Intra-Articular Hyaluronic Acid Injection after Arthroscopic Debridement for Knee Osteoarthritis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

JIANG Xie ¹ , ZHAN Mei ² , LI Qi ¹ , LIU Dong ¹ ,  LI Jian ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu 610041, China;2. Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Jian, Email: hxlijian.china@163.com

Keywords：

Arthroscopic debridement; Knee osteoarthritis; Hyaluronic acid; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20120212

Video：

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Objective 　To systematically evaluate the effectiveness of intra-articular hyaluronic acid injection after arthroscopic debridement for knee osteoarthritis (KOA).
Methods 　Databases including The Cochrane Library, SCI, MEDLINE, EMbase, CBM and WanFang Data were searched from inception to 2012, so as to collect randomized controlled trials (RCTs) on intra-articular hyaluronic acid injection after arthroscopic debridement (combined therapy) vs. monotherapy in treating KOA. Two reviewers independently screened literature according to inclusion and exclusion criteria, evaluated quality, and extracted data. Then the meta-analysis was conducted using RevMan5.0 software.
Results 　A total of 7 RCTs involving 526 patients were included. The results of meta-analyses showed that: there was no significant difference in the excellent-good rate between the combined therapy group and the monotherapy groups including either the intra-articular hyaluronic acid injection group (RR=1.40, 95%CI 0.99 to 1.98, P=0.06) or the arthroscopic debridement group (RR=1.09, 95%CI 0.93 to 1.26, P=0.29). But the intra-articular hyaluronic acid injection group was inferior to the combined therapy group in improving Lysholm score, with a significant difference (MD=–14.81, 95%CI –17.55 to –12.08, P lt;0.000 01).
Conclusion 　Arthroscopic debridement combined with intra-articular hyaluronic acid injection for KOA shows no significant difference in the excellent-good rate compared with the monotherapy, but it is superior to the monotherapy of hyaluronic acid injection in improving Lysholm score, so it is believed the combined therapy group is superior to the control groups in therapeutic effects. Due to the limited quantity and quality of the included studies, this conclusion needs to be proved by performing more high quality RCTs

Citation： JIANG Xie,ZHAN Mei,LI Qi,LIU Dong,LI Jian. Intra-Articular Hyaluronic Acid Injection after Arthroscopic Debridement for Knee Osteoarthritis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(11): 1361-1366. doi: 10.7507/1672-2531.20120212 Copy

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16.	唐新桥, 刘忠, 梁培雄. 膝关节镜术后注射玻璃酸钠治疗骨性关节炎疗效观察. 中国医师杂志, 2008, 10(9): 1277-1278.
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22.	American Academy of Orthopaedic Surgeons Treatment of osteoarthritis of the knee (non-arthroplasty): fullguideline.December 6, 2008.Available from: http://www.aaos.org/Research/guidelines/GuidelineOA Knee.asp. Accessed February 16, 2009.
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24.	Buckwalter JA, Lohmander S, Operative treatment of osteoarthrosis. Current practice and future development (Current Concepts Review). J Bone Joint Surg Am, 1994, 76(9): 1405-1418.

1. 胥少汀, 葛宝丰, 徐印坎. 实用骨科学. 第3版. 北京: 人民军医出版社, 2006: 1337.
2. Felson DT. Osteoarthritis of the knee. N Engl J Med, 2006, 354: 841-848.
3. 吴在德, 吴肇汉. 外科学. 第6版. 北京: 人民卫生出版社, 2004: 330.
4. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol, 1993, 39(Suppl): 3.
5. Peyron JG, Balazs EA. Preliminary clinical assessment of Na-hyaluronate injection into human arthritic joints. Pathol Biol, 1974, 22: 731-733.
6. Choi HK, Modawal A, Ferrer M, et al. A meta–analysis on the efficacy of intra–articular viscosupplementation therapy for knee osteoarthritis. Arthritis & Rheumatism, 1999, 42(9): 293.
7. Espallargues M, Pons JMV. Efficacy and safety of viscosupplementation with Hylan G-F 20 for the treatment of knee osteoarthritis. A systematic review. International Journal of Technology Assessment in Health Care, 2003, 19(1): 41-56.
8. Lo GH, La Valley M, McAlindon T, et al. Intra–articular hyaluronic acid in treatment of knee osteoarthritis. A meta–analysis. JAMA, 290(23): 3115-3121.
9. Berstein J. Therapeutic effects of hyaluronic acid onosteoarthritis of the knee. The Journal of Bone and Joint Surgery, 2004, 86(11): 2567- 2567.
10. Wang CT, Lin J, Chang CJ, et al. Therapeutic effects of hyaluronic acid on osteoarthritis of the knee. A meta-analysis of randomized controlled trials. The Journal of Bone and Joint Surgery, 2004, 86A(3): 538-545.
11. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum, 2000, 43: 1905-1915.
12. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated February 2011]. The Cochrane Collaboration, 2011. Available from: http://www.cochrane-handbook.org.
13. RevMan 2011 Review Manager (Revman) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
14. Deeks JJ, Higgins JPT, Altman DG (editors). Chapter 9: Analysing data and undertaking meta-analyses. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from: http://www.cochrane-handbook.org.
15. 张智材, 李金德, 韵向东, 等. 膝关节镜清理术联合应用玻璃酸钠关节注射治疗膝关节骨关节炎的临床应用研究. 卫生职业教育, 2010, 28(20): 135-137.
16. 唐新桥, 刘忠, 梁培雄. 膝关节镜术后注射玻璃酸钠治疗骨性关节炎疗效观察. 中国医师杂志, 2008, 10(9): 1277-1278.
17. 李有才, 刘晋平, 李正南, 等. 关节镜术后加玻璃酸钠治疗膝骨性关节炎疗效研究. 中国医师进修杂志, 2011, 34(8): 36-38.
18. 杨海波. 医用透明质酸钠在膝骨关节炎关节镜术后的应用价值. 中华临床医师杂志(电子版), 2010, 4(7): 1094-1095.
19. 陈建锋, 熊昌源, 陈大伟, 等. 联合顺次法治疗膝关节骨性关节炎的临床研究. 中国中医骨伤科杂志, 2007, 15(4): 1-5.
20. Hempfling H. Intra-articular hyaluronic acid after knee arthroscopy: a two-year study. Knee Surg Sports Traumatol Arthrosc, 2007, 15: 537-546.
21. Heybeli N, Doral MN, Atay OA, et al. Intra-articular sodium hyaluronate injections after arthroscopic debridement for osteoarthritis of the knee: a prospective, randomized, controlled study. Acta Orthop Traumatol Turc, 2008, 42(4): 221-227.
22. American Academy of Orthopaedic Surgeons Treatment of osteoarthritis of the knee (non-arthroplasty): fullguideline.December 6, 2008.Available from: http://www.aaos.org/Research/guidelines/GuidelineOA Knee.asp. Accessed February 16, 2009.
23. Felson DT, Buckwalter J. Debridement and lavage for ostecoarthritis of the knee. N Engl J Med, 2002, 347: 132-133.
24. Buckwalter JA, Lohmander S, Operative treatment of osteoarthrosis. Current practice and future development (Current Concepts Review). J Bone Joint Surg Am, 1994, 76(9): 1405-1418.

Chinese Journal of Evidence-Based Medicine

Intra-Articular Hyaluronic Acid Injection after Arthroscopic Debridement for Knee Osteoarthritis: A Systematic Review

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