GPs should be ‘discouraged’ from recommending viscosupplementation in patients with knee osteoarthritis due to an increased risk of adverse events, say researchers of a new review.
They investigated the efficacy of the treatment by pooling 89 trials that compared viscosupplementation against placebo or no intervention, using knee pain as a primary outcome and a flare-up in the injected knee as a primary safety outcome.
Using recent studies in patients with knee osteoarthritis, they pre-defined a clinically important difference of -0.37 effect sizes for knee pain.
Although the overall meta-analysis found that viscosupplementation had an effect size of -0.37 compared to placebo, thereby meeting the pre-defined clinically important difference, it was associated with a 51% increase in risk for flare-ups in the knee injected knee
Additionally, the risk of serious adverse events and local adverse events increased compared to placebo by 41% and 34% respectively.
Study lead Dr Anne Rutjes, epidemiologist at the University of Bern, Switzerland, said: ‘The increased risk in serious adverse events associated with viscosupplementation is particularly concerning, but causal mechanisms are unclear.
‘Because of this, the administration of these preparations should be discouraged.’