Scolaris Content Display Scolaris Content Display

Comparison 1 Corticosteroid versus placebo, Outcome 1 Pain: number of patients reporting pain reduction.
Figures and Tables -
Analysis 1.1

Comparison 1 Corticosteroid versus placebo, Outcome 1 Pain: number of patients reporting pain reduction.

Comparison 1 Corticosteroid versus placebo, Outcome 2 Number of knees reported with improvement 2 weeks post injection.
Figures and Tables -
Analysis 1.2

Comparison 1 Corticosteroid versus placebo, Outcome 2 Number of knees reported with improvement 2 weeks post injection.

Comparison 1 Corticosteroid versus placebo, Outcome 3 Number of knees reported with improvement 2 weeks post injection.
Figures and Tables -
Analysis 1.3

Comparison 1 Corticosteroid versus placebo, Outcome 3 Number of knees reported with improvement 2 weeks post injection.

Comparison 1 Corticosteroid versus placebo, Outcome 4 Pain: 0‐100 mm VAS.
Figures and Tables -
Analysis 1.4

Comparison 1 Corticosteroid versus placebo, Outcome 4 Pain: 0‐100 mm VAS.

Comparison 1 Corticosteroid versus placebo, Outcome 5 Number of responders (greater than 30% decrease in pain VAS from baseline).
Figures and Tables -
Analysis 1.5

Comparison 1 Corticosteroid versus placebo, Outcome 5 Number of responders (greater than 30% decrease in pain VAS from baseline).

Comparison 1 Corticosteroid versus placebo, Outcome 6 Number of responders (greater than 15% decrease in pain VAS) 3 weeks post injection.
Figures and Tables -
Analysis 1.6

Comparison 1 Corticosteroid versus placebo, Outcome 6 Number of responders (greater than 15% decrease in pain VAS) 3 weeks post injection.

Comparison 1 Corticosteroid versus placebo, Outcome 7 Pain: WOMAC pain (0‐100 mm VAS).
Figures and Tables -
Analysis 1.7

Comparison 1 Corticosteroid versus placebo, Outcome 7 Pain: WOMAC pain (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 8 Pain: at night (0‐100 mm VAS).
Figures and Tables -
Analysis 1.8

Comparison 1 Corticosteroid versus placebo, Outcome 8 Pain: at night (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 9 Function: WOMAC physical function (0‐100 mm VAS).
Figures and Tables -
Analysis 1.9

Comparison 1 Corticosteroid versus placebo, Outcome 9 Function: WOMAC physical function (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 10 Function: Lequesne Index (0‐24).
Figures and Tables -
Analysis 1.10

Comparison 1 Corticosteroid versus placebo, Outcome 10 Function: Lequesne Index (0‐24).

Comparison 1 Corticosteroid versus placebo, Outcome 11 Function: Modified HAQ (0‐9).
Figures and Tables -
Analysis 1.11

Comparison 1 Corticosteroid versus placebo, Outcome 11 Function: Modified HAQ (0‐9).

Comparison 1 Corticosteroid versus placebo, Outcome 12 Function: 50 foot walking time (sec).
Figures and Tables -
Analysis 1.12

Comparison 1 Corticosteroid versus placebo, Outcome 12 Function: 50 foot walking time (sec).

Comparison 1 Corticosteroid versus placebo, Outcome 13 Function: walking distance (m).
Figures and Tables -
Analysis 1.13

Comparison 1 Corticosteroid versus placebo, Outcome 13 Function: walking distance (m).

Comparison 1 Corticosteroid versus placebo, Outcome 14 Range of motion (degrees).
Figures and Tables -
Analysis 1.14

Comparison 1 Corticosteroid versus placebo, Outcome 14 Range of motion (degrees).

Comparison 1 Corticosteroid versus placebo, Outcome 15 Global assessment: number of patients showing improvement.
Figures and Tables -
Analysis 1.15

Comparison 1 Corticosteroid versus placebo, Outcome 15 Global assessment: number of patients showing improvement.

Comparison 1 Corticosteroid versus placebo, Outcome 16 Global assessment: number of patients preferring treatment.
Figures and Tables -
Analysis 1.16

Comparison 1 Corticosteroid versus placebo, Outcome 16 Global assessment: number of patients preferring treatment.

Comparison 1 Corticosteroid versus placebo, Outcome 17 Patient global assessment (0‐100 mm VAS).
Figures and Tables -
Analysis 1.17

Comparison 1 Corticosteroid versus placebo, Outcome 17 Patient global assessment (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 18 WOMAC stiffness (0‐100 mm VAS).
Figures and Tables -
Analysis 1.18

Comparison 1 Corticosteroid versus placebo, Outcome 18 WOMAC stiffness (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 19 WOMAC total (0‐100 mm VAS).
Figures and Tables -
Analysis 1.19

Comparison 1 Corticosteroid versus placebo, Outcome 19 WOMAC total (0‐100 mm VAS).

Comparison 1 Corticosteroid versus placebo, Outcome 20 Joint space width (mm).
Figures and Tables -
Analysis 1.20

Comparison 1 Corticosteroid versus placebo, Outcome 20 Joint space width (mm).

Comparison 1 Corticosteroid versus placebo, Outcome 21 Safety: total withdrawals overall.
Figures and Tables -
Analysis 1.21

Comparison 1 Corticosteroid versus placebo, Outcome 21 Safety: total withdrawals overall.

Comparison 1 Corticosteroid versus placebo, Outcome 22 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 1.22

Comparison 1 Corticosteroid versus placebo, Outcome 22 Safety: withdrawals due to lack of efficacy.

Comparison 1 Corticosteroid versus placebo, Outcome 24 Safety: number of patients experiencing post injection flare.
Figures and Tables -
Analysis 1.24

Comparison 1 Corticosteroid versus placebo, Outcome 24 Safety: number of patients experiencing post injection flare.

Comparison 1 Corticosteroid versus placebo, Outcome 25 Safety: number of patients reporting local discomfort.
Figures and Tables -
Analysis 1.25

Comparison 1 Corticosteroid versus placebo, Outcome 25 Safety: number of patients reporting local discomfort.

Comparison 2 Corticosteroid verus joint lavage, Outcome 1 Pain: number of responders (greater than 30% reduction in pain VAS from baseline).
Figures and Tables -
Analysis 2.1

Comparison 2 Corticosteroid verus joint lavage, Outcome 1 Pain: number of responders (greater than 30% reduction in pain VAS from baseline).

Comparison 2 Corticosteroid verus joint lavage, Outcome 2 Pain (0‐100 mm VAS).
Figures and Tables -
Analysis 2.2

Comparison 2 Corticosteroid verus joint lavage, Outcome 2 Pain (0‐100 mm VAS).

Comparison 2 Corticosteroid verus joint lavage, Outcome 3 Pain on movement: number of responders (at least 30% reduction).
Figures and Tables -
Analysis 2.3

Comparison 2 Corticosteroid verus joint lavage, Outcome 3 Pain on movement: number of responders (at least 30% reduction).

Comparison 2 Corticosteroid verus joint lavage, Outcome 4 Pain (0‐10 cm VAS).
Figures and Tables -
Analysis 2.4

Comparison 2 Corticosteroid verus joint lavage, Outcome 4 Pain (0‐10 cm VAS).

Comparison 2 Corticosteroid verus joint lavage, Outcome 5 Pain: number of knees with spontaneous pain.
Figures and Tables -
Analysis 2.5

Comparison 2 Corticosteroid verus joint lavage, Outcome 5 Pain: number of knees with spontaneous pain.

Comparison 2 Corticosteroid verus joint lavage, Outcome 6 Pain: number of knees with pain on active motion.
Figures and Tables -
Analysis 2.6

Comparison 2 Corticosteroid verus joint lavage, Outcome 6 Pain: number of knees with pain on active motion.

Comparison 2 Corticosteroid verus joint lavage, Outcome 7 Pain: number of knees with pain on passive motion.
Figures and Tables -
Analysis 2.7

Comparison 2 Corticosteroid verus joint lavage, Outcome 7 Pain: number of knees with pain on passive motion.

Comparison 2 Corticosteroid verus joint lavage, Outcome 8 Pain: number of knees with pain on pressue.
Figures and Tables -
Analysis 2.8

Comparison 2 Corticosteroid verus joint lavage, Outcome 8 Pain: number of knees with pain on pressue.

Comparison 2 Corticosteroid verus joint lavage, Outcome 9 Function: number of knees with restricted motion.
Figures and Tables -
Analysis 2.9

Comparison 2 Corticosteroid verus joint lavage, Outcome 9 Function: number of knees with restricted motion.

Comparison 2 Corticosteroid verus joint lavage, Outcome 10 Function: Lequesne Index (0‐24).
Figures and Tables -
Analysis 2.10

Comparison 2 Corticosteroid verus joint lavage, Outcome 10 Function: Lequesne Index (0‐24).

Comparison 2 Corticosteroid verus joint lavage, Outcome 11 OARSI responsder criteria (20% decrease in pain VAS and >10 mm and/or improved function >20% and 10 units).
Figures and Tables -
Analysis 2.11

Comparison 2 Corticosteroid verus joint lavage, Outcome 11 OARSI responsder criteria (20% decrease in pain VAS and >10 mm and/or improved function >20% and 10 units).

Comparison 2 Corticosteroid verus joint lavage, Outcome 12 Crepitation: number of knees with symptom.
Figures and Tables -
Analysis 2.12

Comparison 2 Corticosteroid verus joint lavage, Outcome 12 Crepitation: number of knees with symptom.

Comparison 2 Corticosteroid verus joint lavage, Outcome 13 Global assessment (0‐100 mm VAS).
Figures and Tables -
Analysis 2.13

Comparison 2 Corticosteroid verus joint lavage, Outcome 13 Global assessment (0‐100 mm VAS).

Comparison 2 Corticosteroid verus joint lavage, Outcome 14 Effusion: number of knees with effusion.
Figures and Tables -
Analysis 2.14

Comparison 2 Corticosteroid verus joint lavage, Outcome 14 Effusion: number of knees with effusion.

Comparison 2 Corticosteroid verus joint lavage, Outcome 15 Effusion: number of patients with effusion.
Figures and Tables -
Analysis 2.15

Comparison 2 Corticosteroid verus joint lavage, Outcome 15 Effusion: number of patients with effusion.

Comparison 2 Corticosteroid verus joint lavage, Outcome 16 Safety: total withdrawals overall.
Figures and Tables -
Analysis 2.16

Comparison 2 Corticosteroid verus joint lavage, Outcome 16 Safety: total withdrawals overall.

Comparison 2 Corticosteroid verus joint lavage, Outcome 17 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 2.17

Comparison 2 Corticosteroid verus joint lavage, Outcome 17 Safety: withdrawals due to lack of efficacy.

Comparison 2 Corticosteroid verus joint lavage, Outcome 18 Safety: number of patients reporting local discomfort.
Figures and Tables -
Analysis 2.18

Comparison 2 Corticosteroid verus joint lavage, Outcome 18 Safety: number of patients reporting local discomfort.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 1 Spontaneous pain intensity (0‐100 mm VAS).
Figures and Tables -
Analysis 3.1

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 1 Spontaneous pain intensity (0‐100 mm VAS).

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 2 Number of joints with moderate or severe pain under load.
Figures and Tables -
Analysis 3.2

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 2 Number of joints with moderate or severe pain under load.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 3 Number of patients with moderate or severe pain under load.
Figures and Tables -
Analysis 3.3

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 3 Number of patients with moderate or severe pain under load.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 4 Number of joints with moderate or severe walking pain.
Figures and Tables -
Analysis 3.4

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 4 Number of joints with moderate or severe walking pain.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 5 Number of patients with at least moderate or greater night pain.
Figures and Tables -
Analysis 3.5

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 5 Number of patients with at least moderate or greater night pain.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 6 Number of patients with moderate or greater rest pain.
Figures and Tables -
Analysis 3.6

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 6 Number of patients with moderate or greater rest pain.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 7 Function: range of motion (flexion in degrees).
Figures and Tables -
Analysis 3.7

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 7 Function: range of motion (flexion in degrees).

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 8 Patient global (number of patients very good/good, excellent/good).
Figures and Tables -
Analysis 3.8

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 8 Patient global (number of patients very good/good, excellent/good).

