Background & Aims
Knee osteoarthritis (OA) is a degenerative disease and a significant cause of disability and pain globally. Effective non-surgical treatments are crucial for symptom management. With the emergence of new treatments such as radiofrequency ablation (RFA) and intra-articular mesenchymal stem cells (IA MSC) for knee OA, there are alternatives to intra-articular corticosteroids, hyaluronic acid, and platelet-rich plasma. This study aimed to compare the efficacy of RFA and IA MSC injection in the treatment of knee OA through a network meta-analysis (NMA).
Methods
A literature search of published data was conducted using PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and handsearching. Eligible randomized controlled trials (RCTs) with knee OA patients comparing RFA or IA MSC injection to conventional treatments were included. The main outcomes were the visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Clinical outcomes were compared using a frequentist approach, and the treatments were ranked using the surface under the cumulative ranking curve (SUCRA) values.
Results
A total of 34 RCTs (n=2371) were included. RFA ranked highest at 3 months (SUCRA: 0.921) VAS scores, and MSC slightly surpassed RFA at 6 months (SUCRA: 0.828 vs. 0.826). RFA achieved the highest probability ranking at both 3 and 6 months WOMAC scores (SUCRA: 0.821 and 0.806, respectively). Individual modalities were evaluated, with thermal GN RFA leading in VAS scores at 3 months (SUCRA: 0.856), and ADMSC leading at 6 months (SUCRA: 0.860). Pulsed GN RFA led in WOMAC scores at 3 months (SUCRA: 0.809), while Cooled GN RFA excelled at 6 months (SUCRA 0.906).
Conclusions
In knee OA treatment, RFA, especially Thermal GN RFA at 3 months and Cooled GN RFA at 6 months, demonstrated superior efficacy. MSC showed comparable effectiveness, slightly outperforming RFA at 6 months. These findings provide valuable insights for clinical decision-making in managing knee OA.
References
1.Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. Jama. Feb 9 2021;325(6):568-578. doi:10.1001/jama.2020.22171
2.Deshpande BR, Katz JN, Solomon DH, et al. Number of Persons With Symptomatic Knee Osteoarthritis in the US: Impact of Race and Ethnicity, Age, Sex, and Obesity. Arthritis Care Res (Hoboken). Dec 2016;68(12):1743-1750. doi:10.1002/acr.22897
3.Fine M. Quantifying the impact of NSAID-associated adverse events. Am J Manag Care. Nov 2013;19(14 Suppl):s267-72.
4.Bennell KL, Hinman RS. A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. J Sci Med Sport. Jan 2011;14(1):4-9. doi:10.1016/j.jsams.2010.08.002
5.Orchard JW. Is there a place for intra-articular corticosteroid injections in the treatment of knee osteoarthritis? Bmj. Jan 15 2020;368:l6923. doi:10.1136/bmj.l6923
6.Bahrami MH, Raeissadat SA, Cheraghi M, Rahimi-Dehgolan S, Ebrahimpour A. Efficacy of single high-molecular-weight versus triple low-molecular-weight hyaluronic acid intra-articular injection among knee osteoarthritis patients. BMC Musculoskelet Disord. Aug 15 2020;21(1):550. doi:10.1186/s12891-020-03577-8
7.Zhang Y, Yang H, He F, Zhu X. Intra-articular injection choice for osteoarthritis: making sense of cell source—an updated systematic review and dual network meta-analysis. Review. Arthritis Research and Therapy. 2022;24(1)doi:10.1186/s13075-022-02953-0
8.Wu L, Li Y, Si H, et al. Radiofrequency Ablation in Cooled Monopolar or Conventional Bipolar Modality Yields More Beneficial Short-Term Clinical Outcomes Versus Other Treatments for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Arthroscopy. Jul 2022;38(7):2287-2302. doi:10.1016/j.arthro.2022.01.048
9.Choi WJ, Hwang SJ, Song JG, et al. Radiofrequency treatment relieves chronic knee osteoarthritis pain: a double-blind randomized controlled trial. Pain. Mar 2011;152(3):481-487. doi:10.1016/j.pain.2010.09.029
10.Barry F. MSC Therapy for Osteoarthritis: An Unfinished Story. J Orthop Res. Jun 2019;37(6):1229-1235. doi:10.1002/jor.24343
11.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Rev Esp Cardiol (Engl Ed). Sep 2021;74(9):790-799. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. doi:10.1016/j.rec.2021.07.010
12.Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Annals of internal medicine. Jun 2 2015;162(11):777-84. doi:10.7326/m14-2385
13.GS. HJ. Cochrane handbook for systematic reviews of interventions. March, 2011. .
14.Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta-analyses can provide accurate results. J Clin Epidemiol. Jan 2006;59(1):7-10. doi:10.1016/j.jclinepi.2005.06.006
15.Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC medical research methodology. Dec 19 2014;14:135. doi:10.1186/1471-2288-14-135
16.Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). Aug 28 2019;366:l4898. doi:10.1136/bmj.l4898
17.Schünemann HJ, Oxman AD, Brozek J, et al. GRADE: assessing the quality of evidence for diagnostic recommendations. Evid Based Med. Dec 2008;13(6):162-3. doi:10.1136/ebm.13.6.162-a
18.Dias S, Welton NJ, Caldwell DM, Ades AE. Checking consistency in mixed treatment comparison meta-analysis. Stat Med. Mar 30 2010;29(7-8):932-44. doi:10.1002/sim.3767
19.Rücker G, Schwarzer G. Ranking treatments in frequentist network meta-analysis works without resampling methods. BMC Med Res Methodol. Jul 31 2015;15:58. doi:10.1186/s12874-015-0060-8
20.Ikeuchi M, Ushida T, Izumi M, Tani T. Percutaneous radiofrequency treatment for refractory anteromedial pain of osteoarthritic knees. Pain medicine (Malden, Mass). Apr 2011;12(4):546-51. doi:10.1111/j.1526-4637.2011.01086.x
21.Chou SH, Shen PC, Lu CC, et al. Comparison of Efficacy among Three Radiofrequency Ablation Techniques for Treating Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. Jul 12 2021;18(14)doi:10.3390/ijerph18147424
22.Xu S, Liu H, Xie Y, Sang L, Liu J, Chen B. Effect of mesenchymal stromal cells for articular cartilage degeneration treatment: a meta-analysis. Cytotherapy. Oct 2015;17(10):1342-52. doi:10.1016/j.jcyt.2015.05.005
23.Xia P, Wang X, Lin Q, Li X. Efficacy of mesenchymal stem cells injection for the management of knee osteoarthritis: a systematic review and meta-analysis. Int Orthop. Dec 2015;39(12):2363-72. doi:10.1007/s00264-015-2785-8
24.Yubo M, Yanyan L, Li L, Tao S, Bo L, Lin C. Clinical efficacy and safety of mesenchymal stem cell transplantation for osteoarthritis treatment: A meta-analysis. PLoS One. 2017;12(4):e0175449. doi:10.1371/journal.pone.0175449
Presenting Author
Sukhee Park
Poster Authors
Sukhee Park
MD
Catholic kwandong University School of Medicine
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Rheumatology, Arthritis, and Other