A Meta-Analytical Way of Systematizing the Use of Hyaluronan Gels for the Relief of Osteoarthritis, Compared with New Treatment Alternatives

Author:

Pinteala Tudor12ORCID,Maier Stelian Sergiu3ORCID,Forna Norin12ORCID,Savin Liliana12,Sirbu Mihnea Theodor1,Popescu Dragos Cristian14,Cionca Viorel Dan4,Putineanu Dan Constantin5,Sirbu Paul Dan12ORCID

Affiliation:

1. Department of Orthopedics and Traumatology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania

2. Department Orthopedics and Traumatology, Clinical Rehabilitation Hospital, 700661 Iasi, Romania

3. Department of Chemical Engineering, Faculty of Industrial Design and Business Management, “Gheorghe Asachi” Technical University of Iasi, 73 Mangeron Blvd., 700050 Iasi, Romania

4. Department of Orthopaedics and Traumatology, “Sf. Spiridon” Emergency Universitary Hospital, 700115 Iasi, Romania

5. Orthopedic Surgery Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium

Abstract

Hyaluronic acid, in the form of a gel or viscoelastic colloidal solution, is currently used for the viscosupplementation of joints affected by osteoarthritis, but its effectiveness is under debate in relation to newer alternatives. Based on meta-analytical arguments, the present article reinforces the opinion that there are still no decisive arguments for its complete replacement but for its use adapted to the peculiarities of the disease manifestation and of the patients. A “broad” comparison is first made with almost all alternatives studied in the last decade, and then a meta-regression study is performed to compare and predict the effect size induced by viscosupplementation therapy and its main challenger of clinical interest, the platelet-rich plasma treatment. If they are computerized, the developed models can represent tools for clinicians in determining the appropriateness of the option or not for viscosupplementation in a manner adapted to the pain felt by the patients, to their age, or to other clinical circumstances. The models were generated using algorithms implemented in the R language and assembled in different R packages. All primary data and necessary R scripts are provided in accordance with the philosophy of reproducible research. Finally, we adhere in a documented way to the opinion that HA-based products, currently under circumspection, are still clinically useful.

Publisher

MDPI AG

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