Different Intra-articular Injections as Therapy for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis

Zhao, Zhihu; Ma, Jianxiong; Ma, Xinlong

doi:10.1016/j.arthro.2019.09.043

Cited by 48 publications

(47 citation statements)

References 33 publications

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“…Knee osteoarthritis (KOA) is a common disease associated with progressive deterioration of the cartilage and narrowing of the joint space [1]. It was reported that KOA in the USA was nearly 27 million, and the number of KOA is continually growing due to the aging population [2,3].…”

Section: Introductionmentioning

confidence: 99%

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

et al. 2020

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Background This study aimed to evaluate the clinical efficacy of platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA) injection for patients undergoing knee osteoarthritis. Methods We systematically searched electronic databases including PubMed, Embase, Web of Science, and the Cochrane Library on January 23, 2020 to identify relevant studies issued in English languages. The outcomes evaluating the efficacy of knee osteoarthritis (KOA) treatment were Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores (WOMAC pain, function, stiffness, and total scores) at 1, 3, 6, and 12 months; International Knee Documentation Committee (IKDC) scores, Lequesne Index score, Visual Analog Scale (VAS) scores, EQ-VAS scores, and KOOS scores. The pooled data were analyzed by Stata 12.0. Results A total of 20 RCTs were enrolled in the present meta-analysis. The pooled results demonstrated that platelet-rich plasma (PRP) injection reduced pain more effectively than hyaluronic acid (HA) injection at 6-month and 12-month follow-up evaluated by WOMAC pain scores and VAS scores. EQ-VAS in the patients treated with PRP injection was lower than that in patients with HA injection at 12 months. Moreover, the patients with PRP injection had a better function recovery than those with HA injection at 1-month, 3-month, 6-month, and 12-month follow-up, as evaluated by WOMAC function scores. WOMAC total scores showed significant difference at 6-month and 12-month follow-up. The IKDC scores indicated PRP injection was significantly more effective than HA injection at 3 months and 6 months. However, the Lequesne Index scores, KOOS scores, and adverse events did not show any significant difference between groups. Conclusion Intra-articular PRP injection appeared to be more efficacious than HA injection for the treatment of KOA in terms of short-term functional recovery. Moreover, PRP injection was superior to HA injection in terms of long-term pain relief and function improvement. In addition, PRP injection did not increase the risk of adverse events compared to HA injection.

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Section: Introductionmentioning

confidence: 99%

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

et al. 2020

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“…Osteoarthritis (OA) is among the uppermost kinds of degenerative disorders in joints worldwide that features cartilage degradation, osteophyte formation, and joint stiffness [ 1 ]. It is estimated that about 3 million newly diagnosed OA could be presented each year [ 2 ]. The incidence of OA increases year by year as the population ages [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Resveratrol alleviates the interleukin-1β-induced chondrocytes injury through the NF-κB signaling pathway

Zhang

Cui

et al. 2020

J Orthop Surg Res

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Background Osteoarthritis (OA) is a regular age-related disease that affects millions of people. Resveratrol (RSV) is a flavonoid with a stilbene structure with different pharmacological effects. The purpose of the experiment was to evaluate the protective role of RSV against the human OA chondrocyte injury induced by interleukin-1β (IL-1β). Methods Chondrocytes were isolated from OA patients and identified by type II collagen, safranin O staining, and toluidine blue staining. Differentially expressed genes in chondrocytes treated RSV were identified by RNA sequencing. Kyoto encyclopedia of genes and genomes (KEGG) pathway as well as gene ontology (GO) were further conducted through Metascape online tool. A cell counting kit-8 (CCK-8) assay was applied to discover the viability of chondrocytes (6, 12, 24, and 48 μM). Many genes associated with inflammation and matrix degradation are evaluated by real-time PCR (RT-PCR) as well as western blot (WB). The mechanism of RSV for protecting IL-1β induced chondrocytes injury was further measured through immunofluorescence and WB assays. Results A total of 845 differentially expressed genes (upregulated = 499, downregulated = 346) were found. These differentially expressed genes mainly enriched into negative regulation of catabolic process, autophagy, and cellular catabolic process, intrinsic apoptotic, apoptotic, and regulation of apoptotic signaling pathway, cellular response to abiotic stimulus, external stimuli, stress, and radiation. These differentially expressed genes were obviously enriched in NF-kB signaling pathway. RSV at the concentration of 48 μM markedly weakened the viability of the cells after 24 h of treatment (87% vs 100%, P < 0.05). No obvious difference was observed between the 6, 12, and 24 μM groups (106% vs 100%, 104% vs 100%, 103% vs 100%, P > 0.05). RSV (24 μM) also markedly depressed the levels of PGE2 and NO induced by IL-1β by 25% and 29% respectively (P < 0.05). Our experiment pointed out that RSV could dramatically inhibit the inflammatory response induced by IL-1β, including the MMP-13, MMP-3, and MMP-1 in human OA chondrocytes by 50%, 35%, and 33% respectively. On the other hand, RSV inhibited cyclooxygenase-2 (COX-2), matrix metalloproteinase-1 (MMP-1), MMP-3, MMP-13, and inducible nitric oxide synthase (iNOs) expression (P < 0.05), while increased collagen-II and aggrecan levels (P < 0.05). From a mechanistic perspective, RSV inhibited the degradation of IκB-α as well as the activation of nuclear factor-kappa B (NF-κB) induced by IL-1β. Conclusion In summary, RSV regulates the signaling pathway of NF-κB, thus inhibiting inflammation and matrix degradation in chondrocytes. More studies should be focused on the treatment efficacy of RSV for OA in vivo.