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 9 Safety: total withdrawals overall.
Figures and Tables -
Analysis 3.9

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 9 Safety: total withdrawals overall.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 10 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 3.10

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 10 Safety: withdrawals due to lack of efficacy.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 11 Safety: withdrawals due to adverse events.
Figures and Tables -
Analysis 3.11

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 11 Safety: withdrawals due to adverse events.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 12 Safety: number of patients with local or systemic reactions.
Figures and Tables -
Analysis 3.12

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 12 Safety: number of patients with local or systemic reactions.

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 13 Safety: number of joints with local reactions but continued in trial.
Figures and Tables -
Analysis 3.13

Comparison 3 Methylprednisolone acetate versus Hyalgan, Outcome 13 Safety: number of joints with local reactions but continued in trial.

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 1 Pain on nominated activity (0‐100 mm VAS).
Figures and Tables -
Analysis 4.1

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 1 Pain on nominated activity (0‐100 mm VAS).

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 2 Pain at rest (0‐100 mm VAS).
Figures and Tables -
Analysis 4.2

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 2 Pain at rest (0‐100 mm VAS).

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 3 Pain at night (0‐100 mm VAS).
Figures and Tables -
Analysis 4.3

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 3 Pain at night (0‐100 mm VAS).

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 4 Safety: total withdrawals overall.
Figures and Tables -
Analysis 4.4

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 4 Safety: total withdrawals overall.

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 5 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 4.5

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 5 Safety: withdrawals due to lack of efficacy.

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 6 Safety: wIthdrawals due to adverse events.
Figures and Tables -
Analysis 4.6

Comparison 4 Triamcinolone hexacetonide versus Hyalgan, Outcome 6 Safety: wIthdrawals due to adverse events.

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 1 Safety: total withdrawals overall.
Figures and Tables -
Analysis 5.1

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 1 Safety: total withdrawals overall.

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 2 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 5.2

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 2 Safety: withdrawals due to lack of efficacy.

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 3 Safety: withdrawals due to acute local reaction.
Figures and Tables -
Analysis 5.3

Comparison 5 Betamethasone versus hylan G‐F 20, Outcome 3 Safety: withdrawals due to acute local reaction.

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 1 WOMAC pain walking on a flat surface (question 1: 0‐4 Likert).
Figures and Tables -
Analysis 6.1

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 1 WOMAC pain walking on a flat surface (question 1: 0‐4 Likert).

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 2 WOMAC physical function subscale (0‐68 Likert).
Figures and Tables -
Analysis 6.2

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 2 WOMAC physical function subscale (0‐68 Likert).

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 3 WOMAC total score (0‐96 Likert).
Figures and Tables -
Analysis 6.3

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 3 WOMAC total score (0‐96 Likert).

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 4 Patient global overall assessment (0‐100 mm VAS).
Figures and Tables -
Analysis 6.4

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 4 Patient global overall assessment (0‐100 mm VAS).

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 5 Number of responders (greater than or equal to one category on WOMAC pain question 1).
Figures and Tables -
Analysis 6.5

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 5 Number of responders (greater than or equal to one category on WOMAC pain question 1).

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 6 Analgesic usage.
Figures and Tables -
Analysis 6.6

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 6 Analgesic usage.

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 7 Safety: total withdrawals overall.
Figures and Tables -
Analysis 6.7

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 7 Safety: total withdrawals overall.

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 8 Safety: wIthdrawals due to adverse event.
Figures and Tables -
Analysis 6.8

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 8 Safety: wIthdrawals due to adverse event.

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 9 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 6.9

Comparison 6 Triamcinolone hexacetonide versus hylan G‐F 20, Outcome 9 Safety: withdrawals due to lack of efficacy.

Comparison 7 Betamethasone versus Orthovisc, Outcome 1 WOMAC function (17‐85 Likert).
Figures and Tables -
Analysis 7.1

Comparison 7 Betamethasone versus Orthovisc, Outcome 1 WOMAC function (17‐85 Likert).

Comparison 7 Betamethasone versus Orthovisc, Outcome 2 Flexion (degrees).
Figures and Tables -
Analysis 7.2

Comparison 7 Betamethasone versus Orthovisc, Outcome 2 Flexion (degrees).

Comparison 7 Betamethasone versus Orthovisc, Outcome 3 Patient global assessment: number of patients good or very good.
Figures and Tables -
Analysis 7.3

Comparison 7 Betamethasone versus Orthovisc, Outcome 3 Patient global assessment: number of patients good or very good.

Comparison 7 Betamethasone versus Orthovisc, Outcome 4 Safety: total withdrawals overall.
Figures and Tables -
Analysis 7.4

Comparison 7 Betamethasone versus Orthovisc, Outcome 4 Safety: total withdrawals overall.

Comparison 7 Betamethasone versus Orthovisc, Outcome 5 Safety: withdrawals due to adverse events.
Figures and Tables -
Analysis 7.5

Comparison 7 Betamethasone versus Orthovisc, Outcome 5 Safety: withdrawals due to adverse events.

Comparison 7 Betamethasone versus Orthovisc, Outcome 6 Safety: number of patients with local adverse events.
Figures and Tables -
Analysis 7.6

Comparison 7 Betamethasone versus Orthovisc, Outcome 6 Safety: number of patients with local adverse events.

Comparison 7 Betamethasone versus Orthovisc, Outcome 7 Safety: number of patients with systemic adverse events.
Figures and Tables -
Analysis 7.7

Comparison 7 Betamethasone versus Orthovisc, Outcome 7 Safety: number of patients with systemic adverse events.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 1 Pain on weight bearing (0‐100 mm VAS).
Figures and Tables -
Analysis 8.1

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 1 Pain on weight bearing (0‐100 mm VAS).

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 2 Pain at rest (0‐100 mm VAS).
Figures and Tables -
Analysis 8.2

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 2 Pain at rest (0‐100 mm VAS).

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 3 Pain on walking (0‐100 mm VAS).
Figures and Tables -
Analysis 8.3

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 3 Pain on walking (0‐100 mm VAS).

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 4 Lequesne Index (0‐24).
Figures and Tables -
Analysis 8.4

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 4 Lequesne Index (0‐24).

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 5 Flexion (active range in degrees).
Figures and Tables -
Analysis 8.5

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 5 Flexion (active range in degrees).

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 6 Safety: total withdrawals overall.
Figures and Tables -
Analysis 8.6

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 6 Safety: total withdrawals overall.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 7 Safety: number of patients withdrawn due to increased pain.
Figures and Tables -
Analysis 8.7

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 7 Safety: number of patients withdrawn due to increased pain.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 8 Safety: number of patients reporting musculoskeletal adverse events.
Figures and Tables -
Analysis 8.8

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 8 Safety: number of patients reporting musculoskeletal adverse events.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 9 Safety: number of patients reporting skin adverse events.
Figures and Tables -
Analysis 8.9

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 9 Safety: number of patients reporting skin adverse events.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 10 Safety: number of patients reporting gastrointestinal adverse events.
Figures and Tables -
Analysis 8.10

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 10 Safety: number of patients reporting gastrointestinal adverse events.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 11 Safety: number of patients reporting general adverse events.
Figures and Tables -
Analysis 8.11

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 11 Safety: number of patients reporting general adverse events.

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 12 Safety: number of patients reporting knee pain after injection.
Figures and Tables -
Analysis 8.12

Comparison 8 6‐Methylprednisolone acetate versus Orthovisc, Outcome 12 Safety: number of patients reporting knee pain after injection.

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 1 Pain (0‐100 mm VAS).
Figures and Tables -
Analysis 9.1

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 1 Pain (0‐100 mm VAS).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 2 WOMAC pain (0‐20 Likert).
Figures and Tables -
Analysis 9.2

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 2 WOMAC pain (0‐20 Likert).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 3 WOMAC physical function (0‐68 Likert).
Figures and Tables -
Analysis 9.3

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 3 WOMAC physical function (0‐68 Likert).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 4 50 foot walking time (seconds).
Figures and Tables -
Analysis 9.4

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 4 50 foot walking time (seconds).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 5 Range of motion (degrees).
Figures and Tables -
Analysis 9.5

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 5 Range of motion (degrees).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 6 WOMAC stiffness (0‐8 Likert).
Figures and Tables -
Analysis 9.6

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 6 WOMAC stiffness (0‐8 Likert).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 7 WOMAC total score (0‐96 Likert).
Figures and Tables -
Analysis 9.7

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 7 WOMAC total score (0‐96 Likert).

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 8 Safety: total withdrawals overall.
Figures and Tables -
Analysis 9.8

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 8 Safety: total withdrawals overall.

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 9 Safety: withdrawals due to lack of efficacy.
Figures and Tables -
Analysis 9.9

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 9 Safety: withdrawals due to lack of efficacy.

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 10 Safety: number of patients reporting adverse events (local reactions).
Figures and Tables -
Analysis 9.10

Comparison 9 Triamcinolone acetonide plus Orthovisc versus Orthovisc, Outcome 10 Safety: number of patients reporting adverse events (local reactions).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 1 Pain: number of patients reporting pain reduction.
Figures and Tables -
Analysis 10.1

Comparison 10 Corticosteroid versus corticosteroid, Outcome 1 Pain: number of patients reporting pain reduction.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 2 Pain: number of knees reported with improvement 2 weeks post injection.
Figures and Tables -
Analysis 10.2

Comparison 10 Corticosteroid versus corticosteroid, Outcome 2 Pain: number of knees reported with improvement 2 weeks post injection.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 3 Pain: during movement (0‐3).
Figures and Tables -
Analysis 10.3

Comparison 10 Corticosteroid versus corticosteroid, Outcome 3 Pain: during movement (0‐3).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 4 Pain: at rest (0‐3).
Figures and Tables -
Analysis 10.4

Comparison 10 Corticosteroid versus corticosteroid, Outcome 4 Pain: at rest (0‐3).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 5 Pain: on pressure (0‐3).
Figures and Tables -
Analysis 10.5

Comparison 10 Corticosteroid versus corticosteroid, Outcome 5 Pain: on pressure (0‐3).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 6 Pain (0‐100 mm VAS).
Figures and Tables -
Analysis 10.6

Comparison 10 Corticosteroid versus corticosteroid, Outcome 6 Pain (0‐100 mm VAS).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 7 Lequesne Index.
Figures and Tables -
Analysis 10.7

Comparison 10 Corticosteroid versus corticosteroid, Outcome 7 Lequesne Index.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 8 Function: range of motion (flexion 4 weeks post injection).
Figures and Tables -
Analysis 10.8

Comparison 10 Corticosteroid versus corticosteroid, Outcome 8 Function: range of motion (flexion 4 weeks post injection).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 9 Stair climb time (seconds).
Figures and Tables -
Analysis 10.9

Comparison 10 Corticosteroid versus corticosteroid, Outcome 9 Stair climb time (seconds).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 10 Index of disease activity (0‐10).
Figures and Tables -
Analysis 10.10

Comparison 10 Corticosteroid versus corticosteroid, Outcome 10 Index of disease activity (0‐10).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 11 Global assessment: number of patients showing improvement 1 week post injection.
Figures and Tables -
Analysis 10.11

Comparison 10 Corticosteroid versus corticosteroid, Outcome 11 Global assessment: number of patients showing improvement 1 week post injection.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 12 Global assessment: number of patients improved 1 week post injection.
Figures and Tables -
Analysis 10.12

Comparison 10 Corticosteroid versus corticosteroid, Outcome 12 Global assessment: number of patients improved 1 week post injection.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 13 Global assessment: number of patients reporting improvement from baseline.
Figures and Tables -
Analysis 10.13

Comparison 10 Corticosteroid versus corticosteroid, Outcome 13 Global assessment: number of patients reporting improvement from baseline.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 14 Global assessment: number of knees excellent or good as assessed by physician at 20 weeks post injection.
Figures and Tables -
Analysis 10.14

Comparison 10 Corticosteroid versus corticosteroid, Outcome 14 Global assessment: number of knees excellent or good as assessed by physician at 20 weeks post injection.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 15 Safety: number of patients reporting local pain after injection (triamcinolone hexacetonide versus betamethaso.
Figures and Tables -
Analysis 10.15

Comparison 10 Corticosteroid versus corticosteroid, Outcome 15 Safety: number of patients reporting local pain after injection (triamcinolone hexacetonide versus betamethaso.

Comparison 10 Corticosteroid versus corticosteroid, Outcome 16 Safety: number of patients reporting local pain after injection (hydrocortisone acetate vs hydrocortisone TBA).
Figures and Tables -
Analysis 10.16

Comparison 10 Corticosteroid versus corticosteroid, Outcome 16 Safety: number of patients reporting local pain after injection (hydrocortisone acetate vs hydrocortisone TBA).

