptomatology in dissociative identity disorder - a reply to Gleaves, Hernandez and Warner ." Professional Psychology: Research and Practice. 34 (1), pp. 114-116. https://doi.org/10.1037//0735-7028.34.1.114
Participation and chronic disease self-management: are we risking inequitable resource allocation?
Foster, Michele, Kendall, Elizabeth, Dickson, Paul, Chaboyer, Wendy, Hunter, Beth and Gee, Travis. 2003. "Participation and chronic disease self-management: are we risking inequitable resource allocation?" Australian Journal of Primary Health. 9 (2-3), pp. 132-140. https://doi.org/10.1071/PY03037
Outcome measurement in Australian rehabilitation environments
Douglas, Heather, Swanson, Cheryl, Gee, Travis and Bellamy, Nicholas. 2005. "Outcome measurement in Australian rehabilitation environments ." Journal of Rehabilitation Medicine. 37 (5), pp. 325-329. https://doi.org/10.1080/16501970510035089
Long-term outcomes of seriously injured children: a study using the Child Health Questionnaire
Davey, Tamzyn M., Aitken, Leanne M., Kassulke, Desley, Bellamy, Nicholas, Ambrose, Jane, Gee, Travis and Clark, Michele. 2005. "Long-term outcomes of seriously injured children: a study using the Child Health Questionnaire." Journal of Paediatrics and Child Health. 41 (5), pp. 278-283. https://doi.org/10.1111/j.1440-1754.2005.00611.x
Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hylan in osteoarthritis of the knee.
Campbell, J., Bellamy, N. and Gee, T.. 2007. "Differences between systematic reviews/meta-analyses of hyaluronic acid/hyaluronan/hylan in osteoarthritis of the knee. " Osteoarthritis and Cartilage. 15, pp. 1424-1436 . https://doi.org/10.1016/j.joca.2007.01.022
Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies
Kendall, Elizabeth, Muenchberger, Heidi and Gee, Travis. 2006. "Vocational rehabilitation following traumatic brain injury: a quantitative synthesis of outcome studies." Journal of Vocational Rehabilitation. 25 (3), pp. 149-160.
Predictors of nonpathological dissociation in Northern Ireland: the effects of trauma and exposure to political violence
Dorahy, Martin J., Lewis, Christopher Alan, Millar, Robert G. and Gee, Travis. 2003. "Predictors of nonpathological dissociation in Northern Ireland: the effects of trauma and exposure to political violence." Journal of Traumatic Stress. 16 (6), pp. 611-615. https://doi.org/10.1023/B:JOTS.0000004087.27216.24