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“…For patients suffering from hip osteoarthritis (OA), intraarticular injection therapy with corticosteroids (CS) or hyaluronic acid (HA) is generally considered a valid treatment option to relieve pain and to possibly postpone the need for total hip arthroplasty (THA) [1]. Noncomparative studies consistently show satisfactory pain reduction and functional improvement after intra-articular hyaluronic acid (IAHA) [2].…”

mentioning

confidence: 99%

“…Noncomparative studies consistently show satisfactory pain reduction and functional improvement after intra-articular hyaluronic acid (IAHA) [2]. Yet, recent metaanalyses reported contrasting findings, ranging from statistically significant pain reduction to no effect, regarding the efficacy of IAHA in hip OA [1,3,4]. More methodologically sound, adequately powered studies to evaluate intra-articular agents for hip OA are required [1,4,5].…”

mentioning

confidence: 99%

“…Yet, recent metaanalyses reported contrasting findings, ranging from statistically significant pain reduction to no effect, regarding the efficacy of IAHA in hip OA [1,3,4]. More methodologically sound, adequately powered studies to evaluate intra-articular agents for hip OA are required [1,4,5]. Meanwhile, IAHA may still be used as a nonoperative treatment option for short-term pain relief in hip OA [4].…”

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confidence: 99%

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Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients

Colen

Hoorntje

Maeckelbergh

et al. 2021

The Journal of Arthroplasty

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Background: Intra-articular hyaluronic acid (IAHA) can be injected into an osteoarthritic hip joint to reduce pain and to improve functionality. Several studies report IAHA to be safe, with minor adverse effects that normally disappear spontaneously within a week. However, intra-articular corticosteroids prior to total hip arthroplasty (THA) have been associated with increased infection rates. This association has never been investigated for IAHA and THA. We aimed to assess the influence of IAHA on the outcome of THA, with an emphasis on periprosthetic joint infection (PJI). Methods: At a mean follow-up of 52 months (±18), we compared complication rates, including superficial and deep PJIs, of THA in patients who received an IAHA injection 6 months prior to surgery (injection group) with that of patients undergoing THA without any previous injection in the ipsilateral hip (control group). One hundred thirteen patients (118 hips) could be retrospectively included in the injection group, and 452 patients (495 hips) in the control group. Results: No differences in baseline characteristics nor risk factors for PJI between the 2 groups were found. The clinical outcomes in terms of VAS pain scores (1.4 vs 1.7 points, P ¼ .11), modified Harris Hip Scores (77 vs 75 points, P ¼ .09), and Hip disability and Osteoarthritis Outcome Scores (79 vs 76 points, P ¼ .24) did not differ between the injection group and the control group. Also, complications in terms of persistent wound leakage (0% vs 1.2%, P ¼ .60), thromboembolic events (0% vs 0.6%, P ¼ 1.00), periprosthetic fractures (1.7% vs 1.2%, P ¼ .65), and dislocations (0% vs 0.4%, P ¼ 1.00) did not differ. However, in the injection group there was a higher rate of PJIs (4% vs 0%, P < .001) and postoperative wound infections (9% vs 3%, P ¼ .01), compared to the control group. Conclusion: Our findings suggest that IAHA performed 6 months or less prior to THA may pose a risk for increased rates of PJI. We recommend refraining from performing THA within 6 months after IAHA administration.

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Different Intra-articular Injections as Therapy for Hip Osteoarthritis: A Systematic Review and Network Meta-analysis

Cited by 48 publications

References 33 publications

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: a meta-analysis

Resveratrol alleviates the interleukin-1β-induced chondrocytes injury through the NF-κB signaling pathway

Intra-Articular Hyaluronic Acid Injections Less Than 6 Months Before Total Hip Arthroplasty: Is It Safe? A Retrospective Cohort Study in 565 Patients

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