Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians

Reid, M. Carrington

doi:10.1007/s12325-013-0068-6

Cited by 35 publications

(25 citation statements)

References 89 publications

(146 reference statements)

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“…IN, USA); LMWHA Hyglan (HCPCS codes: J7317, Q4083, and J7321, Manufacturer: Fidia Pharma Inc., Parsippany, NJ, USA) or Supartz (HCPCS codes: J7317, Q4083, and J7321, Manufacturer: Bioventus, Durham, NC, USA). [16,17]…”

Section: Methodsmentioning

confidence: 99%

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Shewale

Barnes

Fischbach

et al. 2017

The Journal of Arthroplasty

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Background We compared the effectiveness of low molecular weight (LMWHA), moderate molecular weight (MMWHA), and high molecular weight (HMWHA) hyaluronic acid for prevention or delay of knee surgery in patients with knee osteoarthritis (OA). Methods An observational cohort study using Lifelink Plus claims (2006-2015) was used. The primary outcome measure of the study included all surgical interventions of the knee. The secondary outcome measures were 1) unicompartmental (UKR) or total knee replacement (TKR) and 2) TKR only. A high dimensional propensity score (hdPS) using 1:1 matching was used to adjust for confounding. The likelihood of each outcome was assessed using Cox proportional hazard models. Results A cohort of 30,417 incident HA users with knee OA met our inclusion-exclusion criteria. There was no difference in the likelihood of composite surgical events between LMWHA users (HR: 0.939; 95%CI: 0.870-1.013) and MMWHA users (HR: 1.032; 95%CI: 0.952-1.119) when compared to HMWHA users in a matched hdPS analysis. However, a significantly lower likelihood for all outcome measures was demonstrated in LMWHA and MMWHA users compared to HMWHA users when hdPS was not used. Conclusion There was no significant difference in the likelihood of surgical interventions between LMWHA, MMWHA and HMWHA users after accounting for empirically derived confounders.

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Section: Methodsmentioning

confidence: 99%

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Shewale

Barnes

Fischbach

et al. 2017

The Journal of Arthroplasty

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“…In recent years, intra-articular (IA) knee joint injections have been used to relieve symptoms of this condition. These have succeeded to varying degrees either with sodium hyaluronate preparations [1, 2], platelet-rich plasma (PRP) [3], or with a low molecular weight fraction (< 5kDa) of human serum albumin (LMWF-5A) [4, 5]. In all of these studies, the control arm was injection of the same volume of sterile physiological saline ( i.e .…”

Section: Introductionmentioning

confidence: 99%

Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief

Bar‐Or¹,

Rael²,

Brody³

2017

TORJ

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Background:Osteoarthritis of the knee (OAK) is a severe debilitating condition characterized by joint pain, stiffness, and resultant limited mobility. In recent years, intra-articular (IA) injections have been used to relieve symptoms and have succeeded to varying degrees either with sodium hyaluronate preparations or with a biologic.Objective:The objective of this review is to evaluate multiple studies that demonstrate some relief from the symptoms of OAK in the saline arm of various clinical trials.Method:A thorough literature search (PubMed) was performed assessing the pain efficacy of various compounds compared to saline injections in clinical trials. A total of 73 studies were identified in the literature search including a total of 5,816 patients. These clinical trials all involved the IA injection of a viscosupplement (hyaluronate, platelet rich plasma (PRP), etc.) or a biologic (the low molecular weight fraction (< 5kDa) of human serum albumin (LMWF-5A)). For all of these studies, the control arm was injection of sterile physiological saline that approximates the salt concentration and total solute concentration of blood and most tissues.Results:Based on our review of the current literature, the tested compounds performed with mixed results when compared to saline injections. Moreover, OAK is a variable disease, with severity measured on the Kellgren and Lawrence (KL) scale where various hyaluronate preparations have a therapeutic effect mostly on KL 2-3 patients while a biologic works best on KL 3-4 patients.Conclusion:Since the effect of saline injection is always greater than no treatment, the evaluations of these treatments can be confounded in clinical trials. Therefore, the question of whether there are known therapeutic effects of saline injections might explain these results.

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“…On the other hand, the rate of use of assistive devices is lower in patients who receive HA injections than in those who do not. Thus, it is beyond doubt that using HA at the earliest time possible after OA diagnosis can benefit patients17, 18 ) . HA injections are at least as effective as NSAIDs, and are much safer than NSAIDs in terms of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…HA injections are at least as effective as NSAIDs, and are much safer than NSAIDs in terms of adverse effects. Furthermore, HA injections are associated with decreased need for NSAIDs and corticosteroids17, 18 ) .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis

et al. 2016

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[Purpose] There are many types of hyaluronic acid preparations, but no clear data are available about which preparations is more effective. The aim of this trial was to investigate the effectiveness of different types of hyaluronic acid preparations on pain and function of inpatients with knee osteoarthritis. [Subjects and Methods] All patients were diagnosed by clinical examination and x-ray. Ostenil PLUS® was injected into 28 patients (group 1, 1.6 million daltons), and MONOVISC® (group 2, 2.5 million daltons) was injected into 46 patients. Demographic data and Western Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were used for clinical evaluation at 1, 3, and 6 months post injection. [Results] In both groups, baseline Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores were higher compared with those in subsequent evaluations. Based on the pre- and post-injection data, a significant reduction in all scores was observed after the injections for in both groups. According to intergroup comparisons, there was no significant difference in any of the scores between the two groups. [Conclusion] There were no difference in Ontario and McMaster Universities Osteoarthritis Index and Visual Analog Scale scores in patients with knee osteoarthritis injected with two different hyaluronic acid structures in short-term preparations.

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Viscosupplementation for Osteoarthritis: a Primer for Primary Care Physicians

Cited by 35 publications

References 89 publications

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Use of Saline as a Placebo in Intra-articular Injections in Osteoarthritis: Potential Contributions to Nociceptive Pain Relief

Efficacy of single-dose hyaluronic acid products with two different structures in patients with early-stage knee osteoarthritis

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