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Am J Sports Med. 2016 Aug;44(8):2158-65. doi: 10.1177/0363546515609599. Epub 2015 Nov 17.

Product Differences in Intra-articular Hyaluronic Acids for Osteoarthritis of the Knee.

Author information

1
Division of Rheumatology and Immunology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California, USA journals@royaltman.com.
2
Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.
3
Department of Orthopedics, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.
4
Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
5
Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.

Abstract

BACKGROUND:

Knee osteoarthritis (OA) is a common and often disabling joint disorder among adults that may result in impaired activity and daily function. A variety of treatment options are currently available and prescribed for knee OA depending on the severity of the disorder and physician preference. Intra-articular hyaluronic acid (IA-HA) injection is a treatment for knee OA that reportedly provides numerous biochemical and biological benefits, including shock absorption, chondroprotection, and anti-inflammatory effects within the knee. Clarity is needed as to whether the available IA-HA products should be considered for therapy as a group or whether there are significant differences in the products that need to be considered in treatment of OA of the knee.

PURPOSE:

To determine whether there are differences in efficacy and safety with respect to intrinsic properties of available IA-HA injections for knee OA.

STUDY DESIGN:

Meta-analysis.

METHODS:

A comprehensive literature search of the Medline, EMBASE, and PubMed databases was conducted for all existing randomized trials of IA-HA. The primary outcome measure analyzed was the mean pain score at the reported follow-up nearest to 26 weeks after injection. Pooled efficacy and safety results were recorded for subgroupings of HA product characteristics.

RESULTS:

A total of 68 studies were included for analysis. Products with an average molecular weight ≥3000 kDa provided favorable efficacy results when compared with products of an average molecular weight <3000 kDa. Products with a molecular weight ≥3000 kDa demonstrated significantly fewer discontinuations due to treatment-related adverse events than did ≤1500 kDa counterparts, while trial discontinuation rates were similar between biological fermentation-derived HA products and avian-derived HA. The results did not demonstrate a significant difference in the occurrence of effusion across molecular weight subgroups. Additionally, biological fermentation-derived HA had a significantly smaller incidence of effusion than did avian-derived HA. Biological fermentation-derived HA demonstrated fewer acute flare-ups at the injection site than did avian-derived HA products, while high-molecular-weight products demonstrated the highest rate of injection site flare-up.

CONCLUSION:

Despite similarities, IA-HA products should not be treated as a group, as there are differences in IA-HA products that influence both efficacy and safety. In the available literature, IA-HA products with a molecular weight ≥3000 kDa and those derived from biological fermentation relate to superior efficacy and safety-factors that may influence selection an IA-HA product for OA of the knee.

KEYWORDS:

hyaluronic acid; knee; osteoarthritis; viscosupplementation

PMID:
26578719
DOI:
10.1177/0363546515609599
[Indexed for MEDLINE]

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