Comparison 10 Corticosteroid versus corticosteroid, Outcome 17 Safety: number of adverse events recorded.
Figures and Tables -
Analysis 10.17

Comparison 10 Corticosteroid versus corticosteroid, Outcome 17 Safety: number of adverse events recorded.

Table 1. Clinical benefit: Corticosteroid versus placebo ‐ pain (dichotomous)

Study

Time

Treatment

Outcome

No. improved

No. of pts.

Risk (% occurrence)

Risk difference

NNT

Friedman 1980

1 wk

T: Triamcinolone hexacetonide

Numeber of patients reporting pain reduction

15

17

88%

17%

No significant difference

C: Vehicle

12

17

71%

Friedman 1980

8 wk

T: Triamcinolone hexacetonide

Number of patients reporting pain reduction

11

17

65%

0%

No significant difference

C: Vehicle

11

17

65%

Jones 1996

3 wk

T: Methylprednisolone

% responders (greater than 15% decrease in VAS pain)

28

59

47%

32%

3.1

C: Saline

9

59

15%

Ravaud 1999

1 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

16

25

64%

39%

2.6

C: Saline

7

28

25%

Ravaud 1999

4 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

14

25

56%

27%

No significant difference

C: Saline

8

28

29%

Ravaud 1999

12 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

13

25

52%

23%

No significant difference

C: Saline

8

28

29%

Ravaud 1999

24 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

12

25

48%

26%

No significant difference

C: Saline

6

28

22%

Figures and Tables -
Table 1. Clinical benefit: Corticosteroid versus placebo ‐ pain (dichotomous)
Table 2. Clinical benefit: Corticosteroid versus placebo ‐ patient global assessment

Study(ies)

Time

Treatment

Outcome

No. improved

No. of pts.

Risk (% occurrence)

Risk Difference

NNT

Cederlof 1966, Gaffney 1995, Popov 1989

1 wk

T: IA corticosteroid

Number of patients showing improvement

62

80

78%

23%

4.35*

C: IA placebo

42

78

54%

Dieppe 1980a, Dieppe 1980b, Jones 1996

6 wk

T: IA corticosteroid

Number of patients preferring treatment

60

95

63%

35%

2.86*

C: IA placebo

27

95

28%

Cederlof 1966

1 wk

T: Prednisolone acetate

Distinct improvement

18

26

69%

13%

No significant difference

C: Saline

14

25

56%

Cederlof 1966

3 wk

T: Prednisolone acetate

Distinct improvement

19

26

73%

‐7%

No significant difference

C: Saline

20

25

80%

Cederlof 1966

8 wk

T: Prednisolone acetate

Distinct improvement

17

26

65%

‐11%

No significant difference

C: Saline

19

25

76%

Dieppe 1980a

6 wk

T: Triamcinolone hexacetonide

Patient treatment preference

10

12

83%

66%

1.5

C: Saline

2

12

17%

Dieppe 1980b

2 wk

T: Triamcinolone hexacetonide

Patient treatment preference

20

24

83%

37%

2.7

C: Saline

11

24

46%

Gaffney 1995

1 wk

T: Triamcinolone hexacetonide

Overall improvement

33

42

79%

31%

3.2

C: Saline

20

42

48%

Gaffney 1995

6 wk

T: Trimacinolone hexacetonide

Overall improvement

24

42

57%

2%

No significant difference

C: Saline

23

42

55%

Jones 1996

3 wk

T: Methylprednisolone

Treatment preference

30

59

51%

27%

3.7

C: Saline

14

59

24%

Miller 1958

6 wk

T: Hydrocortisone

Patient opinion

31

37

84%

6%

No significant difference

C: Saline

28

36

78%

Miller 1958

6 mth

T: Hydrocortisone

Patient opinion

30

34

88%

‐6%

No significant difference

C: Saline

32

34

94%

Popov 1989

1 wk

T: Hydrocortisone

Patient global

11

12

92%

19%

No significant difference

C: Physiologic solution

8

11

73%

Popov 1989

1 wk

T: Triamcinolone acetonide

Patient global

7

7

100%

27%

3.7

C: Physiologic solution

8

11

73%

Wright 1960

2 wk

T: Hydrocortisone

Number of knees improved

19

38

50%

14%

No significant difference

C: Vehicle

12

33

36%

Wright 1960

2 wk

T: Hydrocortisone tertiary butylacetate

Number of knees improved

25

38

66%

30%

3.3

C: Vehicle

12

33

36%

* Pooled NNT

Figures and Tables -
Table 2. Clinical benefit: Corticosteroid versus placebo ‐ patient global assessment
Table 3. Clinical benefit: Corticosteroid versus arthroscopy (joint lavage) ‐ dichotomous

Study

Time

Treatment

Outcome

No. improved

No. of pts.

Risk (%)

Risk Difference

NNT

Ravaud 1999

1 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

16

25

64%

16%

No significant difference

C: Joint lavage + IA Placebo

10

21

48%

Ravaud 1999

4 wk

T: Cortivazol

% responders (greater than30% decrease in VAS pain)

14

25

56%

8%

No significant difference

C: Joint lavage + IA Placebo

10

21

48%

Ravaud 1999

12 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

13

25

52%

4%

No significant difference

C: Joint lavage + IA Placebo

10

21

48%

Ravaud 1999

24 wk

T: Cortivazol

% responders (greater than 30% decrease in VAS pain)

12

25

48%

0%

No significant difference

C: Joint lavage + IA Placebo

10

21

48%

Smith 2003

2 wk

T: Arthroscopy+joint lavage+ methylprednisolone acetate

% responders (greater than or equal to 30% decrease in pain on movement)

26

38

68%

13%

No significant difference

C: Arthroscopy+joint lavage+saline

18

33

55%

Smith 2003

4 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

% responders (greater than or equal to 30% decrease in pain on movement)

25

38

66%

8%

No significant difference

C: Arthroscopy+joint lavage+saline

19

33

58%

Smith 2003

8 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

% responders (greater than or equal to 30% decrease in pain on movement)

23

38

61%

6%

No significant difference

C: Arthroscopy+joint lavage+saline

18

33

55%

Smith 2003

12 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

% responders (greater than or equal to 30% decrease in pain on movement)

18

38

47%

‐8%

No significant difference

C: Arthroscopy+joint lavage+saline

18

33

55%

Smith 2003

24 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

% responders (greater than or equal to 30% decrease in pain on movement)

15

38

39%

‐3%

No significant difference

C: Arthroscopy+joint lavage+saline

14

33

42%

Smith 2003

2 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

OARSI responder criteria (greater than or equal to 20% decrease in pain VAS and greater than10 mm absolute and/or improvement in function greater than 20% and greater than 10 mm absolute)

25

38

66%

11%

No significant difference

C: Arthroscopy+joint lavage+saline

15

33

45%

Smith 2003

4 wk

T: Arthroscopy+joint lavage+methylprednisolone

OARSI responder criteria (greater than or equal to 20% decrease in pain VAS and greater than 10 mm absolute and/or improvement function greater than 20% and greater than 10 mm absolute)

22

38

58%

25%

No significant difference

C: Arthroscopy+joint lavage+saline

11

33

33%

Smith 2003

8 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

OARSI responder criteria (greater than or equal to 20% decrease in pain VAS and greater than 10 mm absolute and/or improvement function greater than 20% and greater than 10 mm absolute)

21

38

55%

22%

No significant difference

C: Arthroscopy+joint lavage+saline

11

33

33%

Smith 2003

12 wk

T: Arthroscopy+joint lavage+methylprednisolone

OARSI responder criteria (greater than or equal to 20% decrease in pain and greater than 10 mm absolute and/or improvement function greater than 20% and greater than 10 mm absolute)

18

38

47%

17%

No significant difference

C: Arthroscopy+joint lavage+saline

10

33

30%

Smith 2003

24 wk

T: Arthroscopy+joint lavage+methylprednisolone

OARSI responder criteria (greater than or equal to 20% decrease in pain VAS and greater than 10 mm absolute and/or improvement function greater than 20% and greater than 10 mm absolute)

16

38

42%

21%

No significant difference

C: Arthroscopy+joint lavage+saline

7

33

21%

Smith 2003

2 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

Presence of effusion

2

38

5%

‐22%

5

C: Arthroscopy+joint lavage+saline

9

33

27%

Smith 2003

4 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

Presence of effusion

6

38

16%

‐17%

No significant difference

C: Arthroscopy+joint lavage+saline

11

33

33%

Smith 2003

8 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

Presence of effusion

6

38

16%

‐17%

No significant difference

C: Arthroscopy+joint lavage+saline

11

33

33%

Smith 2003

12 wk

T: Arthroscopy+joint lavage+methylprednisolone acetate

Presence of effusion

9

38

24%

‐3%

No significant difference

C: Arthroscopy+joint lavage+saline

9

33

27%

Smith 2003

24 wk

T: Arthroscopy+joint lavage+methylprednisolone

Presence of effusion

10

38

26%

‐10%

No significant difference

C: Arthroscopy+joint lavage+saline

12

33

36%

Figures and Tables -
Table 3. Clinical benefit: Corticosteroid versus arthroscopy (joint lavage) ‐ dichotomous
Table 4. Clinical benefit: Corticosteroid versus Hyalgan ‐ dichotomous outcome measures

Study

Time

Treatment

Outcome

No. improved

No. of pts

Risk (%)

Risk Difference

NNT

Leardini 1987

1‐4 wk

T: Hyalgan

Number of joints with moderate or severe pain under load

8

20

40

0

C: MPA

8

20

40

Leardini 1991

1‐4 wk

T: Hyalgan

Number of patients with moderate or severe pain under load

14

20

70

25

4

C: MPA

19

20

95

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Number of patients with moderate or severe pain under load

21

45

47

7

14.3

C: MPA

18

45

40

Leardini 1987

5‐13 wk

T: Hyalgan

Number of joints with moderate or severe pain under load

6

20

30

5

20

C: MPA

7

20

35

Leardini 1991

5‐13 wk

T: Hyalgan

Number of patients with moderate or severe pain under load

13

20

65

35

2.9

C: MPA

20

20

100

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Number of patients with moderate or severe pain under load

13

44

30

21

4.8

C: MPA

23

45

51

Leardini 1987

45.52 wk

T: Hyalgan

Number of joints with moderate or severe pain under load

8

15

53

12

8.3

C: MPA

11

17

65

Leardini 1987

1‐4 wk

T: Hyalgan

Number of joints with moderate or severe walking pain

11

20

55

10

10

C: MPA

9

20

45

Leardini 1987

5‐13 wk

T: Hyalgan

Number of joints with moderate or severe walking pain

8

20

40

10

10

C: MPA

10

20

50

Leardini 1987

45‐52 wk

T: Hyalgan

Number of joints with moderate or severe walking pain

11

15

73

2

50

C: MPA

12

17

71

Leardini 1991

1‐4 wk

T: Hyalgan

Number of patients with at least moderate or greater night pain

1

20

5

15

6.7

C: MPA

4

20

20

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Number of patients with at least moderate or greater night pain

5

45

11

9

11.1

C: MPA

1

45

2

Leardini 1991

5‐13 wk

T: Hyalgan

Number of patients with at least moderate or greater night pain

0

20

0

20

5

C: MPA

4

20

20

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Number of patients with at least moderate or greater night pain

0

44

0

C: MPA

2

45

4

4

25

Leardini 1991

1‐4 wk

T: Hyalgan

Number of patients with moderate or greater rest pain

6

20

30

30

3.3

C: MPA

12

20

60

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Number of patients with moderate or greater rest pain

7

45

16

0

0

C: MPA

7

45

16

Leardini 1991

5‐13 wk

T: Hyalgan

Number of patients with moderate or greater rest pain

6

20

30

45

2.2

C: MPA

15

20

75

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Number of patients with moderate or greater rest pain

1

44

2

5

20

C: MPA

3

45

7

Frizziero 2002

1‐4 wk

T: Hyalgan

Patient global (number of patients very good or good)

21

46

46

‐40

2.5

C: MPA

32

37

86

Leardini 1991

1‐4 wk

T: Hyalgan

Patient global (number of patients very good or good)

11

20

55

10

10

C: MPA

9

20

45

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Patient global (number of patients very good or good)

32

45

71

24

4.2

C: MPA

21

45

47

Leardini 1991

5‐13 wk

T: Hyalgan

Patient global (number of patients very good or good)

10

20

50

15

6.7

C: MPA

7

20

35

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Patient global (number of patients very good or good)

31

45

69

36

2.8

C: MPA

15

45

33

Frizziero 2002

14‐26 wk

T: Hyalgan

Patient global (number of patients very good or good)

30

38

79

4

25

C: MPA

24

32

75

Figures and Tables -
Table 4. Clinical benefit: Corticosteroid versus Hyalgan ‐ dichotomous outcome measures
Table 5. Clinical benefit: Betamethasone versus Orthovisc ‐ dichotomous outcome measures

Study

Time

Treatment

Outcome

No. improved

No. of pts.

