Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis

Berkani, Sabryne; Eymard, Florent; Latourte, Augustin; Richette, Pascal; Bérenbaum, Francis; Sellam, Jérémie; Louati, Karine

doi:10.3390/jcm11143985

Cited by 6 publications

(4 citation statements)

References 59 publications

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“…Furthermore, the delay effect was more pronounced with an increased number of HA treatment cycles [17]. Recent systematic reviews also reported a delay effect to TKA of approximately 9.8 months with IA-HA [19]. The present study revealed that the mean time to TKA after KOA diagnosis was 7.4 and 6.3 years in the HA group and non-IA-HA groups, respectively, suggesting that patients receiving HA treatment experienced an approximate 1-year delay until TKA compared to those without HA treatment.…”

Section: Discussionmentioning

confidence: 94%

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Efficacy of Intra-Articular Hyaluronic Acid Injections in Delaying Total Knee Arthroplasty and Safety Evaluation in Primary Knee Osteoarthritis: Analysis Based on Health Insurance Review and Assessment Service (HIRA) Claim Database in Korea

Park,

Sim,

Han

2023

Preprint

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Background This retrospective cohort study aimed to evaluate the efficacy of intra-articular hyaluronic acid (IA-HA) injections in delaying total knee arthroplasty (TKA) and the safety of IA-HA according to IA-HA type and combination with intra-articular corticosteroid (IA-CS) using a large health insurance claim database. Methods The study population included patients aged ≥ 50 years with a first diagnosis of knee osteoarthritis (KOA) between 2009 and 2014, who underwent TKA by 2020, using the Health Insurance Review and Assessment Service claim database in Korea. IA-HA injections were categorized as single or multiple injection regimen agents. Cox proportional hazard models estimated hazard ratios (HR) for TKA risk, adjusted for covariates. Logistic regression assessed the occurrence of adverse events after IA-HA administration. Results In all, 36,983 patients were included. Patients who received IA-HA injections had a significantly longer time to TKA compared to those who did not (mean delay of approximately 1 year). The IA-HA group had a significantly lower risk of TKA (HR: 0.61, 95% CI: 0.60–0.62) than non-IA-HA group after adjusting for covariates. Single injection IA-HA regimen agents showed the longest time to TKA and lowest risk (HR: 0.56, 95% CI: 0.53–0.59). TKA risk decreased with the number of IA-HA cycles. Adverse events occurred in 6.7% of IA-HA cases without CS, with very low incidence of infection. Multiple injection regimen agents and concurrent IA-CS use were associated with higher infection risk. Conclusion IA-HA injections were associated with a significant delay in TKA among patients with KOA. Single-injection regimen agents had the lowest TKA risk. Infection risk increased with multiple injections and concurrent IA-CS use. These findings support the use of IA-HA as an effective non-operative intervention for managing KOA and delaying TKA. Careful selection of IA-HA type and consideration of concurrent IA-CS use are important for optimizing outcomes and minimizing complications.

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Section: Discussionmentioning

confidence: 94%

“…Logistic regression between intra-articular hyaluronic acid injection related information and adverse events including procedures associated with suspected infection in patients with intra-articular hyaluronic acid injection (N =19,376) …”

mentioning

confidence: 99%

Efficacy of Intra-Articular Hyaluronic Acid Injections in Delaying Total Knee Arthroplasty and Safety Evaluation in Primary Knee Osteoarthritis: Analysis Based on Health Insurance Review and Assessment Service (HIRA) Claim Database in Korea

Park,

Sim,

Han

2023

Preprint

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“…Studies exploring mechanisms driving IAHA benefit have focused on IAHA-induced changes in cartilage that might promote a slowing in structural disease progression [46][47][48][49], which, in theory, could contribute to a delay in time to TKA [50][51][52][53]. The panel considered two statements related to the effect of an innovative IAHA on joint structure and integrity.…”

Section: Joint Structure and Integritymentioning

confidence: 99%

What We Should Expect from an Innovative Intra-Articular Hyaluronic Acid Product: Expert Opinion Based on a Comprehensive Review of the Literature

