Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

Abstract Background The clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. We conducted a meta-analysis to systematically evaluate the efficacy and safety of RF treatment in patients with knee OA. Methods Searches of the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases were performed through August 30, 2021. The major outcomes from published randomized controlled trials (RCTs) involving patients with knee OA were compared between RF and control groups, including Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Global Perceived Effect (GPE) scale, and adverse effects at available follow-up times. Results Fifteen RCTs involving 1009 patients were included in this meta-analysis, and the results demonstrated that RF treatment correlated with improvements in pain relief (VAS/NRS score, all P < 0.001) and knee function (WOMAC, all P < 0.001) at 1–2, 4, 12, and 24 weeks after treatment as well as patients’ degree of satisfaction with treatment effectiveness (GPE scale, 12 weeks, P < 0.001). OKSs did not differ significantly between the two groups. Moreover, treatment with RF did not significantly increase adverse effects. Subgroup analysis of knee pain indicated that the efficacy of RF treatment targeting the genicular nerve was significantly better than intra-articular RF at 12 weeks after treatment (P = 0.03). Conclusions This meta-analysis showed that RF is an efficacious and safe treatment for relieving knee pain and improving knee function in patients with knee OA.

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Efficacy and safety of radiofrequency ablation for treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

Journal of International Medical Research ◽

10.1177/03000605211006647 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052110066

Author(s):

Hua Zhang ◽

Bo Wang ◽

Jie He ◽

Zhongju Du

Keyword(s):

Radiofrequency Ablation ◽

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Data Extraction ◽

Meta Analysis ◽

Cochrane Review ◽

Controlled Trials ◽

Efficacy And Safety ◽

Serious Adverse Events ◽

Randomized Controlled

Objective To evaluate the efficacy and safety of radiofrequency ablation for the treatment of knee osteoarthritis. Methods A literature review was conducted using the PubMed, Cochrane Review, Embase, and Google Scholar databases. Two reviewers independently assessed the eligibility of all retrieved studies. The research was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure the reliability and verity of the results. The statistical analysis was performed using STATA version 13.0. Results Nine randomized controlled trials were collected for the data extraction and meta-analysis. Significant differences in the pain score at 4, 12, and 24 weeks were found between patients treated with radiofrequency ablation and those treated with placebo. Furthermore, the use of radiofrequency ablation was associated with an improved outcome of the Western Ontario and McMaster Universities Arthritis Index at 4, 12, and 24 weeks. No serious adverse events were observed in any patients who underwent radiofrequency ablation. Conclusion Radiofrequency ablation is efficacious and safe for reducing pain and improving knee function in patients with knee osteoarthritis, without increasing the risk of adverse effects.

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The Efficacy and Safety of Topical β-Blockers in Treating Infantile Hemangiomas: A Meta-Analysis Including 11 Randomized Controlled Trials

Dermatology ◽

10.1159/000510029 ◽

2020 ◽

pp. 1-11

Author(s):

Xinhui Wang ◽

Wei Feng ◽

Xufeng Zhao ◽

Ziyu Liu ◽

Liang Dong

Keyword(s):

Adverse Effects ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Pulsed Dye Laser ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Β Blocker ◽

Β Blockers ◽

Oral Propranolol

Background: To evaluate the efficacy and safety of topical β-blockers in the treatment of superficial infantile hemangiomas (SIH) and mixed infantile hemangiomas (MIH), respectively, and compare the efficacy and safety of topical β-blockers with other interventions. Methods: The PRISMA guidelines were adhered to. We searched for randomized controlled trials in databases from 2010 to 2018 comparing topical β-blockers with other interventions for infantile hemangiomas. The outcomes evaluated were efficacy and adverse effects. Data analyses were performed using RevMan 5.3. Publication bias was assessed to account for bias in patient selection. Results: Eleven studies, involving 1,235 patients, were subjected to this meta-analysis. Six studies compared topical β-blockers with other interventions (propranolol, placebo, corticosteroids or pulsed dye laser) in treating SIH, and 5 studies evaluated the efficacy and safety of a topical β-blocker when it was combined with another intervention in treating MIH. A topical β-blocker was discovered to be as effective as oral propranolol in treating SIH (risk ratio, RR, 0.96, 95% confidence interval, CI, 0.91–1.02, p = 0.20, I2 = 0%), and topical β-blockers were more beneficial than placebo, corticosteroids or pulsed dye laser in treating SIH (RR 2.25, 95% CI 1.66–3.05, p < 0.00001, I2 = 0%). Topical β-blockers combined with another intervention gave rise to a better clinical response in the treatment of MIH than intervention alone (RR 1.99, 95% CI 1.10–3.60, p = 0.02, I2 = 55%) (standard mean difference 0.80, 95% CI 0.28–1.31, p = 0.002, I2 = 0%). Compared with oral propranolol, topical β-blockers were associated with fewer incidences of adverse effects (RR 0.05, 95% CI 0.01–0.39, p = 0.004, I2 = 0%). No significant difference in adverse effects was found when a topical β-blocker was combined with another intervention in treating MIH (RR 1.01, 95% CI 0.58–1.74, p = 0.98, I2 = 0%). Conclusions: This meta-analysis provided evidence that topical β-blockers may replace oral propranolol as first-line therapy for SIH and that they are of additive value in treating MIH.

