Knee pain due to osteoarthritis (OA) is one of the most common complaints in patients presenting to orthopaedic clinics, resulting in significant societal costs including cost of treatment and lost time from work or activities. Several nonoperative and operative treatment options exist to mitigate this pain and the resulting limitations in function occurring in patients with arthritis. The goal of nonoperative treatment modalities is to minimize pain and restore function in a noninvasive manner while prolonging the need for a total knee arthroplasty (TKA). These options include intra-articular viscosupplementation (intra-articular hyaluronic acid
[IA-HA]), intra-articular corticosteroids (IA-corticosteroids), oral nonsteroidal anti- inflammatory drugs (NSAIDs), and intra-articular platelet-rich plasma (IA-PRP).
Viscosupplementation is the injection of an intra- articular compound made of high-molecular-weight fluid containing hylan products (derivative of hyaluronan) that essentially functions as a viscoelastic glycosaminoglycan. Hyaluronic acid (HA) is naturally present in joint fluid and serves multiple purposes including shock absorption, joint lubrication, and energy dissipation; in addition, it coats the articular cartilage surfaces of the femur, tibia, and patella to protect them.
The purpose of this study was to conduct a systematic review of overlapping meta-analyses comparing treatment of knee osteoarthritis (OA) with intra-articular viscosupplementation (intra-articular hyaluronic acid [IA-HA]) versus oral nonsteroidal anti-inflammatory drugs (NSAIDs), intra-articular corticosteroids (IA-corticosteroids), intra-articular platelet-rich plasma (IA-PRP), or intra-articular placebo (IA-placebo) to determine which meta-analyses provide the best current evidence and identify potential causes of discordance.