Risk (%)

Risk difference

NNT

Tekeoglu 1998

1‐4 wk

E: Orthovisc

Patient global (number of patients good or very good)

10

20

50

‐10

10

C: Betamethasone

12

20

60

Tekeoglu 1998

5‐13 wk

E: Orthovisc

Patient global (number of patients good or very good)

15

20

75

35

2.9

C: Betamethasone

Figures and Tables -
Table 5. Clinical benefit: Betamethasone versus Orthovisc ‐ dichotomous outcome measures
Table 6. Clinical benefit: Corticosteroid versus corticosteroid ‐ dichotomous measures

Study

Time

Treatment

Outcome

No. improved

No. of pts

Risk (% occurrence)

Risk Difference

NNT

Thorpe 1985

20 wk

T: Triamcinolone acetonide

Number of knees excellent or good

19

30

63%

4%

No significant difference

C: Methylprednisolone acetate

22

37

59%

Valtonen 1981

1 wk

T: Triamcinolone hexacetonide

Number of patients reporting pain reduction

16

21

76%

33%

3

C: Betamethasone

9

21

43%

Valtonen 1981

2 wk

T: Triamcinolone hexacetonide

Number of patients reporting pain reduction

18

21

86%

38%

3

C: Betamethasone

10

21

48%

Valtonen 1981

4 wk

T: Triamcinolone hexacetonide

Number of patients reporting pain reduction

16

21

76%

38%

3

C: Betamethasone

8

21

38%

Valtonen 1981

1 wk

T: Triamcinolone hexacetonide

Number of patients showing improvement

19

21

90%

23%

No significant difference

C: Betamethasone

14

21

67%

Wright 1980

2 wk

T: Hydrocortisone tertiary‐butylacetate

Number of knees improved

25

38

66%

16%

No significant difference

C: Hydrocortisone

19

38

50%

Popov 1989

1 wk

T: Hydrocortisone

Patient global assessment

11

12

92%

‐8%

No significant difference

C: Triamcinolone acetonide

7

7

100%

Pyne 2004

3 wk

T: Triamcinolone hexacetonide

Number of patients reporting improvement (i.e. better)

25

29

86%

4%

No significant difference

C: Methylprednisolone acetate

23

28

82%

Pyne 2004

8 wk

T: Triamcinolone hexacetonide

Number of patients reporting improvement (i.e. better)

15

29

52%

12%

No significant difference

C: Methylprednisolone acetate

18

28

64%

Figures and Tables -
Table 6. Clinical benefit: Corticosteroid versus corticosteroid ‐ dichotomous measures
Table 7. Clinical benefit: Corticosteroid versus placebo ‐ continuous outcome measures

Study

Time

Treatment

Outcome (scale)

N of pts

Baseline Mean

End of Study Mean

Absolute benefit

Relative difference

Dieppe 1980b

1 wk

T: Triamcinolone hexacetonide first

Pain (0‐10 cm VAS)

12

7.6

3.7

1.1 (W)

15% (W)

C: Saline second

12

7.6

2.6

Dieppe 1980b

1 wk

T: Triamcinolone hexacetonide second

Pain (0‐10 cm VAS)

12

8.2

3.8

‐3.2 (I)

‐39% (I)

C: Saline first

12

8.2

7

Gaffney 1995

6 wk

T: Triamcinolone hexacetonide

Pain (0‐100 mm VAS)

42

52

35.8

‐2.1 (I)

No significant difference

C: Saline

42

57

42.9

Gaffney 1995

6 wk

T: Triamcinolone hexacetonide

Walking distance (m)

42

48.9

50.8

‐3.2 (W)

No significant difference

C: Saline

42

46.5

51.6

Gaffney 1995

6 wk

T: Triamcinolone hexacetonide

Modified HAQ (0‐9)

42

4.7

4.5

0

No significant difference

C: Saline

42

4.4

4.2

Raynauld 2003

52 wk

T: Triamcinolone acetonide

Pain at night (0‐100 mm VAS)

33

26.2

15.5

‐13.3 (I)

No significant difference

C: Saline

33

23.2

25.8

Raynauld 2003

104 wk

T: Triamcinolone acetonide

Pain at night (0‐100 mm VAS)

33

26.2

23.4

‐1.8 (W)

No significant difference

C: Saline

33

23.2

22.2

Raynauld 2003

52 wk

T: Triamcinolone acetonide

WOMAC Pain (0‐100 mm VAS)

33

40.1

22.7

‐6.2 (I)

No significant difference

C: Saline

33

47.7

36.5

Raynauld 2003

104 wk

T: Triamcinolone acetonide

WOMAC pain (0‐100 mm VAS)

33

40.1

28.7

2.4 (I)

No significant difference

C: Saline

33

47.7

33.9

Raynauld 2003

52 wk

T: Triamcinolone acetonide

WOMAC function (0‐100 mm VAS)

33

32.9

20.2

0.4 (I)

No significant difference

C: Saline

33

39.3

26.2

Raynauld 2003

104 wk

T: Triamcinolone acetonide

WOMAC function (0‐100 mm VAS)

33

32.9

22.0

2.2 (I)

No significant difference

C: Saline

33

39.3

26.2

Raynauld 2003

52 wk

T: Triamcinolone acetonide

50 foot walking time (sec)

33

11.6

15.5

3.9 (W)

No significant difference

C: Saline

33

11.6

11.6

Raynauld 2003

104 wk

T: Triamcinolone acetonide

50‐foot walking time (sec)

33

11.6

11.2

‐0.1 (I)

No significant difference

C: Saline

33

11.6

11.9

Raynauld 2003

52 wk

T: Triamcinolone acetonide

Range of motion (degrees)

33

126.9

131.3

1.7 (I)

No significant difference

C: Saline

33

129.9

132.6

Raynauld 2003

104 wk

T: Triamcinolone acetonide

Range of motion (degrees)

33

126.9

140.2

13.4 (I)

10% (I)

C: Saline

33

129.9

129.8

Raynauld 2003

52 wk

T: Triamcinolone acetonide

Patient global assessment (0‐100 mm VAS)

33

44.6

38.8

0.2 (W)

No significant difference

C: Saline

33

45.2

39.2

Raynauld 2003

104 wk

T: Triamcinolone acetonide

Patient global assessment (0‐100 mm VAS)

33

44.6

37.0

‐0.5 (I)

No significant difference

C: Saline

33

45.2

38.1

Raynauld 2003

52 wk

T: Triamcinolone acetonide

WOMAC stiffness (0‐100 mm VAS)

33

45.3

32.1

3.0 (W)

No significant difference

C: Saline

33

55.0

38.8

Raynauld 2003

104 wk

T: Triamcinolone acetonide

WOMAC stiffness (0‐100 mm VAS)

33

45.3

33.2

1.1 (W)

No significant difference

C: Saline

33

55.0

41.8

Raynauld 2003

52 wk

T: Triamcinolone acetonide

WOMAC total Index (0‐100 mm VAS)

33

35.3

21.6

‐0.8

No significant difference

C: Saline

33

42.3

29.4

Raynauld 2003

104 wk

T: Triamcinolone acetonide

WOMAC total Index (0‐100 mm VAS)

33

35.3

24.2

2.4 (W)

No significant difference

C: Saline

33

42.3

28.8

Ravaud 1999

1 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.4

33.7

‐25 (I)

‐39% (I)

C: Saline

28

63.7

53.0

Ravaud 1999

4 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.4

42.8

‐16.9 (I)

‐27% (I)

C: Saline

28

63.7

54.0

Ravaud 1999

12 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.4

47.0

‐19.9 (I)

‐31% (I)

C: Saline

28

63.7

61.2

Ravaud 1999

24 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.4

50.9

‐13.0 (I)

No significant difference

C: Saline

28

63.7

58.2

Ravaud 1999

1 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.5

7.7

‐1.2 (I)

No significant difference

C: Saline

28

12.5

9.9

Ravaud 1999

4 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.5

8.1

‐1.3 (I)

No significant difference

C: Saline

28

12.5

10.4

Ravaud 1999

12 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.5

9.1

0

No significant difference

C: Saline

28

12.5

10.1

Ravaud 1999

24 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.5

9.4

‐0.2 (I)

No significant difference

C: Saline

28

12.5

10.6

Ravaud 1999

1 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.7

41.6

‐14.5 (I)

No significant difference

C: Saline

28

69.7

57.1

Ravaud 1999

4 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.7

47.2

‐11.9 (I)

No significant difference

C: Saline

28

69.7

60.1

Ravaud 1999

12 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.7

50.9

‐8.2 (I)

No significant difference

C: Saline

28

69.7

60.1

Ravaud 1999

24 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.7

58.3

‐2.7 (I)

No significant difference

C: Saline

28

69.7

62.0

Raynauld 2003

52 wk

T: Triamcinolone acetonide

Joint space width (mm)

33

4.07

4.00

0

No significant difference

C: Saline

33

3.93

3.86

Raynauld 2003

104 wk

T: Triamcinolone acetonide

Joint space width (mm)

33

4.07

4.02

0.2 (I)

No significant difference

C: Saline

33

3.93

3.86

Gaffney 1995

1 wk

T: Triamcinolone hexacetonide

Modified HAQ (0‐9)

42

4.7

4.2

‐9 (I)

No significant difference

C: Saline

42

4.4

4.3

Gaffney 1995

1 wk

T: Triamcinolone hexacetonide

Walking distance (m)

42

48.9

50.7

0

No significant difference

C: Saline

42

46.5

48.3

Figures and Tables -
Table 7. Clinical benefit: Corticosteroid versus placebo ‐ continuous outcome measures
Table 8. Clinical benefit: Corticosteroid versus arthroscopy (joint lavage) ‐ continuous

Study

Time

Treatment

Outcome (scale)

N of pts

Baseline Mean

End of study mean

Absolute benefit

Relative difference

Ravaud 1999

1 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.40

33.70

‐7.8 (I)

No significant difference

C: Joint lavage+IA placebo

21

73.60

45.70

Ravaud 1999

4 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.40

42.80

‐1.7 (I)

No significant difference

C: Joint lavage+IA placebo

21

73.60

48.70

Ravaud 1999

12 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.40

47.00

8.7 (W)

No significant difference

C: Joint lavage+IA placebo

21

73.60

42.50

Ravaud 1999

24 wk

T: Cortivazol

Pain (0‐100 mm VAS)

25

69.40

50.90

7.3 (W)

No significant difference

C: Joint lavage+IA placebo

21

73.60

47.80

Ravaud 1999

1 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.50

7.70

‐1.5 (I)

No significant difference

C: Joint lavage+IA placebo

21

10.90

8.60

Ravaud 1999

4 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.50

8.10

‐0.9 (I)

No significant difference

C: Joint lavage+IA placebo

21

10.90

8.40

Ravaud 1999

12 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.50

9.10

0.4 (W)

No significant difference

C: Joint lavage+IA placebo

21

10.90

8.10

Ravaud 1999

24 wk

T: Cortivazol

Lequesne Index (0‐24)

25

11.50

9.40

0

No significant difference

C: Joint lavage+IA placebo

21

10.90

8.80

Ravaud 1999

1 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.70

41.60

‐6.4 (I)

No significant difference

C: Joint lavage+IA placebo

21

72.20

51.50

Ravaud 1999

4 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.70

47.20

2.4 (W)

No significant difference

C: Joint lavage+IA placebo

21

72.20

48.30

Ravaud 1999

12 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.70

50.90

10.4 (W)

No significant difference

C: Joint lavage+IA placebo

21

72.20

44.00

Ravaud 1999

24 wk

T: Cortivazol

Patient global assessment (0‐100 mm VAS)

25

68.70

58.30

11.7 (W)

No significant difference

C: Joint lavage+IA placebo

21

72.20

50.10

Figures and Tables -
Table 8. Clinical benefit: Corticosteroid versus arthroscopy (joint lavage) ‐ continuous
Table 9. Clinical benefit: Corticosteroid versus Hyalgan ‐ continuous outcome measures

Study

Time

Treatment

Outcome (scale)

