Global Health Asia-Pacific July 2022 | Page 37

Common injections for knee pain don ’ t work

Reams of evidence suggest hyaluronic injections offer no benefits

Atreatment widely used in some countries to ease pain from osteoarthritis of the knee has shown to be ineffective while potentially leading to an increased risk of serious adverse events , such as infections , compared to placebo or dummy therapy , according to an analysis of 50 years of trials .

Despite its long history of controversy , hyaluronic acid is often injected into the knees of patients with osteoarthritis to treat symptoms , with one in seven �S patients with the condition receiving the injections , wrote the authors in the BMJ . An age�related disease that affects about ��� million people worldwide , osteoarthritis causes joint pain and limits mobility .
�roponents of the treatment say that the injections can reduce inflammation and friction in the knee , while also slowing degeneration of cartilage and bone .
�ut the review , which looked at data from over 21,000 patients with osteoarthritis , showed that the injections , also called viscosupplementation , offered only small pain reduction that wasn ’ t clinically relevant as it made no difference for patients .
�ore concerning was that the injections could e�pose patients to higher chances of events requiring hospital admission , prolongation of hospital stays , and persistent or major disability , though a clear link between the treatment and those risk wasn ’ t established .
��e don ’ t need new trials , � �runo da Costa , �rofessor at the �niversity of Toronto and one of the study authors , told the A�� , adding that the results were conclusive .
More worryingly , Professor da Costa and his team conducted a similar analysis leading to the same results in ���� , and several subsequent studies confirmed the findings but were never published , he said . �This is concerning and perhaps mainly driven by commercial interests .”
�n the �S , for instance , e�penditures related to the treatment were estimated to be �S���� million in 2018 , the authors wrote , with about 28 percent of that being used to treat joint infections after hyaluronic injections .
�n ���� , the American Academy of �rthopedic Surgeons released a statement advising against the use of hyaluronic acid injections for knee osteoarthritis because they “ did not demonstrate a clinically important benefit over placebo . �
The same recommendation was provided in �ngland by the �ational �nstitute for Health and Care ��cellence , and the treatment is only considered in e�ceptional circumstances , the authors wrote .
�This isn ’ t the first attempt to look at the value of viscosupplementation . And there are other organisations and groups that have performed very thorough reviews of the literature and essentially arrived at very similar conclusions ,” said Professor Cara Cipriano , chief of orthopaedic oncology at Penn �edicine , to STAT .
GlobalHealthAsiaPacific . com JULY 2022