Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others?

Objective This literature review summarizes evidence on the safety and efficacy of intraarticular hyaluronic acid (IAHA) preparations approved in the United States for the treatment of osteoarthritis of the knee. Design A systematic literature search was performed in PubMed, Ovid MEDLINE, and SCOPUS databases. Only studies in which clinical outcomes of individual IAHA preparations alone could be assessed when compared to placebo, no treatment, other standard knee osteoarthritis treatments, and IAHA head-to-head studies were selected. Results One hundred nine articles meeting our inclusion criteria were identified, including 59 randomized and 50 observational studies. Hylan G-F 20 has been the most extensively studied preparation, with consistent results confirming efficacy in placebo-controlled studies. Efficacy is also consistently reported for Supartz, Monovisc, and Euflexxa, but not for Hyalgan, Orthovisc, and Durolane. In the head-to-head trials, high-molecular-weight (MW) Hylan G-F 20 was consistently superior to low MW sodium hyaluronate preparations (Hyalgan, Supartz) up to 20 weeks, whereas one study reported that Durolane was noninferior to Supartz. Head-to-head trials comparing high versus medium MW preparations all used Hylan G-F 20 as the high MW preparation. Of the IAHA preparations with strong evidence of efficacy in placebo-controlled studies, Euflexxa was found to be noninferior to Hylan G-F 20. There are no direct comparisons to Monovisc. One additional IAHA preparation (ie, Synovial), which has not been assessed in placebo-controlled studies, was also noninferior to Hylan G-F 20. Conclusion IAHA efficacy varies widely across preparations. High-quality studies are required to assess and compare the safety and efficacy of IAHA preparations.

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Safety and efficacy of intra articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis. Results of a double-blind, controlled, multicenter, randomized trial

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2016.01.966 ◽

2016 ◽

Vol 24 ◽

pp. S528

Author(s):

T. Conrozier ◽

N. Afif ◽

R. Lecurieux ◽

A. Walliser ◽

X. Chevalier

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Randomized Trial ◽

Double Blind ◽

Safety And Efficacy ◽

Multicenter Randomized Trial ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

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Safety and efficacy of intra-articular injections of a combination of hyaluronic acid and mannitol (HAnOX-M) in patients with symptomatic knee osteoarthritis

The Knee ◽

10.1016/j.knee.2016.05.015 ◽

2016 ◽

Vol 23 (5) ◽

pp. 842-848 ◽

Cited By ~ 6

Author(s):

Thierry Conrozier ◽

Florent Eymard ◽

Naji Afif ◽

Jean-Charles Balblanc ◽

Virginie Legré-Boyer ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Safety And Efficacy ◽

Symptomatic Knee Osteoarthritis ◽

Symptomatic Knee

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Clinicians’ Perspectives on the Use of Intra-Articular Hyaluronic Acid as a Treatment for Knee Osteoarthritis: A North American, Multidisciplinary Survey

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.4137/cmamd.s34496 ◽

2016 ◽

Vol 9 ◽

pp. CMAMD.S34496 ◽

Cited By ~ 3

Author(s):

Jeffrey Rosen ◽

Victoria Avram ◽

Anke Fierlinger ◽

Faizan Niazi ◽

Parag Sancheti ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Patient Outcomes ◽

Current Literature ◽

Early Stage ◽

Sodium Hyaluronate ◽

Cross Linking ◽

Product Characteristics ◽

Knee Oa ◽

Orthopedic Surgeons

Introduction This study aims to describe the perceptions of orthopedic surgeons on the efficacy of intra-articular hyaluronic acid (IA-HA), the influence of IA-HA product characteristics on its efficacy, and to identify patterns and factors related to the use of IA-HA. Additionally, this study examines factors that influence IA-HA brand selection, focusing on Euflexxa¯ (1% sodium hyaluronate). Methods We developed survey questions by reviewing the current literature and consulting with experts on the use of IA-HA in the management of knee osteoarthritis (OA). The survey included questions on demographics, previous experience with knee OA treatment, opinions on different treatment methods, and where information regarding treatments is obtained. Additionally, questions specific to opinions regarding IA-HA and the reasoning behind these opinions were asked. Results A total of 117 orthopedic surgeons and physicians completed the survey. IA-HA is most frequently prescribed to patients with early-stage (82%) or mid-stage (82.8%) OA, while fewer orthopedic surgeons and physicians use IA-HA for patients with late-stage OA (57.4%). Respondents were generally uncertain of the effects that intrinsic characteristics, such as molecular weight, cross-linking, and production process, had on patient outcomes. Respondents typically use their own clinical experience and results as a deciding factor in utilizing IA-HA treatment, as well as in choosing an IA-HA brand. Conclusion Uncertainty regarding the efficacy of IA-HA treatments is likely due to inconsistency within clinical guidelines and the current literature. Additional research investigating the efficacy of IA-HA treatment and how product characteristics affect outcome and safety is required to provide clarity to the controversy surrounding IA-HA treatment for knee OA.