N of Pts

Baseline Mean

End of study mean

Absolute benefit

Relative benefit

Leardini 1991

1‐4 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

20

41.30

13.00

‐4.5 (I)

‐13.5% (I)

C: MPA

20

33.40

9.60

Leardini 1991

1‐4 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

20

47.40

10.73

‐14.0 (I)

‐32.1% (I)

C: MPA

20

43.54

20.83

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

45

64.89

20.00

‐5.3 (I)

‐8.2% (I)

C: MPA

45

64.89

25.32

Leardini 1987

5‐13 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

20

41.30

11.20

‐5.8 (I)

‐17.4% (I)

C: MPA

20

33.40

9.10

Leardini 1991

5‐13 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

20

47.40

9.48

‐17.7 (I)

‐40.7% (I)

C: MPA

20

43.54

23.33

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

45

64.89

19.71

‐7.3 (I)

‐11.3% (I)

C: MPA

17

33.40

17.80

Leardini 1987

45‐52 wk

T: Hyalgan

Pain intensity (0‐100 mm VAS)

15

41.30

20.30

‐5.4 (I)

‐16.2% (I)

C: MPA

17

33.40

17.80

Leardini 1987

1‐4 wk

T: Hyalgan

Range of motion (flexion ‐ degrees)

20

108.40

113.40

‐3.2 (W)

‐3.1% (W)

C: MPA

20

104.20

112.40

Pietrogrande 1991

1‐4 wk

T: Hyalgan

Range of motion (flexion ‐ degrees)

45

114.13

121.38

3.3 (I)

3% (I)

C: MPA

45

108.81

112.75

Leardini 1987

5‐13 wk

T: Hyalgan

Range of motion (flexion ‐degrees)

20

108.40

116.70

‐1.8 (W)

‐1.7% (W)

C: MPA

20

104.20

114.30

Pietrogrande 1991

5‐13 wk

T: Hyalgan

Range of motion (flexion ‐ degrees)

45

114.13

121.10

2.4 (I)

2.2% (I)

C: MPA

45

108.81

113.35

Leardini 1987

45‐52 wk

T: Hyalgan

Range of motion (flexion ‐ degrees)

15

108.40

109.60

‐2.7 (W)

‐2.6% (W)

C: MPA

17

104.20

108.10

Jones 1995

End of treatment

T: Hyalgan

Pain on nominated activity (0‐100 mm VAS)

32

77.2

56.5

‐1.6 (I)

‐2.1% (I)

C: Triamcinolone hexacetonide

31

75.8

56.7

Jones 1995

End of treatment

T: Hyalgan

Pain at rest (0‐100 mm VAS)

32

53.2

39.9

1.4 (W)

2.5% (W)

C: Triamcinolone hexacetonide

31

55.3

40.6

Jones 1995

End of treatment

T: Hyalgan

Pain at night (0‐100 mm VAS)

32

57.8

35.9

‐2.7 (I)

‐4.3% (I)

C: Triamcinolone hexacetonide

31

62.2

43.0

Jones 1995

14‐26 wk

T: Hyalgan

Pain on nominated activity (0‐100 mm VAS)

12

77.2

44.3

‐11.4 (I)

‐15.0% (I)

C: Triamcinolone hexacetonide

8

75.8

54.3

Jones 1995

14‐26 wk

T: Hyalgan

Pain at rest (0‐100 mm VAS)

12

53.2

28.2

‐18.3 (I)

‐33.1% (I)

C: Triamcinolone hexacetonide

8

55.3

48.6

Jones 1995

14‐26 wk

T: Hyalgan

Pain at night (0‐100 mm VAS)

12

57.8

15.4

‐16.3 (I)

‐26.2% (I)

C: Triamcinolone hexacetonide

8

62.2

36.1

Figures and Tables -
Table 9. Clinical benefit: Corticosteroid versus Hyalgan ‐ continuous outcome measures
Table 10. Clinical benefit: Triamcinolone hexacetonide versus Hylan G‐F 20 ‐ continuous

Study

Time

Treatment group

Outcome (scale)

N of Pts

Baseline Mean

End of Study Mean

Absolute Benefit

Relative Benefit

Caborn 2004

5‐13 wk

E: Hylan G‐F 20

WOMAC ‐ pain walking on a flat surface (0‐4 Likert)

113

2.12

1.20

‐0.37 (I)

‐17.2% (I)

C: Triamcinolone hexacetonide

102

2.15

1.60

Caborn 2004

14‐26 wk

E: Hylan G‐F 20

WOMAC ‐ pain walking on a flat surface (0‐4 Likert)

113

2.12

1.40

‐0.37 (I)

‐17.2% (I)

C: Triamcinolone hexacetonide

102

2.15

1.80

Caborn 2004

5‐13 wk

E: Hylan G‐F 20

WOMAC physical function (0‐68 Likert)

113

38.60

23.50

‐5.70 (I)

‐15.0% (I)

C: Triamcinolone hexacetonide

102

37.90

28.50

Caborn 2004

14‐26 wk

E: Hylan G‐F 20

WOMAC physical function (0‐68 Likert)

113

38.60

25.50

‐7.20 (I)

‐19.0% (I)

C: Triamcinolone hexacetonide

102

37.90

30.70

Caborn 2004

5‐13 wk

E: Hylan G‐F 20

WOMAC total score (0‐96 Likert)

113

54.00

32.70

‐8.30 (I)

‐15.6% (I)

C: Triamcinolone hexacetonide

102

53.10

40.10

Caborn 2004

14.26 wk

E: Hylan G‐F 20

WOMAC total score (0‐96 Likert)

113

54.00

35.60

‐8.20 (I)

‐15.4% (I)

C: Triamcinolone hexacetonide

102

53.10

42.90

Caborn 2004

5‐13 wk

E: Hylan G‐F 20

Patient global assessment (0‐100 mm VAS)

113

68.40

36.70

‐14.50 (I)

‐21.5% (I)

C: Triamcinolone hexacetonide

102

53.10

42.90

Caborn 2004

14‐26 wk

E: Hylan G‐F 20

Patient global assessment (0‐100 mm VAS)

113

68.40

40.30

‐16.20 (I)

‐24.1% (I)

C: Triamcinolone hexacetonide

102

67.30

55.40

Figures and Tables -
Table 10. Clinical benefit: Triamcinolone hexacetonide versus Hylan G‐F 20 ‐ continuous
Table 11. Clinical benefit: Corticosteroid versus Orthovisc ‐ continuous outcome measures

Study

Time

Treatment

Outcome (scale)

N of Pts

Baseline Mean

End of Study Mean

Absolute

Relative

Tascioglu 2003

1‐4 wk

E: Orthovisc

Pain on weight bearing (0‐100 mm VAS)

28

54.26

31.83

3.87 (W)

7.3% (W)

C: 6‐MPA

27

53.10

26.80

Tascioglu 2003

2‐4 wk

E: Orthovisc

Pain at rest (0‐100 mm VAS)

28

30.43

11.83

3.00 (W)

10.0% (W)

C: 6‐MPA

27

29.90

8.30

Tascioglu 2003

1‐4 wk

E: Orthovisc

Pain on walking (0‐100 mm VAS)

28

67.60

37.60

1.00 (W)

1.5% (W)

C: 6‐MPA

27

69.00

38.00

Tascioglu 2003

1‐4 wk

E: Orthovisc

Lequesne Index (0‐24)

28

10.23

7.86

‐0.47 (I)

‐4.8% (I)

C: 6‐MPA

27

9.86

7.96

Tascioglu 2003

1‐4 wk

E: Orthovisc

Flexion (degrees)

28

108.70

116.36

1.52 (I)

1.4% (I)

C: 6‐MPA

27

108.06

114.20

Tascioglu 2003

5‐13 wk

E: Orthovisc

Pain on weight bearing (0‐100 mm VAS)

28

54.26

22.86

‐16.80 (I)

‐31.6% (I)

C: 6‐MPA

27

53.10

38.50

Tascioglu 2003

5‐13 wk

E: Orthovisc

Pain at rest (0‐100 mm VAS)

28

30.43

12.00

‐8.23 (I)

‐27.5% (I)

C: 6‐MPA

27

29.90

19.70

Tascioglu 2003

5‐13 wk

E: Orthovisc

Pain on walking (0‐100 mm VAS)

28

67.60

32.03

‐17.03 (I)

‐24.7% (I)

C: 6‐MPA

27

69.00

50.46

Tascioglu 2003

5‐13 wk

E: Orthovisc

Lequesne Index (0‐24)

28

10.23

7.66

‐1.77 (I)

‐17.9% (I)

C: 6‐MPA

27

9.86

9.06

Tascioglu 2003

5‐13 wk

E: Orthovisc

Flexion (degrees)

28

108.70

115.76

1.72 (I)

1.6% (I)

C: 6‐MPA

27

108.06

113.40

Tascioglu 2003

14‐26 wk

E: Orthovisc

Pain on weight bearing (0‐100 mm VAS)

28

54.26

40.96

‐16.56 (I)

‐31.2% (I)

C: 6‐MPA

27

53.10

56.36

Tascioglu 2003

14‐26 wk

E: Orthovisc

Pain at rest (0‐100 mm VAS)

28

30.43

23.56

‐3.43 (I)

‐11.5% (I)

C: 6‐MPA

27

29.90

26.46

Tascioglu 2003

14‐26 wk

E: Orthovisc

Pain on walking (0‐100 mm VAS)

28

67.60

51.16

‐13.50 (I)

‐19.6% (I)

C: 6‐MPA

27

69.00

66.06

Tascioglu 2003

14‐26 wk

E: Orthovisc

Lequesne Index (0‐24)

28

10.23

8.46

‐1.51 (I)

‐15.3% (I)

C: 6‐MPA

27

9.86

9.60

Tascioglu 2003

14‐26 wk

E: Orthovisc

Flexion (degrees)

28

108.70

114.60

4.36 (I)

4.0% (I)

C: 6‐MPA

27

108.06

109.60

Tekeoglu 1998

1‐4 wk

E: Orthovisc

WOMAC function (17‐85 Likert)

20

45.50

34.30

3.10 (W)

6.8% (W)

C: Betamethasone

20

45.60

31.30

Tekeoglu 1998

5‐13 wk

E: Orthovisc

WOMAC function (17‐85 Likert)

20

45.50

30.90

‐8.90 (I)

‐19.5% (I)

C: Betamethasone

20

45.60

39.90

Tekeoglu 1998

1‐4 wk

E: Orthovisc

Maximum flexion (degrees)

20

110.50

117.30

0.60 (I)

0.5% (I)

C: Betamethasone

20

116.00

122.20

Tekeoglu 1998

5‐13 wk

E: Orthovisc

Maximum flexion (degrees)

20

110.50

121.20

‐1.55 (W)

‐1.3% (W)

C: Betamethasone

20

116.00

128.25

Figures and Tables -
Table 11. Clinical benefit: Corticosteroid versus Orthovisc ‐ continuous outcome measures
Table 12. Clinical benefit: Corticosteroid versus corticosteroid ‐ continuous measures

Study

Time

Treatment

Outcome (scale)

N of pts

Baseline Mean

End of Study

Absolute benefit

Relative difference

Valtonen 1981

4 wk

T: Triamcinolone hexacetonide

Flexion (degrees)

21

96

102

4 (I)

No significant difference

C: Betamethasone

21

100

102

Figures and Tables -
Table 12. Clinical benefit: Corticosteroid versus corticosteroid ‐ continuous measures
Table 13. Effect size based on Standardised Mean Difference: Corticosteroid versus placebo

Product

Comparison

Outcome

1 wk

2 wk

4 wk

6 wk

12 wk

24 wk

52 wk

Corticosteroid

Placebo

Pain (0‐100 mm VAS)

‐0.83;(‐1.16,‐0.51);p<0.00001

‐0.42;(‐0.96,0.13);p=0.13

‐0.27;(‐0.70,0.16);p=0.22

‐0.58;(‐1.13,‐0.03);p=0.04

‐0.26;(‐0.80,0.29);p=0.4

Triamcinolone acetonide

Saline

WOMAC pain (0‐100 mm VAS)

*‐0.51;(‐1.00,‐0.02);p=0.04

**‐0.19;(‐0.67,0.29);p=0.44

Triamcinolone acetonide

Saline

Pain at night (0‐100 mm VAS)

*‐0.39;(‐0.87,0.10);p=0.12

**0.05;(‐0.44,0.53);p=0.85

Triamcinolone acetonide

Saline

WOMAC function (0‐100 mm VAS)

