Purpose

There are a number of developments in intra-articular therapies that have been determined to be differentiating factors within the classes of treatments. This study evaluated the efficacy and safety of intra-articular treatments of primary knee osteoarthritis in the short term (3 months follow-up), using a network meta-analysis design, while taking within-class differentiating factors into consideration.

Methods

A literature search of MEDLINE (through OVID), EMBASE (through OVID), Cochrane Central Register of Controlled Trials for all trials comparing intra-articular therapies was conducted on November 12, 2018. The treatments assessed were high molecular weight and low molecular weight hyaluronic acid injections, extended-release corticosteroids, standard-release corticosteroids, platelet-rich plasma, and saline. A frequentist network meta-analysis was conducted for each outcome.

Results

Sixty-four articles (9710 patients) met the inclusion criteria. High molecular weight hyaluronic acid (− 0.53, 95% CI − 0.81 to − 0.25) and PRP (− 0.79, 95% CI − 1.32 to − 0.26) were the only treatments with a confidence interval that lay completely above the MID threshold; however, PRP results varied within sensitivity analyses. For the function analysis, high molecular weight hyaluronic acid (SMD − 0.76, 95% CI − 1.30 to − 0.22) was the only treatment with a confidence interval entirely above the MID. Extended-release corticosteroid demonstrated a possible benefit in functional improvement (SMD − 0.98, 95% CI − 1.79 to − 0.17) compared to that of standard-release corticosteroid (SMD − 0.14, 95% CI − 0.72 to 0.44).

Conclusion

High molecular weight HA was the only treatment to surpass the MID for both pain and function outcomes. Extended-release corticosteroids may provide additional clinical benefit over standard-release corticosteroids. Platelet-rich plasma demonstrated possibly beneficial results; however, wide confidence intervals and sensitivity analyses made the conclusions of efficacy uncertain.

Level of evidence

Level 1. Systematic review of level 1 evidence.

中文翻译：

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关节内注射剂的差异化因素对膝骨关节炎的结局有重要影响：网络荟萃分析。

目的

关节内治疗方面的许多发展已被确定为治疗类别中的差异化因素。这项研究使用网络荟萃分析设计，同时考虑了同类差异因素，评估了短期（3个月随访）的原发性膝骨关节炎的关节内治疗的有效性和安全性。

方法

2018年11月12日对MEDLINE（通过OVID），EMBASE（通过OVID），Cochrane对照试验中心注册进行了文献检索，以比较所有关节内治疗的试验。评估的治疗方法是高分子量和低分子量透明质酸酸注射液，缓释皮质类固醇，标准释放皮质类固醇，富含血小板的血浆和盐水。对每个结局均进行了频频网络荟萃分析。

结果

符合纳入标准的文章64篇（9710例）。高分子量透明质酸（-0.53，95％CI-0.81至-0.25）和PRP（-0.79，95％CI-1.32至-0.26）是仅有的置信区间完全高于MID阈值的治疗; 但是，PRP结果在灵敏度分析中有所不同。对于功能分析，高分子量透明质酸（SMD-0.76，95％CI-1.30至-0.22）是唯一置信区间完全高于MID的治疗。与标准释放皮质类固醇激素（SMD-0.14，95％CI-0.72-0.44）相比，缓释皮质类固醇激素在功能改善（SMD-0.98，95％CI-1.79至-0.17）方面显示出可能的益处。

结论

高分子量HA是唯一在疼痛和功能结局方面均超过MID的治疗方法。缓释皮质类固醇可能比标准释放皮质类固醇提供更多的临床益处。富含血小板的血浆可能显示出有益的结果。然而，广泛的置信区间和敏感性分析使疗效结论不确定。

证据水平

1级。对1级证据的系统评价。