ISAKOS: 2019 Congress in Cancun, Mexico
ISAKOS

2019 ISAKOS Biennial Congress ePoster #1310

 

Non-Operative Treatments for Knee Osteoarthritis: Are They Equally Effective?

Christopher Vannabouathong, MSc, Hamilton, ON CANADA
Mohit Bhandari, MD, PhD, FRCSC, Hamilton, ON CANADA
Asheesh Bedi, MD, Ann Arbor, MI UNITED STATES
Vickas Khanna, MD, FRCSC, Ottawa, ON CANADA
Patrick S. H. Yung, FRCS(Orth), FHKCOS, FHKAM, FRCS, MBChB, Shatin, NT HONG KONG
Vijay Shetty, MD, MSc, FRCSC, Mumbai INDIA
Moin Khan, MD, MSc, FRCSC, Hamilton, ON CANADA

McMaster University - Division of Orthopaedic Surgery, Hamitlon, ON, CANADA

FDA Status Not Applicable

Summary

While many non-operative treatments demonstrated statistically significant improvements in pain, we found the greatest effect estimates for intra articular treatments.

Abstract

Introduction

Guidelines recommending various non-operative treatments for patients with knee osteoarthritis (OA) remain inconsistent. Much of this controversy relates to what constitutes a clinically important effect. The purpose of this study was to compare treatment effect sizes from recent meta-analyses evaluating pharmacological or medical device knee OA interventions, and to further assess the clinical impact that the intra-articular (IA) placebo effect may have on IA injection therapies.

Methods

A search of, PubMed, MEDLINE and Embase, from the database inception date through May 30th, 2017 was conducted for all articles evaluating meta-analyses of pharmacological or medical device knee OA treatments compared to controls. Two reviewers independently screened articles for eligibility and extracted data for analysis. We presented effect estimates on a standardized mean difference (SMD) scale and compared them all against a threshold for clinical importance of 0.50 standard deviation (SD) units.

Results

Ten meta-analyses (sample size range: 110-39,814) providing a total of 19 different effect sizes for pain were included in this review. SMD estimates ranged from 0.08-0.79, for various electrical modalities, orthotic devices, topical and oral nonsteroidal anti-inflammatory drugs (NSAIDs), dietary supplements, and IA injection therapies. Seventeen treatments reported statistically significant improvements in pain when compared to controls. Treatments with the greatest effect estimates were PRP, IA-HA, and corticosteroids. When judged according to our threshold for clinical importance, IA-HA was found to have the most precise effect estimate, particularly high molecular weight formulations. PRP was found to provide the greatest point estimate in treatment effect.

Conclusion

While many non-operative treatments demonstrated statistically significant improvements in pain, we found the greatest effect estimates for intra articular treatments. While PRP provided the greatest point estimate in treatment effect, variability among studies suggests future research is required into optimal formulations. The strongest current evidence supports clinically and statistically significant treatment effects with IA-HA formulations between 1500kDa and >6000 kDa.

Level of Evidence: Level 1 (Systematic Review of Meta-Analysis)