*‐0.24;(‐0.73,0.24);p=0.33

**‐0.17;(‐0.65,0.31);p=0.49

Cortivazol

Saline

Lequesne Index (0‐24)

‐0.43;(‐0.98,0.11);p=0.12

‐0.51;(‐1.06,0.03);p=0.07

‐0.23;(‐0.77,0.32);p=0.4

‐0.27;(‐0.81,0.27);p=0.3

Triamcinolone hexacetonide

Saline

Modified HAQ (0‐9)

‐0.05;(‐0.43,0.38);p=0.8

0.14;(‐0.29,0.57);p=0.5

Triamcinolone acetonide

Saline

50 foot walk time (sec)

*‐0.07;(‐0.55,0.42);p=0.79

**‐0.23;(‐0.72,0.25);p=0.34

Triamcinolone hexacetonide

Saline

Walking distance (m)

0.15;(‐0.28,0.58);p=0.5

‐0.05;(‐0.48,0.37);p=0.8

Triamcinolone acetonide

Saline

Range of motion (degrees)

*‐0.10;(‐0.58,0.39);p=0.69

**0.78;(0.28,1.28);p=0.002

Cortivazol

Saline

Patient global (0‐100 mm VAS)

‐0.49;(‐1.04,0.06);p=0.08

‐0.41;(‐0.96,0.13);p=0.14

‐0.33;(‐0.87,0.21);p=0.2

‐0.12;(‐0.66,0.42);p=0.7

Triamcinolone acetonide

Saline

Patient global (0‐100 mm VAS)

*‐0.01;(‐0.50,0.47);p=0.96

**‐0.04;(‐0.52,0.44);p=0.88

Triamcinolone acetonide

Saline

WOMAC stiffness (0‐100 mm VAS)

*‐0.20;(‐0.68,0.28);p=0.42

**‐0.34;(‐0.82,0.15);p=0.17

Triamcinolone acetonide

Saline

WOMAC total (0‐100 mm VAS)

*‐0.30;(‐0.78,0.19);p=0.23

**‐0.18;(‐0.66,0.31);p=0.48

Triamcinolone acetonide

Saline

Joint space width (mm)

*0.02;(‐0.46,0.50);p=0.9

**0.03;(‐0.43,0.51);p=0.9

*Wk 52, ***Wk 104

Figures and Tables -
Table 13. Effect size based on Standardised Mean Difference: Corticosteroid versus placebo
Table 14. Effect size based on Standardised Mean Difference:Corticosteroid versus joint la

Product

Comparison

Outcome

1 wk

4 wk

12 wk

24 wk

Cortivazol

Joint lavage+IA Placebo

Pain (0‐100 mm VAS)

‐0.47;(‐1.06,0.12);p=0.12

‐0.21;(‐0.79,0.37);p=0.5

0.16;(‐0.42,0.74);p=0.6

0.11;(‐0.47,0.69);p=0.7

Cortivazol

Joint lavage+IA Placebo

Lequesne Index (0‐24)

‐0.20;(0.78,0.38);p=0.5

‐0.07;(‐0.65,0.51);p=0.8

0.23;(‐0.35,0.81);p=0.4

0.13;(‐0.45,0.71);p=0.7

Cortivazol

Joint lavage+IA Placebo

Patient global (0‐100 mm VAS)

‐0.32;(‐0.91,0.26);p=0.3

‐0.04;(‐0.62,0.55);p=0.9

0.22;(‐0.36,0.81);p=0.5

0.25;(‐0.33,0.83);p=0.4

Figures and Tables -
Table 14. Effect size based on Standardised Mean Difference:Corticosteroid versus joint la
Table 15. Effect size based on Standardised Mean Difference:Corticosteroid versus Hyalgan

Product

Comparison

Outcome

1‐4 wk

5‐13 wk

14‐26 wk

45‐52 wk

Hyalgan

Methylprednisolone acetate

Spontaneous pain intensity (0‐100 VAS)

‐0.27;(‐0.58,0.03);p=0.08

‐0.41;(‐0.90,0.08);p=0.10

0.10;(‐0.60,0.79);p=0.8

Methylprednsolone acetate

Range of motion

0.39;(0.05,0.74);p=0.03

0.40;(0.05,0.75);p=0.02

0.07;(‐0.62,0.77);p=0.8

Triamcinolone hexacetonide

Pain on nominated activity (0‐100 mm VAS)

‐0.01;(‐0.53,0.52);p=1 (end of treatment)

‐0.39;(‐1.29,0.52);p=0.4

Triamcinolone hexacetonide

Pain at rest (0‐100 mm VAS)

‐0.02;(‐0.54,0.50);p=0.9 (end of treatment)

‐0.76;(‐1.69,0.18);p=0.11

Triamcinolone hexacetonide

Pain at night (0‐100 mm VAS)

‐0.21;(‐0.74,0.31);p=0.4 (end of treatment)

‐1.11;(‐2.09,‐0.14);p=0.03

Mucopolysaccharide polysulfuric acid ester

Pain (0‐30)

0.66;(0.14,1.19);p=0.01 (end of treatment)

Mucopolysaccharide polysulfuric acid ester

Function (0‐30)

0.11;(‐0.40,0.63);p=0.7 (end of treatment)

Mucopolysaccharide polysulfuric acid ester

Range of motion (0‐10)

0.39;(‐0.13,0.91);p=0.14 (end of treatment)

Mucopolysaccharide polysulfuric acid ester

Total Larson rating score (0‐77)

0.63;(0.10,1.16);p=0.02 (end of treatment)

Figures and Tables -
Table 15. Effect size based on Standardised Mean Difference:Corticosteroid versus Hyalgan
Table 16. Effect size based on Standardised Mean Difference:Corticosteroid versus Hylan GF

Product

Comparison

Outcome

1‐4 wk

5‐13 wk

14‐26 wk

45‐52 wk

Hylan G‐F 20

Triamcinolone hexacetonide

WOMAC pain question one (Likert)

‐0.43;(‐0.70,‐0.16);p=0.002

‐0.38;(‐0.65,‐0.11);p=0.005

Triamcinolone hexacetonide

WOMAC function (Likert)

‐0.35;(‐0.62,‐0.08);p=0.01

‐0.36;(‐0.63,‐0.09);p=0.010

Triamcinolone hexacetonide

WOMAC total score (Likert)

‐0.37;(‐0.64,‐0.10);p=0.007

‐0.36;(‐0.63,‐0.09);p=0.010

Triamcinolone hexacetonide

Patient global (VAS)

‐0.54;(‐0.81;‐0.27);p=0.0001

‐0.57;(‐0.84,‐0.30);p=0.00004

Figures and Tables -
Table 16. Effect size based on Standardised Mean Difference:Corticosteroid versus Hylan GF
Table 17. Effect size based on Standardised Mean Difference:Corticosteroid versus Orthovis

Product

Comparison

Outcome

1‐4 wk

5‐13 wk

14‐26 wk

45‐52 wk

Orthovisc

Betamethasone

WOMAC function (VAS)

0.34;(‐0.29,0.96);p=0.3

‐1.06;(‐1.73,‐0.40);p=0.002

Betamethasone

Flexion (degrees)

‐0.30;(‐0.93,0.32);p=0.3

‐0.51;(‐1.14,0.12);p=0.11

6‐MPA

Pain weight bearing (VAS)

0.26;(‐0.27,0.79);p=0.3

‐0.92;(‐1.48,‐0.36);p=0.001

‐0.76;(‐1.31,‐0.21);p=0.007

6‐MPA

Pain at rest (VAS)

0.33;(‐0.21,0.86);p=0.2

‐0.69;(‐1.24,‐0.15);p=0.01

‐0.23;(‐0.76,0.30);p=0.4

6‐MPA

Pain on walking (VAS)

‐0.02;(‐0.55,0.51);p=0.9

‐0.89;(‐1.45,‐0.33);p=0.002

‐0.71;(‐1.25,‐0.16);p=0.01

6‐MPA

Lequesne Index (0‐24)

‐0.06;(‐0.59,0.46);p=0.8

‐0.99;(‐1.56,‐0.43);p=0.0005

‐0.58;(‐1.12,‐0.04);p=0.04

6‐MPA

Flexion (degrees)

0.24;(‐0.29,0.77);p=0.4

0.29;(‐0.24,0.83);p=0.3

0.54;(0.00,1.08);p=0.05

Figures and Tables -
Table 17. Effect size based on Standardised Mean Difference:Corticosteroid versus Orthovis
Table 18. Effect size based on Standardised Mean Difference:Corticosteroid versus Corticos

Trial

Product

Comparison

Outcome

Time

SMD(95% CI);P value

Valtonen 1981

Triamcinolone hexacetonide

Betamethasone

Flexion (degrees)

4 wk

0.00; (‐0.60,0.60); p=1

Figures and Tables -
Table 18. Effect size based on Standardised Mean Difference:Corticosteroid versus Corticos
Table 19. Discrepancies between RevMan analysis and published reports

Product

Study ID

Outcome

p value

Analysis

Statistical test

Description

6‐MPA/Orthovisc

Tascioglu 2003

six month pain on weight bearing

P (paper):ns, R (report): P value 0.004

ITT

one‐way ANOVA

P: no significant difference between groups; R: significant difference in favour of Orthovisc

6‐MPA/Orthovisc

Tascioglu 2003

six month pain on walking

P:ns, R: P value 0.008

ITT

one‐way ANOVA

P: no significant difference, R: significant difference in favour of Orthovisc

6‐MPA/Orthovisc

Tascioglu 2003

six month Lequesne Index

P:ns, R: P value 0.03

ITT

one‐way ANOVA

P: no significant difference, R:significant difference in favour of Orthovisc

6‐MPA/Orthovisc

Tascioglu 003

six month flexion

P:ns, R: P value 0.04

ITT

one‐way ANOVA

P: no significant difference, R: significant difference in favour of Orthovisc

Triamcinolone hexacetonide/Hyalgan

Jones 1995

Pain at rest (week 29)

P:significant, R: P value 0.09

PP/ITT

Not reported in publication.

P: significant difference in favour of HA versus TH (Table III) but with ITT, LOCF no statistically significant difference. R: based on on Table III, no difference.

Triamcinolone hexacetonide/Hyalgan

Jones 1995

Pain on nominated activity (week 29)

P:significant, R: P value 0.4

PP/ITT

Not reported in publication.

P: significant difference in favour of HA versus TH (Table III) but with ITT, LOCF no statistically significant difference. R: based on Table III, no difference.

Triamcinolone acetonide/Saline

Raynauld 2003

WOMAC pain at one year

P: ns (P value 0.22), R: P value 0.006

ITT

2‐sample t‐test at one‐year

P: no significant difference, R: significant difference in favour of triamcinolone acetonide compared to saline

Triamcinolone acetonide/Saline

Raynauld 2003

Pain at night (0‐100 mm VAS) at 2 years

P: P value 0.0047, R: P value 0.9

ITT

AUC for normalized values

P: significant difference in favour of triamcinolone acetonide compared to saline; R: no difference. However, using ANOVA for repeated measurements, the P reported no statistically significant difference at 2 years as well, P value 0.74.

Triamcinolone acetonice/Saline

Raynauld 2003

Range of motion at 2 years

P: P value 0.16, R: p<0.00001

ITT

ANOVA for repeated measurements at 2 years

P: no significant difference, R: significant difference in favour of triamcinolone hexacetonide compared to saline

Triamcinolone acetonide/Saline

Raynauld 2003

WOMAC stiffness at 2 years

P: P value 0.0511, R: P value 0.17

ITT

AUC for normalized values

P: significant difference in favour of triamcinolone acetonide compared to saline, R: no difference. However, using ANOVA for repeated measurements, the P (P value 0.86) and R (P value 0.17) both found no difference

Methylprednisolone acetate +arthroscopy/Saline + arthroscopy

Smith 2003

OARSI response criteria at 4 week

P: P value 0.004, R: P value 0.05

ITT

Generalized linear model with log link and binary error distribution to model the RR and RR was adjusted for severity of X‐ray grade and baseline score.