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Safety of Intra-Articular Hyaluronic Acid for Knee Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Trials Involving More than 8,000 Patients

Cartilage ◽

10.1177/1947603519888783 ◽

2019 ◽

pp. 194760351988878

Author(s):

Larry E. Miller ◽

Samir Bhattacharyya ◽

William R. Parrish ◽

Michael Fredericson ◽

Brad Bisson ◽

...

Keyword(s):

Systematic Review ◽

Hyaluronic Acid ◽

Adverse Events ◽

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Controlled Trials ◽

Knee Oa ◽

Randomized Controlled ◽

Symptomatic Knee

Objective The objective of this systematic review and meta-analysis was to report the safety of intra-articular hyaluronic acid (IAHA) in patients with symptomatic knee osteoarthritis (OA). Methods We identified randomized controlled trials reporting the safety of IAHA versus IA saline in adults with symptomatic knee OA. Main safety outcomes were adverse events (AEs), local AEs, serious adverse events (SAEs), study withdrawals, and AE-related study withdrawals. Results A total of 35 randomized controlled trials with 38 group comparisons comprising 8,078 unique patients (IAHA: 4,295, IA saline: 3,783) were included in the meta-analysis. Comparing IAHA with IA saline over a median of 6 months follow-up, there were no differences in the risk of AEs (42.4% vs. 39.7%, risk ratio [RR] = 1.01, 95% CI = 0.96-1.07, P = 0.61), SAEs (1.8% vs. 1.2%, RR = 1.44, 95% CI = 0.91-2.26, P=0.12), study withdrawals (12.3% vs. 12.7%, RR = 0.99, 95% CI = 0.87-1.12, P = 0.83), or AE-related study withdrawals (2.7% vs. 2.1%, RR = 1.37, 95% CI = 0.97-1.93, P = 0.08). Local AEs, all of which were nonserious, were more common with IAHA vs. IA saline (14.5% vs. 11.7%, RR = 1.21, 95% CI = 1.07-1.36, P = 0.003) and typically resolved within days. Conclusion IAHA was shown to be safe for use in patients with symptomatic knee OA. Compared with IA saline, IAHA is associated with an increased risk of nonserious, transient local reactions. There was no evidence to suggest any additional safety risks of IAHA.

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Comparing the Efficacy and Safety of Intralesional Verapamil With Intralesional Triamcinolone Acetonide in Treatment of Hypertrophic Scars and Keloids: A Meta-Analysis of Randomized Controlled Trials

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa357 ◽

2020 ◽

Author(s):

Pu Wang ◽

Luosha Gu ◽

Hongsen Bi ◽

Qifei Wang ◽

Zelian Qin

Keyword(s):

Adverse Effects ◽

Randomized Controlled Trials ◽

Triamcinolone Acetonide ◽

Meta Analysis ◽

Controlled Trials ◽

Hypertrophic Scars ◽

Efficacy And Safety ◽

Skin Atrophy ◽

Randomized Controlled ◽

First Session

Abstract Background Clinical treatment of hypertrophic scars (HS) and keloids is often unsatisfactory. Intralesional injections of triamcinolone acetonide (TAC) and verapamil are widely used to treat HS and keloids, but their efficacy and safety are controversial. Objectives: To conduct a meta-analysis of the effectiveness and safety of verapamil and TAC in the treatment of HS and keloids. Methods Embase, Google Scholar, and PubMed were searched for randomized controlled trials (RCTs) from inception to February 2020. RCTs that evaluated treatment effects with the Vancouver Scar Scale or reported adverse effects were included. The continuous data and the dichotomous variables were analyzed as mean difference (MD) and relative risk (RR), respectively. Results Seven RCTs (461 patients) were included. Compared to baseline, TAC rapidly changed the △height (MD=0.07; P<0.05) and △pliability (MD=0.23; P<0.05) after the first session, with no significant differences in the △height (after last session: MD=0.50; P=0.42), △pigmentation (after first session: MD=0.07; P=0.51, after last session: MD=-0.10; P=0.14), △vascularity(after first session: MD=-0.25; P=0.57, after last session: MD=-0.02; P=0.79) and △pliability (after last session MD=0.52; P=0.48). Although total adverse effects (RR=0.42; P=0.1) were not significantly different, in the subgroup analysis, the incidence of telangiectasia (RR=0.04; P<0.05) and skin atrophy (RR=0.10; P<0.05) but not pain (RR=1.27; P=0.77) was significantly lower with verapamil than with TAC. Conclusions Verapamil may be an effective substitute for TAC. Although total adverse effects did not change, the incidence of telangiectasia and skin atrophy was lower with verapamil than with TAC.

