Abstract
The purpose of this study was to use meta-analytic approach to compare the efficacy
and safety of intraarticular hylan and hyaluronic acid (HA) for knee osteoarthritis
(OA) treatment. We searched PubMed, Embase, and the Cochrane databases through July
2017 to identify Level I randomized controlled trials (RCTs) that evaluated clinical
efficacy and safety of hylan compared with HA for knee OA. The primary outcomes were
Visual Analogue Scale (VAS) for pain and Western Ontario and McMaster Universities
Osteoarthritis Index (WOMAC) pain, and WOMAC function scores. In each study and for
the outcome measures (VAS for pain, WOMAC pain, function and stiffness scores, and
Lequesne score), we calculated the treatment effect from the difference between the
preintervention and postintervention changes in the hylan and HA groups. Twenty-one
RCTs involving 3,058 patients were included. Pooled analysis suggested that compared
with HA, hylan was associated with similar pain relief and function improvement in
patients with knee OA (VAS for pain: mean difference [MD], –3.04; 95% confidence interval
[CI], –9.13 to 3.04; p = 0.33; I
2 = 76%. WOMAC pain score: MD, 0.23; 95% CI, –0.25 to 0.70; p = 0.35; I
2 = 0%. WOMAC function score: MD, –0.47; 95% CI, –6.81 to 5.88; p = 0.88; I
2 = 84%). No significant difference was found comparing the patients with treatment-related
adverse events. The relationship was robust in sensitivity analysis and consistent
in most of the subgroup analyses. As to the primary outcomes (WOMAC pain, function
scores, VAS for pain), the difference between hylan and HA did not reach the previously
reported minimum clinically important difference (MCID) values (–13.4 for VAS for
pain, –2.0 for WOMAC pain score, –7.7 for WOMAC function score). Our meta-analysis
showed that there were no statistically and clinically significant differences in
pain relief and function improvement between hylan and HA injections for knee OA treatment.
In view of its higher costs, we discourage the use of hylan in patients with knee
OA in clinical practice. The level of evidence is I, meta-analysis of Level I studies.
Keywords
knee osteoarthritis - hyaluronic acid - hylan