P: significant difference in favour of steroid group compared to the placebo group

XXXTriamcinolone acetonide + joint lavage/joint lavage alone

Frias 2004

Pain (0‐10 cm VAS)

P: ns; R:P<0.00001

ITT

Friedman's test

P: no significant between‐group difference, R: significant between‐group difference in favour of joint lavage plus TA at one month; and in favour of joint lavage alone at three months

Triamcinolone acetonide + joint lavage/joint lavage alone

Frias 2004

Crepitation (number of knees with symptom)

P: P value 0.043; R:ns

ITT

Cochran's Q‐test

P: significant difference in favour of joint lavage alone at month three; R: no significant between‐group difference

Triamcinolone acetonide + joint lavage/joint lavage alone

Frias 2004

Function (number of knees with restricted motion)

P: P value 0.042 and 0.011; R: P value 0.05 and 0.02

ITT

Cochran's Q‐test

P: significant between‐group difference at one month (P value 0.042); R: no significant difference at one month (P value 0.05); at three months, p values differ but both P and R result significant between‐group difference in favour of joint lavage alone

Triamcinolone acetonide+Orthovisc/Orthovisc

Ozturk 2005

WOMAC OA Index pain subscale (Likert)

P: p<0.05; R: ns

ITT

Repeated measures ANOVA

P: significant between‐group difference in favour of triamcinolone acetonide plus Orthovisc compared to Orthovisc alone

Triamcinolone acetonide

Ozturk 2005

WOMAC OA Index stiffness subscale

P: ns; R: P values 0.04 at 1‐4 wk, 0.02 at 34 wk, 0.04 at 45‐52 weeks

ITT

Repeated measures ANOVA

P: no statistically significant between‐group difference whereas RevMan statistically significant between‐group difference in favour of triamcinolone acetonide plus Orthovisc compared to Orthovisc alone at three timepointsXXX

Figures and Tables -
Table 19. Discrepancies between RevMan analysis and published reports
Comparison 1. Corticosteroid versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain: number of patients reporting pain reduction Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 1 week post injection

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.88, 1.78]

1.2 8 weeks post injection

1

34

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.61, 1.64]

2 Number of knees reported with improvement 2 weeks post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Number of knees reported with improvement 2 weeks post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4 Pain: 0‐100 mm VAS Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 1 week post injection

3

161

Mean Difference (IV, Fixed, 95% CI)

‐21.91 [‐29.93, ‐13.89]

4.2 4 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐11.20 [‐25.49, 3.09]

4.3 6 weeks post injection

1

84

Mean Difference (IV, Fixed, 95% CI)

‐7.10 [‐18.39, 4.19]

4.4 12 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐14.20 [‐27.44, ‐0.96]

4.5 24 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐7.30 [‐22.61, 8.01]

5 Number of responders (greater than 30% decrease in pain VAS from baseline) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 1 week post injection

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

2.56 [1.26, 5.18]

5.2 4 weeks post injection

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

1.96 [0.99, 3.87]

5.3 12 weeks post injection

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

1.82 [0.91, 3.65]

5.4 24 weeks post injection

1

53

Risk Ratio (M‐H, Fixed, 95% CI)

2.24 [0.99, 5.08]

6 Number of responders (greater than 15% decrease in pain VAS) 3 weeks post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7 Pain: WOMAC pain (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐13.8 [‐26.79, ‐0.81]

7.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐5.20 [‐18.19, 7.79]

8 Pain: at night (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

8.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐10.3 [‐22.98, 2.38]

8.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

1.20 [‐11.48, 13.88]

9 Function: WOMAC physical function (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐6.0 [‐17.77, 5.77]

9.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐4.20 [‐15.97, 7.57]

10 Function: Lequesne Index (0‐24) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 1 week post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐2.2 [‐4.87, 0.47]

10.2 4 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐2.30 [‐4.67, 0.07]

10.3 12 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐3.32, 1.32]

10.4 24 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐3.58, 1.18]

11 Function: Modified HAQ (0‐9) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

11.1 1 week post injection

1

84

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.96, 0.76]

11.2 6 weeks post injection

1

84

Mean Difference (IV, Fixed, 95% CI)

0.30 [‐0.62, 1.22]

12 Function: 50 foot walking time (sec) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

12.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐1.62, 1.22]

12.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐2.12, 0.72]

13 Function: walking distance (m) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 1 week post injection

1

84

Mean Difference (IV, Fixed, 95% CI)

2.40 [‐4.36, 9.16]

13.2 6 weeks post injection

1

84

Mean Difference (IV, Fixed, 95% CI)

‐0.80 [‐7.20, 5.60]

14 Range of motion (degrees) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

14.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐1.30 [‐7.66, 5.06]

14.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

10.40 [4.04, 16.76]

15 Global assessment: number of patients showing improvement Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 1 week post injection

3

158

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [1.13, 1.82]

15.2 3 weeks post injection

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

0.91 [0.67, 1.24]

15.3 6 weeks post injection

2

157

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.86, 1.31]

15.4 8 weeks post injection

1

51

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.60, 1.23]

15.5 6 months post injection

1

68

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.81, 1.09]

16 Global assessment: number of patients preferring treatment Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

17 Patient global assessment (0‐100 mm VAS) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

17.1 1 week post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐15.5 [‐32.32, 1.32]

17.2 4 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐12.90 [‐29.51, 3.71]

17.3 12 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐9.20 [‐24.18, 5.78]

17.4 24 weeks post injection

1

53

Mean Difference (IV, Fixed, 95% CI)

‐3.70 [‐20.47, 13.07]

17.5 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐14.16, 13.36]

17.6 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐14.86, 12.66]

18 WOMAC stiffness (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

18.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐6.70 [‐22.70, 9.30]

18.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐8.60 [‐24.60, 7.40]

19 WOMAC total (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

19.1 52 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐7.80 [‐20.28, 4.68]

19.2 104 weeks post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

‐4.60 [‐17.08, 7.88]

20 Joint space width (mm) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

20.1 1 year post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

0.14 [‐2.90, 3.18]

20.2 2 years post injection

1

66

Mean Difference (IV, Fixed, 95% CI)

0.16 [‐2.23, 2.55]

21 Safety: total withdrawals overall Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

22 Safety: withdrawals due to lack of efficacy Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

23 Safety: withdrawals due to adverse events

0

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

24 Safety: number of patients experiencing post injection flare Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

25 Safety: number of patients reporting local discomfort Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 1. Corticosteroid versus placebo
Comparison 2. Corticosteroid verus joint lavage

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain: number of responders (greater than 30% reduction in pain VAS from baseline) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 1 week post injection

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.34 [0.79, 2.30]

1.2 4 weeks post injection

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.67, 2.07]

1.3 12 weeks post injection

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.61, 1.96]

1.4 24 weeks post injection

1

46

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.55, 1.85]

2 Pain (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 1 week post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐12.0 [‐26.66, 2.66]

2.2 4 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐5.90 [‐21.82, 10.02]

2.3 12 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

4.5 [‐11.34, 20.34]

2.4 24 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

3.10 [‐13.48, 19.68]

3 Pain on movement: number of responders (at least 30% reduction) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 2 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.86, 1.83]

3.2 4 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.14 [0.79, 1.66]

3.3 8 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.11 [0.74, 1.66]

3.4 12 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.55, 1.37]

3.5 24 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.93 [0.53, 1.63]

4 Pain (0‐10 cm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 One month post injection

1

299

Mean Difference (IV, Fixed, 95% CI)

0.20 [0.12, 0.28]

4.2 Three months post injection

1

299

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐0.38, ‐0.22]

5 Pain: number of knees with spontaneous pain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 One month post injection

1

217

Risk Ratio (M‐H, Fixed, 95% CI)

1.40 [0.44, 4.48]

5.2 Three months post injection

1

264

Risk Ratio (M‐H, Fixed, 95% CI)

0.99 [0.42, 2.31]

6 Pain: number of knees with pain on active motion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 One month post injection

1

219

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.51, 1.45]

6.2 Three months post injection

1

249

Risk Ratio (M‐H, Fixed, 95% CI)

0.76 [0.53, 1.09]

7 Pain: number of knees with pain on passive motion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7.1 One month post injection

1

212

Risk Ratio (M‐H, Fixed, 95% CI)

2.15 [0.87, 5.32]

7.2 Three months post injection

1

252

Risk Ratio (M‐H, Fixed, 95% CI)

1.24 [0.68, 2.28]

8 Pain: number of knees with pain on pressue Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 One month post injection

1

220

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.68, 2.19]

8.2 Three months post injection

1

251

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.58, 1.27]

9 Function: number of knees with restricted motion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 One month post injection

1

217

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.60, 1.00]

9.2 Three months post injection

1

249

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.56, 0.94]

10 Function: Lequesne Index (0‐24) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 1 week post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐0.90 [‐3.45, 1.65]

10.2 4 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐0.30 [‐2.89, 2.29]

10.3 12 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

1.0 [‐1.51, 3.51]

10.4 24 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

0.60 [‐2.11, 3.31]

11 OARSI responsder criteria (20% decrease in pain VAS and >10 mm and/or improved function >20% and 10 units) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 2 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [0.93, 2.24]

11.2 4 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.74 [1.00, 3.02]

11.3 8 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.66 [0.95, 2.91]

11.4 12 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.56 [0.84, 2.90]

11.5 24 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

1.98 [0.93, 4.23]

12 Crepitation: number of knees with symptom Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 One month post injection

1

218

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.93, 1.03]

12.2 Three months post injection

1

248

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.90, 1.01]

13 Global assessment (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

13.1 1 week post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐9.90 [‐27.27, 7.47]

13.2 4 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐18.85, 16.65]

13.3 12 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

6.90 [‐10.76, 24.56]

13.4 24 weeks post injection

1

46

Mean Difference (IV, Fixed, 95% CI)

8.20 [‐10.22, 26.62]

14 Effusion: number of knees with effusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

14.1 One month post injection

1

225

Risk Ratio (M‐H, Fixed, 95% CI)

0.5 [0.22, 1.13]

14.2 Three months post injection

1

249

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.39, 1.20]

15 Effusion: number of patients with effusion Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15.1 2 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.19 [0.04, 0.83]

15.2 4 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.20, 1.14]

15.3 8 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.47 [0.20, 1.14]

15.4 12 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.87 [0.39, 1.93]

15.5 24 weeks post injection

1

71

Risk Ratio (M‐H, Fixed, 95% CI)

0.72 [0.36, 1.45]

16 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

17 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

18 Safety: number of patients reporting local discomfort Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 2. Corticosteroid verus joint lavage
Comparison 3. Methylprednisolone acetate versus Hyalgan

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Spontaneous pain intensity (0‐100 mm VAS) Show forest plot

3

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 1 to 4 weeks post injection

3

170

Mean Difference (IV, Fixed, 95% CI)

‐4.90 [‐9.91, 0.10]

1.2 5 to 13 weeks post injection

3

170

Mean Difference (IV, Fixed, 95% CI)

‐7.73 [‐12.81, ‐2.64]

1.3 45 to 52 weeks post injection

1

32

Mean Difference (IV, Fixed, 95% CI)

2.5 [‐14.98, 19.98]

2 Number of joints with moderate or severe pain under load Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2.1 1 to 4 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.47, 2.14]

2.2 5 to 13 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.86 [0.35, 2.10]

2.3 45 to 52 weeks post injection

1

32

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.46, 1.49]

3 Number of patients with moderate or severe pain under load Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 1 to 4 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.95 [0.71, 1.27]

3.2 5 to 13 weeks post injection

2

129

Risk Ratio (M‐H, Fixed, 95% CI)

0.62 [0.45, 0.85]

4 Number of joints with moderate or severe walking pain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 1 to 4 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.22 [0.65, 2.29]

4.2 5 to 13 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.8 [0.40, 1.60]

4.3 45 to 52 weeks post injection

1

32

Risk Ratio (M‐H, Fixed, 95% CI)

1.04 [0.67, 1.60]

5 Number of patients with at least moderate or greater night pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 1 to 4 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

1.2 [0.38, 3.80]

5.2 5 to 13 weeks post injection

2

129

Risk Ratio (M‐H, Fixed, 95% CI)

0.14 [0.02, 1.13]

6 Number of patients with moderate or greater rest pain Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 1 to 4 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

0.68 [0.38, 1.24]

6.2 5 to 13 weeks post injection

2

129

Risk Ratio (M‐H, Fixed, 95% CI)

0.39 [0.19, 0.78]

7 Function: range of motion (flexion in degrees) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 1 to 4 weeks post injection

2

130

Mean Difference (IV, Fixed, 95% CI)

5.93 [0.71, 11.14]

7.2 5 to 13 weeks post injection

2

130

Mean Difference (IV, Fixed, 95% CI)

5.41 [0.54, 10.28]

7.3 45 to 52 weeks post injection

1

32

Mean Difference (IV, Fixed, 95% CI)

1.5 [‐12.92, 15.92]

8 Patient global (number of patients very good/good, excellent/good) Show forest plot

3

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8.1 1 to 4 weeks post injection