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Comparing the Efficacy of Hyaluronic Acid and Platelet Rich Plasma Treatment by using Visual analogue Scale in the Patients of Knee Osteoarthritis

Esculapio ◽

10.51273/esc20.251648 ◽

2021 ◽

Vol 16 (4 (oct 2020 - dec 2020)) ◽

Author(s):

Muhammad Ali ◽

M. Mudassar Azam ◽

Maimoona Zaheer ◽

Fahad Wali Shah Khagha ◽

Amjad Waseem Shah ◽

...

Keyword(s):

Hyaluronic Acid ◽

Visual Analogue Scale ◽

Knee Osteoarthritis ◽

Plasma Treatment ◽

Analogue Scale ◽

Platelet Rich Plasma ◽

Controlled Trial ◽

Sodium Hyaluronate ◽

P Value ◽

Group B

Objective: To compare the efficacy of Hyaluronic acid (HA) and Platelet rich plasma (PRP) for treatment of Knee osteoarthritis. Methods: A randomized controlled trial done at department of Orthopedics Unit-I, Mayo Hospital Lahore. 130 cases fulfilling inclusion criteria were enrolled. All patients were divided into two groups. In group-A, cases were treated with HA (1% sodium Hyaluronate mixed in a phosphate buffered saline). In group-B, cases were treated with 10ml of PRP extracted from 100ml of their blood. Before and after procedure pain and efficacy was recorded. Results: The frequency of pain reduction ≥ 50% was statistically higher in PRP group as compared to HA group, p-value < 0.05. Conclusion: Through the findings of this study we conclude that the efficacy of efficacy of PRP was high than HA for treatment of Knee osteoarthritis. Key Words: Osteoarthritis, platelet-rich plasma, efficacy, hyaluronic acid. How to Cite: Ali M, Azam M.M, Zaheer M, Shah F, Shah A, Masood F. Comparing the efficacy of hyaluronic acid and platelet rich plasma treatment by using visual analogue scale in the patients of knee osteoarthritis. Esculapio.2020;16(04):37-40.

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Predictors of post-thyroidectomy hypocalcaemia: a systematic and narrative review

The Journal of Laryngology & Otology ◽

10.1017/s0022215120001024 ◽

2020 ◽

Vol 134 (6) ◽

pp. 541-552 ◽

Cited By ~ 1

Author(s):

A E L McMurran ◽

R Blundell ◽

V Kim

Keyword(s):

Observational Studies ◽

Hormone Level ◽

Narrative Review ◽

Narrative Synthesis ◽

Parathyroid Hormone Level ◽

Completion Thyroidectomy ◽

Common Complication ◽

Inclusion Criteria ◽

Ovid Medline ◽

Median Incidence

AbstractObjectiveHypocalcaemia is the most common complication after total or completion thyroidectomy. This study assesses recent evidence on predictive factors for post-thyroidectomy hypocalcaemia in order to identify the patients affected and aid prevention.MethodTwo authors independently assessed articles and extracted data to provide a narrative synthesis. This study was an updated systematic search and narrative review regarding predictors of post-thyroidectomy hypocalcaemia using the Ovid Medline, Embase, Cochrane and Cinahl databases. Results were limited to papers published from January 2012 to August 2019.ResultsSixty-three observational studies with a total of 210 401 patients met the inclusion criteria. The median incidence was 27.5 per cent for transient biochemical hypocalcaemia, 12.5 per cent for symptomatic hypocalcaemia and 2.2 per cent for permanent hypocalcaemia. The most frequent statistically significant predictor of hypocalcaemia was peri-operative parathyroid hormone level. Symptomatic hypocalcaemia and permanent hypocalcaemia were seen more frequently in patients undergoing concomitant neck dissection.ConclusionMany factors have been studied for their link to post-thyroidectomy hypocalcaemia, and this study assesses the recent evidence presented in each case.

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Functional and Radiological Comparison of Umbilical Cord Mesenchymal Stem Cells, Somatotropin, and Hyaluronic Acid Injection for Cartilage Repair in Early Osteoarthritis of the Knee: A Randomized Controlled Trial

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00045 ◽

2020 ◽

Vol 8 (5_suppl5) ◽

pp. 2325967120S0004

Author(s):

