Knee Osteoarthritis Interventional Treatment: Corticosteroids versus Hyaluronates versus Platelet Rich Plasma: A Narrative Review
DOI:
https://doi.org/10.25759/spmfr.349Keywords:
Adrenal Cortex Hormones/therapeutic use, Hyaluronic Acid/therapeutic use, Injections, Intra-Articular, Platelet-Rich Plasma, Osteoarthritis, Knee/therapy, ViscosupplementsAbstract
Introduction: Osteoarthritis is a common and debilitating disease, associated with loss of quality of life and important healthcare costs. It usually presents with pain, stiffness, diminished range of motion and loss of functional capacity. The treatment is multimodal, envolving oral/topic medication, patient education, physiotherapy; in refractory cases with moderate to severe pain the interventional procedures are a valid option. Intrarticular injection is a procedure for decades, and nowadays the componentes usually injected are: corticosteroids, hyaluronates and platelet rich plasma. The objective of this paper is to find the evidence available to date related to the interventional treatment of the osteoarthritis of the knee, comparing the three options available and mentioned previously.
Methods: Narrative revision of the literature published on the following medical databases: Medscape, Cochrane Library and PubMed.
Results: There is evidence of positive results with the three options in analysis; the safety profile is favorable. Corticosteroids are a safe and eficient option, mainly on inflamatory periods/flare, providing good short term pain relief. Hyaluronates also show efficacy, with possible benefit up to 24 weeks, with a potentially unfavorable profile of cost/effectiveness. Platelet rich plasma, more recent, presents a promising profile of efficacy on pain and quality of life, with potential benefit up to 12 months.
Discussion: The interventional treatment of the osteoarthritis of the knee is widely used, in the meanwhile, there are no formal guidelines to date. Other issue is the fact that the concept of osteoarthritis deserves, probably, a revision, since it is an extremely heterogeneous and hard to define disease. In this sense, a detailed semiology and objective examination are of utmost importance, since the focus of the clinician should be the identification of the source of pain, leading to a correct line of thought that allows a selection of the best approach possible that guarantees a good symptomatic control The majority of the studies analysed present a suboptimal methodological quality, which compromises the result analysis and eventual conclusions.
Conclusion: Osteoarthritis of the knee is a worldwide health issue, that tends to increase accordingly to the evolution of the demographic pyramid. Intrarticular injections are a safe and valid option, that must be considered following a detailed clinical examinations and, given the objective, staging and functional prognosis the most valid option should be selected. More investigation is necessary, studies with better methodological profiles and longer follow-up times, so that more robust conclusions can be achieved.
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