Comparison between intra-articular infiltrations of placebo, steroids, hyaluronic and PRP for knee osteoarthritis: a Bayesian network meta-analysis
Introduction
Knee pain related to osteoarthritis is the biggest form of joint arthritis causing huge disability and poor quality of life. Current joint injection treatment involves corticosteroid, platelet rich plasma (PRP) and hyaluronic acid. Regarding the efficacy of these intra-articular injections, current evidence is controversial. The superiority of one technique over another is questioned and debates are ongoing. The purpose of the present review and comparison study was to compare and investigate the efficacy of these joint injection treatments in patients with knee pain related to osteoarthritis (OA). A Bayesian network meta-analysis of randomised clinical trials (RCTs) was conducted comparing patient outcomes at 3, 6 and 12-months of follow-up.
Materials and methods
All the clinical trials comparing the outcomes of two or more joint injection treatment of interest for knee OA were considered for inclusion.
Results
Data from 30 clinical trials involving a total of 3463 patients were collected. At 3-months follow-up, PRP showed the best outcome, followed by the corticosteroid and hyaluronic acid injection treatment. At 6-months follow-up, PRP showed the best outcome, followed by hyaluronic acid, corticosteroid and placebo. At 12-months follow-up, PRP showed the best clinical outcomes, followed by the hyaluronic acid, placebo and corticosteroid.
Conclusion
Intra-articular joint injections of PRP demonstrated the best overall outcome compared to steroids, hyaluronic acid and placebo for patients with knee pain related to osteoarthrosis at 3, 6 and 12-months follow-up. Quite clearly demonstrating reduced pain and improved function. Furthermore, this is a natural, safe, easy treatment that holds practically no side-effects. In addition, PRP treatment in combination with hyaluronic acid is recommended for joint preservation and further improving function.
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