Migliore,

Maheu,

Saccone

et al. 2023

JCM

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Background: Intra-articular hyaluronic acid (IAHA) products are often used in the treatment of adults with mild-to-moderate knee osteoarthritis (KOA). The International Symposium on Intra-Articular Treatment (ISIAT) convened a multidisciplinary technical expert panel to define characteristics for an innovative IAHA product that should answer unmet needs in the clinical management of adults with mild-to-moderate KOA. Methods: An initial set of evidence-based statements was developed based on data extracted from articles identified through a comprehensive literature search. A Delphi panel comprising 19 experts in KOA voted in 3 rounds to rate their degree of agreement with accepted statements. Results: The final set of 13 accepted statements focus on the effect of an innovative IAHA across 5 key domains of nociceptive pain, joint function, quality of life, joint structure and integrity, and adverse effects. The statements set thresholds for clinically meaningful improvements that exceed those generally achievable by currently available IAHA products. Conclusion: The characteristics described by these statements from the ISIAT set new standards for what should be expected from an innovative IAHA. These statements should serve as a framework for driving the development of innovative IAHA products that will surpass the actual outcomes achieved by current viscosupplements in patients with mild-to-moderate KOA.

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“…PRP is mainly administered intra-articularly for treating KOA. In patients with KOA, PRP is reported to provide better clinical outcome than hyaluronic acid [13]. Some reports have shown that the intra-articular administration of PRP to patients with early KOA has improved cartilage lesions in the patellofemoral joint evaluated on MRI T2 mapping images [14].…”

Section: Introductionmentioning

confidence: 99%

The Preventive Effects of Platelet-Rich Plasma Against Knee Osteoarthritis Progression in Rats

Takemura,

Okumo,

Tatsuo

et al. 2023

Cureus

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Background: In recent years, the intra-articular administration of platelet-rich plasma (PRP), a novel therapeutic strategy for knee osteoarthritis (KOA), has gained attention. However, the efficacy of PRP in inhibiting degenerative joint changes remains unclear. The current study aimed to evaluate the therapeutic effect of the intra-articular administration of PRP in rats with induced KOA.Materials and methods: PRP was prepared from the whole blood of nine-week-old male Wistar rats via centrifugation at 25°C, 200 × g, for seven minutes. KOA was induced in the right knees of the rats via destabilization of the medial meniscus (DMM) surgery. The animals were divided into the control, sham, DMM, and DMM + PRP groups (n = 5 each). The rats in the DMM + PRP group received 50 μL of intraarticular PRP in the right knee joint four weeks after surgery. The rotarod test was conducted to assess locomotive function. Eight weeks after DMM surgery, the degree of medial meniscus extrusion was measured via computed tomography (CT) images on the right knee. Then, a histological analysis of the harvested knees was conducted. KOA progression was assessed using the Osteoarthritis Research Society International (OARSI) score. The number of multinucleated tartrate-resistant acid phosphatase (TRAP)positive osteoclasts in the subchondral bone was counted via histological analysis.Results: The degree of medial meniscus extrusion did not significantly differ between the DMM and DMM + PRP groups. Similarly, there were no significant differences in the walking time based on the rotarod test between the DMM and DMM + PRP groups. However, the DMM group had a significantly higher OARSI score than the DMM + PRP group. The number of TRAP-positive osteoclasts in the subchondral bone of the DMM group increased over time, peaking four weeks after surgery. The DMM + PRP group had a higher number of TRAP-positive osteoclasts in the subchondral bone than the control group. However, there was no significant difference between the number of TRAP-positive osteoclasts between the DMM group and the control and sham groups. Conclusion:The intra-articular administration of PRP may inhibit KOA progression in a rat model, especially in the articular cartilage degradation and osteophyte formation. The results can provide further evidence about the efficacy of PRP against KOA progression and can contribute to the current practice of healthcare professionals based on accurate knowledge.

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Time to Total Knee Arthroplasty after Intra-Articular Hyaluronic Acid or Platelet-Rich Plasma Injections: A Systematic Literature Review and Meta-Analysis

Cited by 6 publications

References 59 publications

Efficacy of Intra-Articular Hyaluronic Acid Injections in Delaying Total Knee Arthroplasty and Safety Evaluation in Primary Knee Osteoarthritis: Analysis Based on Health Insurance Review and Assessment Service (HIRA) Claim Database in Korea

Efficacy of Intra-Articular Hyaluronic Acid Injections in Delaying Total Knee Arthroplasty and Safety Evaluation in Primary Knee Osteoarthritis: Analysis Based on Health Insurance Review and Assessment Service (HIRA) Claim Database in Korea

What We Should Expect from an Innovative Intra-Articular Hyaluronic Acid Product: Expert Opinion Based on a Comprehensive Review of the Literature

The Preventive Effects of Platelet-Rich Plasma Against Knee Osteoarthritis Progression in Rats

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