Evidence map›Paper›PMID 27814744›Full record

ArticleSystematic reviews2016

Hyaluronic acid injection therapy for osteoarthritis of the knee: concordant efficacy and conflicting serious adverse events in two systematic reviews.

Claire E O'Hanlon, Sydne J Newberry, Marika Booth, Sean Grant, Aneesa Motala, Margaret A Maglione, John D FitzGerald, Paul G Shekelle

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Systematic reviews, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 1 pooled it
2.7field-weighted citation impact, top 10% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

10 citing papers in PubMed, 1 synthesis or guideline pooled it, 29 citations in OpenAlex.

  1. Pooled it
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  3. Umbilical cord-derived mesenchymal stem cells for treating osteoarthritis of the knee: a single-arm, open-label study.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2020
    Trial
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  6. Article
  7. Review
  8. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Claire E O'HanlonRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA. cohanlon@rand.org.
Sydne J NewberryRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Marika BoothRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Sean GrantRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Aneesa MotalaRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Margaret A MaglioneRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
John D FitzGeraldRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
Paul G ShekelleRAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA.
RAND Corporation · USFrederick S. Pardee RAND Graduate School · USVA Greater Los Angeles Healthcare System · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe prevalence of knee osteoarthritis (OA)/degenerative joint disease (DJD) is increasing in the USA. Systematic reviews of treatment efficacy and adverse events (AEs) of hyaluronic acid (HA) injections report conflicting evidence about the balance of benefits and harms. We review evidence on efficacy and AEs of intraarticular viscosupplementation with HA in older individuals with knee osteoarthritis and account for differences in these conclusions from another systematic review.

methodsWe searched PubMed and eight other databases and gray literature sources from 1990 to December 12, 2014. Double-blind placebo-controlled randomized controlled trials (RCTs) reporting functional outcomes or quality-of-life; RCTs and observational studies on delay/avoidance of arthroplasty; RCTs, case reports, and large cohort studies and case series assessing safety; and systematic reviews reporting on knee pain were considered for inclusion. A standardized, pre-defined protocol was applied by two independent reviewers to screen titles and abstracts, review full text, and extract details on study design, interventions, outcomes, and quality. We compared our results with those of a prior systematic review and found them to be discrepant; our analysis of why this discrepancy occurred is the focus of this manuscript.

resultsEighteen RCTs reported functional outcomes: pooled analysis of ten placebo-controlled, blinded trials showed a standardized mean difference of -0.23 (95 % confidence interval (CI) -0.45 to -0.01) favoring HA at 6 months. Studies reported few serious adverse events (SAEs) and no significant differences in non-serious adverse events (NSAEs) (relative risk (RR) [95 % CI] 1.03 [0.93-1.15] or SAEs (RR [95 % CI] 1.39 [0.78-2.47]). A recent prior systematic review reported similar functional outcomes, but significant SAE risk. Differences in SAE inclusion and synthesis accounted for the disparate conclusions.

conclusionsTrials show a small but significant effect of HA on function on which recent systematic reviews agree, but lack of AE synthesis standardization leads to opposite conclusions about the balance of benefits and harms. A limitation of the re-analysis of the prior systematic review is that it required imputation of missing data.

Indexed as

Review Literature as TopicHumansHyaluronic AcidInjections, Intra-ArticularKnee JointOsteoarthritis, KneeHyaluronic AcidAdverse eventsHyaluronic acidOsteoarthritis, kneeViscosupplementation

Identifiers

PMID27814744
PMCPMC5097414
OpenAlexW2548418153

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.