Long term safety, efficacy, and patient acceptability of hyaluronic acid injection in patients with painful osteoarthritis of the knee

Abstract

The increasing prevalence of painful knee osteoarthritis has created an additional demand for pharmacologic management to prevent or delay surgical management. Viscosupplementation, via intraarticular injection of hyaluronic acid (HA), aims to restore the favorable milieu present in the nonarthritic joint. The safety profile of intraarticular HA injections for painful knee osteoarthritis is well established, with the most common adverse effect being a self-limited reaction at the injection site. Although acceptance of the early literature has been limited by publication bias and poor study quality, more recent and rigorous meta-analysis suggests that intraarticular HA injection is superior to placebo injection for pain relief and matches, if not surpasses, the effect size of other nonoperative treatments, such as nonsteroidal anti-inflammatory medication. Intraarticular HA injection is effective in providing temporary pain relief in patients with painful knee osteoarthritis. Future investigations should focus on optimizing the composition and administration of HA agents to provide prolonged relief of painful osteoarthritis in the knee and other joints.

Hyaluronic Acid Injections Are Associated with Delay of Total Knee Replacement Surgery in Patients with Knee Osteoarthritis: Evidence from a Large U.S. Health Claims Database

“…A more recent meta-analysis that included 4,866 patients, all from peer-reviewed journal papers, concluded that there were no serious AEs related to HA treatment [ 51 ]. Thus, HA injection appears to be safe by comparison to TKR [ 51 , 52 ]. Furthermore, a recent meta-analysis [ 51 ] concluded that there were large treatment effects 4–26 weeks after HA injection; relative to saline-injected controls, the standardized mean difference following HA injection was an improvement of 0.38–0.43 units for knee pain and of 0.32–0.34 units for knee function (all P < 0.001).…”

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) versus Hyaluronic Acid (A one-year randomized clinical trial)

“…There are numerous conservative treatments for knee OA that have short-term efficacy and have their own benefits and disadvantages. 4 For example, Non steroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid are common treatments of arthritis. Despite their low cost and easy access, these treatments have systemic adverse effects and may cause joint cartilage destruction and flare up of the osteoarthritic process.…”

“…12 The rationale for the use of PRP is to stimulate the natural healing cascade and tissue regeneration by a “supraphysiologic” release of platelet-derived factors directly at the site of treatment. 4 …”

A report on the use of a single intra-articular administration of autologous platelet therapy in a naturally occurring canine osteoarthritis model - a preliminary study

“…Autologous platelets are a regenerative treatment modality for OA, used with the aim to stimulate the natural healing cascade and regeneration of tissues by a supraphysiologic release of platelet derived factors directly at the treatment site, without the risk of immune rejection or disease transmission [21][22][23]. Growth factors affect nearly every biological process [24] and, in platelets concentrates, insulin-like growth factor (IGF-1), transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF), signal cells to proliferate and influence their maturation, differentiation and tissue repair [25,26].…”