J Fiolin ◽

IH Dilogo ◽

AMT Lubis ◽

JA Pawitan ◽

IK Liem ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Umbilical Cord ◽

Controlled Trial ◽

Osteoarthritis Of The Knee ◽

Significant Difference ◽

Group A ◽

Ikdc Score

The umbilical cord-mesenchymal stem cells (UC-MSC) has been shown to improve the viability of degenerated chondrocytes in knee osteoarthritis (KOA) in cellular level. Additional somatotropin injection also shown clinical improvement in patients. The present trial is conducted to assess the efficacy of umbilical cord mesenchymal stem cells (UC-MSC) in comparison to somatotropin and hyaluronic acid (HA) injection to treat and slow the progression of knee osteoarthritis. Methods: This study was conducted from January 2016 to April 2018 in Cipto Mangunkusumo General Hospital. A total of 28 knees from 15 patients with early KOA Kellgren Lawrence I-II were randomized into three groups. Group A was treated with 1x106 units of intra-articular UC-MSCs + 2 ml HA followed with 2 consecutive weeks of HA injection; group B was treated with the same dose of HA with additional 8 IU of Somatotropin; group C was treated as control. The International Knee Documentation Committee (IKDC) score, The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue score (VAS), were assessed on the 1st and 3rd month, then every 3rd month until 12 months. Cartilage evaluation using MRI cartigram were performed at pre-implantation, and after the 6th and 12th month after implantation Results: General improvement were observed in all groups after 6 and 12 months. The IKDC score improved significantly among groups after 12 months (69.43 [48.3-89.66], 79.31 [51.72-90.08], and 75.9 [67.82-97.7] in group A, B, and C, respectively, p =0.005). We did not find a significant difference between groups in VAS and WOMAC results. However, we observed a medial T2 improvement in group A (39.55 [32.65-67.85] initially and 45.64 [38.12-70.65] 12 months after implantation). Conclusion: Injection of UC-MSC could improve knee function and cartilage profile in early KOA. However, further multicenter studies with larger samples are required to investigate the efficacy of such treatment for treating knee osteoarthritis.

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How to Choose Platelet-Rich Plasma or Hyaluronic Acid for the Treatment of Knee Osteoarthritis in Overweight or Obese Patients: A Meta-Analysis

Pain Research and Management ◽

10.1155/2020/7587936 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Pan Luo ◽

Zhencheng Xiong ◽

Wei Sun ◽

Lijun Shi ◽

Fuqiang Gao ◽

...

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Meta Analysis ◽

Cochrane Library ◽

Obese Patients ◽

Knee Oa ◽

Significant Difference ◽

Better Than

Objective. The purpose of this meta-analysis was to determine whether platelet-rich plasma (PRP) was better than hyaluronic acid (HA) for the treatment of knee osteoarthritis (OA) in overweight or obese patients. Design. Two reviewers independently used the keywords combined with free words to search English-based electronic databases according to Cochrane Collaboration guidelines, such as PubMed, Embase, ScienceDirect, and Cochrane library. The pooled data were analyzed using RevMan 5.3. Results. Ten randomized controlled trials (RCTs) with 1096 patients were included. During the first two months of follow-up, there was no significant difference between the two groups. At the 3rd, 6th, and 12th months of follow-up, the pooled analysis showed that PRP was better than HA for the treatment of knee OA in overweight or obese patients. There were significant differences between the two groups at Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score (3 months: MD = −1.35, [95% CI: −2.19 to −0.50], P=0.002, I2 = 0%; 6 months: MD = −7.62, [95% CI: −13.51 to −1.72], P=0.01, I2 = 88%; 12 months: MD = −12.11, [95% CI: −20.21 to −4.01], P=0.003, I2 = 94%). Conclusions. For overweight or obese patients with knee OA, intra-articular injection of PRP in a short time was not necessarily superior to HA, but long-term use was better than HA in pain and functional relief.

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Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial

Cartilage ◽

10.1177/1947603517703732 ◽

2017 ◽

Vol 9 (3) ◽

pp. 276-283 ◽

Cited By ~ 19

Author(s):

Laszlo Hangody ◽

Robert Szody ◽

Piotr Lukasik ◽

Wojciech Zgadzaj ◽

Endre Lénárt ◽

...

Keyword(s):

Clinical Trial ◽

Knee Osteoarthritis ◽

Sodium Hyaluronate ◽

Intraarticular Injection ◽

Controlled Clinical Trial ◽

Osteoarthritis Of The Knee ◽

Womac Pain ◽

Double Blind ◽

Triamcinolone Hexacetonide ◽

And Function

Objective: To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. Design: This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. Results: A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from baseline was significantly greater than saline through 12 weeks ( P = 0.0099) and 26 weeks ( P = 0.0072). WOMAC Pain was reduced by 70% at 12 weeks and by 72% at 26 weeks with Cingal. Significant improvements were found in most secondary endpoints for pain and function at most time points through 26 weeks. At 1 and 3 weeks, Cingal was significantly better than Monovisc for most endpoints; Cingal and Monovisc were similar from 6 weeks through 26 weeks. A low incidence of related adverse events was reported. Conclusions: Cingal provides immediate and long-term relief of osteoarthritis-related pain, stiffness, and function, significant through 26 weeks compared to saline. Cingal had similar immediate advantages compared with HA alone, while showing benefit comparable to HA at 6 weeks and beyond.

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