3

213

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.75, 1.18]

8.2 5 to 13 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

1.86 [1.26, 2.75]

8.3 14 to 26 weeks post injection

1

70

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.81, 1.36]

9 Safety: total withdrawals overall Show forest plot

4

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9.1 1 to 4 weeks post injection

1

99

Risk Ratio (M‐H, Fixed, 95% CI)

0.54 [0.21, 1.38]

9.2 5 to 13 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 71.74]

9.3 14 to 26 weeks post injection

1

99

Risk Ratio (M‐H, Fixed, 95% CI)

1.81 [0.67, 4.91]

9.4 45 to 52 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.67 [0.46, 6.06]

10 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10.1 5 to 13 weeks post injection

1

90

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 71.74]

11 Safety: withdrawals due to adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11.1 After first injection

1

99

Risk Ratio (M‐H, Fixed, 95% CI)

0.30 [0.01, 7.24]

12 Safety: number of patients with local or systemic reactions Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12.1 5 to 13 weeks post injection

2

130

Risk Ratio (M‐H, Fixed, 95% CI)

3.0 [0.13, 71.74]

13 Safety: number of joints with local reactions but continued in trial Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 1 to 4 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.33 [0.34, 5.21]

Figures and Tables -
Comparison 3. Methylprednisolone acetate versus Hyalgan
Comparison 4. Triamcinolone hexacetonide versus Hyalgan

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain on nominated activity (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 End of treatment (Week 4)

1

56

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐17.39, 16.99]

1.2 14 to 26 weeks post injection

1

20

Mean Difference (IV, Fixed, 95% CI)

‐10.0 [‐31.83, 11.83]

2 Pain at rest (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 End of treatment (Week 4)

1

56

Mean Difference (IV, Fixed, 95% CI)

‐0.70 [‐18.17, 16.77]

2.2 14 to 26 weeks post injection

1

20

Mean Difference (IV, Fixed, 95% CI)

‐20.40 [‐43.92, 3.12]

3 Pain at night (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 End of treatment (Week 4)

1

56

Mean Difference (IV, Fixed, 95% CI)

‐7.10 [‐24.30, 10.10]

3.2 14 to 26 weeks post injection

1

20

Mean Difference (IV, Fixed, 95% CI)

‐20.70 [‐37.74, ‐3.66]

4 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

4.1 End of treatment (Week 4)

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.73 [0.18, 2.99]

4.2 14 to 26 weeks post injection

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.56, 1.14]

5 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 End of treatment (Week 4)

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

4.85 [0.24, 97.11]

5.2 14 to 26 weeks post injection

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.49, 1.65]

6 Safety: wIthdrawals due to adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 End of treatment (Week 4)

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.97 [0.06, 14.82]

6.2 14 to 26 weeks post injection

1

63

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.23, 2.62]

Figures and Tables -
Comparison 4. Triamcinolone hexacetonide versus Hyalgan
Comparison 5. Betamethasone versus hylan G‐F 20

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

2 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Safety: withdrawals due to acute local reaction Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 5. Betamethasone versus hylan G‐F 20
Comparison 6. Triamcinolone hexacetonide versus hylan G‐F 20

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WOMAC pain walking on a flat surface (question 1: 0‐4 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 5 to 13 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.65, ‐0.15]

1.2 14 to 26 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐0.68, ‐0.12]

2 WOMAC physical function subscale (0‐68 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 5 to 13 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐5.0 [‐8.86, ‐1.14]

2.2 14 to 26 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐5.20 [‐9.10, ‐1.30]

3 WOMAC total score (0‐96 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 5 to 13 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐7.40 [‐12.74, ‐2.06]

3.2 14 to 26 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐7.30 [‐12.76, ‐1.84]

4 Patient global overall assessment (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 5 to 13 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐13.40 [‐20.03, ‐6.77]

4.2 14 to 26 weeks post injection

1

215

Mean Difference (IV, Fixed, 95% CI)

‐15.10 [‐22.17, ‐8.03]

5 Number of responders (greater than or equal to one category on WOMAC pain question 1) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 1 to 4 weeks post injection

1

215

Risk Ratio (M‐H, Fixed, 95% CI)

1.21 [0.96, 1.53]

5.2 5 to 13 weeks post injection

1

215

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [1.09, 1.90]

5.3 14 to 26 weeks post injection

1

215

Risk Ratio (M‐H, Fixed, 95% CI)

1.44 [1.00, 2.09]

6 Analgesic usage Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6.1 From week 0 to prior to week 12

1

215

Risk Ratio (M‐H, Fixed, 95% CI)

1.01 [0.97, 1.06]

6.2 From week 12 prior to week 26

1

153

Risk Ratio (M‐H, Fixed, 95% CI)

0.84 [0.64, 1.11]

7 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8 Safety: wIthdrawals due to adverse event Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 6. Triamcinolone hexacetonide versus hylan G‐F 20
Comparison 7. Betamethasone versus Orthovisc

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 WOMAC function (17‐85 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

3.00 [‐2.39, 8.39]

1.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐9.0 [‐14.15, ‐3.85]

2 Flexion (degrees) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐4.90 [‐14.69, 4.89]

2.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐7.05 [‐15.48, 1.38]

3 Patient global assessment: number of patients good or very good Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3.1 1 to 4 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

0.83 [0.47, 1.47]

3.2 5 to 13 weeks post injection

1

40

Risk Ratio (M‐H, Fixed, 95% CI)

1.88 [1.04, 3.39]

4 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5 Safety: withdrawals due to adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

6 Safety: number of patients with local adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7 Safety: number of patients with systemic adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 7. Betamethasone versus Orthovisc
Comparison 8. 6‐Methylprednisolone acetate versus Orthovisc

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain on weight bearing (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 1 to 4 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

5.03 [‐4.94, 15.00]

1.2 5 to 13 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐15.64 [‐24.51, ‐6.77]

1.3 14 to 26 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐15.40 [‐25.91, ‐4.89]

2 Pain at rest (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 1 to 4 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

3.53 [‐2.09, 9.15]

2.2 5 to 13 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐7.70 [‐13.50, ‐1.90]

2.3 14 to 26 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐2.90 [‐9.47, 3.67]

3 Pain on walking (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 1 to 4 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐11.46, 10.66]

3.2 5 to 13 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐18.43 [‐29.19, ‐7.67]

3.3 14 to 26 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐14.90 [‐25.91, ‐3.89]

4 Lequesne Index (0‐24) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 1 to 4 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.91, 0.71]

4.2 5 to 13 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐1.40 [‐2.13, ‐0.67]

4.3 14 to 26 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

‐1.14 [‐2.16, ‐0.12]

5 Flexion (active range in degrees) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 1 to 4 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

2.16 [‐2.58, 6.90]

5.2 5 to 13 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

2.36 [‐1.82, 6.54]

5.3 14 to 26 weeks post injection

1

55

Mean Difference (IV, Fixed, 95% CI)

5.0 [0.19, 9.81]

6 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

7 Safety: number of patients withdrawn due to increased pain Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

8 Safety: number of patients reporting musculoskeletal adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9 Safety: number of patients reporting skin adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10 Safety: number of patients reporting gastrointestinal adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

11 Safety: number of patients reporting general adverse events Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12 Safety: number of patients reporting knee pain after injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 8. 6‐Methylprednisolone acetate versus Orthovisc
Comparison 9. Triamcinolone acetonide plus Orthovisc versus Orthovisc

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

13.0 [3.77, 22.23]

1.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐2.0 [‐11.36, 7.36]

1.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

5.0 [‐3.99, 13.99]

1.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐8.62, 12.62]

1.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐11.61, 10.41]

2 WOMAC pain (0‐20 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐1.64, 3.24]

2.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐3.54, 1.34]

2.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐4.13, 1.73]

2.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐2.99, 2.79]

2.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐3.03, 3.23]

3 WOMAC physical function (0‐68 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

5.0 [‐3.41, 13.41]

3.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

6.80 [‐0.62, 14.22]

3.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

5.30 [‐1.98, 12.58]

3.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

4.30 [‐1.73, 10.33]

3.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

3.10 [‐4.32, 10.52]

4 50 foot walking time (seconds) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐3.06, 3.26]

4.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐3.16, 3.56]

4.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐3.32, 2.92]

4.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐1.0 [‐2.95, 0.95]

4.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐3.50, 3.10]

5 Range of motion (degrees) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐3.0 [‐10.55, 4.55]

5.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐4.90 [‐12.00, 2.20]

5.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐4.20 [‐11.66, 3.26]

5.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐4.30 [‐12.53, 3.93]

5.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

‐4.5 [‐12.50, 3.50]

6 WOMAC stiffness (0‐8 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.80 [0.02, 1.58]

6.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.59, 0.99]

6.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.23, 1.03]

6.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.80 [0.12, 1.48]

6.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

0.80 [0.06, 1.54]

7 WOMAC total score (0‐96 Likert) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 1 to 4 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

6.80 [‐3.31, 16.91]

7.2 5 to 13 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

5.90 [‐3.58, 15.38]

7.3 14 to 26 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

4.5 [‐4.84, 13.84]

7.4 34 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

4.90 [‐2.99, 12.79]

7.5 45 to 52 weeks post injection

1

40

Mean Difference (IV, Fixed, 95% CI)

3.90 [‐5.24, 13.04]

8 Safety: total withdrawals overall Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

9 Safety: withdrawals due to lack of efficacy Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

10 Safety: number of patients reporting adverse events (local reactions) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 9. Triamcinolone acetonide plus Orthovisc versus Orthovisc
Comparison 10. Corticosteroid versus corticosteroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain: number of patients reporting pain reduction Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

1.1 1 week post injection

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

1.78 [1.03, 3.08]

1.2 2 weeks post injection

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

1.8 [1.11, 2.91]

1.3 4 weeks post injection

1

42

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [1.10, 3.63]

2 Pain: number of knees reported with improvement 2 weeks post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

3 Pain: during movement (0‐3) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

3.1 1 week post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.99, 0.59]

3.2 2 weeks post injection (16 days)

1

24

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.43, 0.63]

3.3 3 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.34, 1.14]

3.4 4 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.52, 0.92]

4 Pain: at rest (0‐3) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

4.1 1 week post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.37, 0.17]

4.2 2 weeks post injection (16 days)

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.53, 0.13]

4.3 3 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.44, 0.44]

4.4 4 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.20 [‐0.63, 0.23]

5 Pain: on pressure (0‐3) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

5.1 1 week post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.5 [‐1.13, 0.13]

5.2 2 weeks post injection (16 days)

1

24

Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.40, 0.40]

5.3 3 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐0.59, 0.39]

5.4 4 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

0.20 [‐0.36, 0.76]

6 Pain (0‐100 mm VAS) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

6.1 3 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

‐19.6 [‐33.50, ‐5.70]

6.2 8 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

10.30 [‐3.99, 24.59]

7 Lequesne Index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 3 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

‐1.10 [‐3.57, 1.37]

7.2 8 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

1.20 [‐1.27, 3.67]

8 Function: range of motion (flexion 4 weeks post injection) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9 Stair climb time (seconds) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

9.1 3 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

0.80 [‐10.23, 11.83]

9.2 8 weeks post injection

1

57

Mean Difference (IV, Fixed, 95% CI)

8.30 [‐2.81, 19.41]

10 Index of disease activity (0‐10) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

10.1 1 week post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.60 [‐1.69, 0.49]

10.2 2 weeks post injection (16 days)

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐1.48, 0.68]

10.3 3 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.10 [‐1.28, 1.08]

10.4 4 weeks post injection

1

24

Mean Difference (IV, Fixed, 95% CI)

‐0.40 [‐1.77, 0.97]

11 Global assessment: number of patients showing improvement 1 week post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

12 Global assessment: number of patients improved 1 week post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13 Global assessment: number of patients reporting improvement from baseline Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

13.1 3 weeks post injection

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

1.05 [0.84, 1.32]

13.2 8 weeks post injection

1

57

Risk Ratio (M‐H, Fixed, 95% CI)

0.80 [0.51, 1.26]

14 Global assessment: number of knees excellent or good as assessed by physician at 20 weeks post injection Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

15 Safety: number of patients reporting local pain after injection (triamcinolone hexacetonide versus betamethaso Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

16 Safety: number of patients reporting local pain after injection (hydrocortisone acetate vs hydrocortisone TBA) Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

17 Safety: number of adverse events recorded Show forest plot

1

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

Figures and Tables -
Comparison 10. Corticosteroid versus corticosteroid