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Efficacy of mesenchymal stromal cells for the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02128-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Huazheng Qu ◽

Shui Sun

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Mesenchymal Stromal Cells ◽

Stromal Cells ◽

Meta Analysis ◽

Biomedical Literature ◽

Womac Pain ◽

Controlled Trials ◽

Knee Oa ◽

Randomized Controlled

Abstract Background Mesenchymal stromal cells (MSCs) are used as an emerging new option for the treatment of knee osteoarthritis (OA). However, their efficacy remains controversial across studies with different doses of MSCs and cell processing methods. We conducted this meta-analysis to assess the efficacy of MSCs in the treatment of knee OA. Methods Randomized controlled trials (RCTs) published in PubMed, Embase, Web of Science, SinoMed (Chinese BioMedical Literature Service System, China), and CNKI (National Knowledge Infrastructure, China) databases were systematically reviewed. The pain level and function improvements were evaluated using visual analog scale (VAS), McMaster Universities Osteoarthritis Index (WOMAC), and International Knee Documentation Committee (IKDC). The pooled estimate was calculated with weighted mean difference (WMD) with 95% confidence intervals (95%CIs). Results Nine RCTs involving 476 patients were included in this meta-analysis. The pooled estimate showed that the treatment of MSCs significantly reduced VAS, WOMAC pain, WOMAC stiffness, and WOMAC function scores at a long-term follow-up (12 or 24 months). However, for the IKDC and WOMAC total scores, MSCs also showed significant improvement in these outcomes, although this was not statistically significant when compared to the control. Conclusion Based on the current studies, our results suggested that MSCs were a promising option for the treatment of patients with knee OA. However, considering the potential limitations, more well-performed, large-scale RCTs are needed to verify our findings.

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Traditional Chinese Medications for Knee Osteoarthritis Pain: A Meta-Analysis of Randomized Controlled Trials

The American Journal of Chinese Medicine ◽

10.1142/s0192415x16500373 ◽

2016 ◽

Vol 44 (04) ◽

pp. 677-703 ◽

Cited By ~ 28

Author(s):

Bo Chen ◽

Hongsheng Zhan ◽

Jolanta Marszalek ◽

Mei Chung ◽

Xun Lin ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Population Characteristics ◽

Chinese Herbs ◽

Controlled Trials ◽

Knee Oa ◽

Randomized Controlled ◽

Pain Subscale ◽

Anti Inflammatory

Traditional Chinese medication (TCM) has analgesic and anti-inflammatory effects in patients with knee osteoarthritis (OA). We conducted the first systematic review of the best quantitative and qualitative evidence currently available in order to evaluate the effectiveness of TCM in relieving pain in knee OA. A comprehensive literature search was conducted using three English and four Chinese biomedical databases from their inception through March 1, 2015. We included randomized controlled trials of TCM for knee OA with intervention durations of at least two weeks. The effects of TCM on pain and other clinical symptoms were measured with the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The total effectiveness rate, which was used to assess overall pain, physical performance and wellness, was also measured. Two researchers independently extracted data on study design, population characteristics, duration, intervention, outcomes, risk of bias, and primary results. We performed a random-effects meta-analysis when appropriate. We also explored factors that could explain the heterogeneity by conducting subgroup and meta-regression analyses. Twenty-three studies, totaling 2362 subjects, met the eligibility criteria. Treatments were formulated with an average of 8 Chinese herbs and were prescribed based on the traditional Chinese diagnostic method of syndrome differentiation. The mean treatment duration was seven weeks, with oral administration occurring one to three times a day. Compared with non-steroidal anti-inflammatory drugs and intra-articular hyaluronate injections, 18 of the studies showed significantly improved VAS pain scores (Mean Difference [MD] [Formula: see text] 0.56; 95% confidence interval [CI], 0.18 to 0.94; [Formula: see text]), six of the studies showed significantly improved WOMAC pain subscale scores (MD [Formula: see text] 2.23; 95% CI, 0.56 to 3.91; [Formula: see text]), and 16 of the trials showed significantly improved total effectiveness rates (risk ratio [Formula: see text] 1.12; 95% CI, 1.05 to 1.19; [Formula: see text] 0.0003). In addition, TCM showed a lower risk of adverse events than standard western treatments. This evidence suggests that TCM is safe and effective for improving pain, function, and wellness in treatments of knee OA. However, there is inherent clinical heterogeneity (diverse TCM formulations, controls, and treatment regimens) among the included trials. Despite these limitations, the potential analgesic effects of TCM warrant further methodologically rigorous research to determine the clinical implications of TCM on pain management in knee OA.

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