Intra-articular infiltration therapy for patients with glenohumeral osteoarthritis: A systematic review of the literature

Sascha Colen, Pieter Geervliet, Daniël Haverkamp, Michel P J Van Den Bekerom, Sascha Colen, Pieter Geervliet, Daniël Haverkamp, Michel P J Van Den Bekerom

Abstract

Background: Conservative treatments are especially in patients with glenohumeral osteoarthritis (GH-OA) important, since shoulder arthroplasty has its limitations. In this systematic review, we will evaluate the current evidence regarding the efficacy of intra-articular (IA) infiltration treatment options in patients with GH-OA.

Materials and methods: The following databases are searched: Pubmed/Medline, Cochrane Clinical Trial Register, Embase and the WHO clinical trial register. All IA injection products used for the treatment of shoulder OA in humans are included.

Results: A total of 8 studies could be included in this review. Hyaluronic acid (HA) showed effect sizes of 2.07, 2.02 and 2.11 at 6, 12 and 26 weeks follow-up, respectively. Placebo (1.60, 1.82 and 1.68) also showed stable effect sizes at the same time points. The efficacy of corticosteroids (CS) decreased rapidly at follow-up (1.08, 0.43 and 0.19). Although statistical significant, the maximum difference in effect sizes between HA and placebo was only 0.43 with absolute values between 2.0 and 6.4 on a 100-point visual analogue score for pain.

Conclusion: IA treatment with HA has a good efficacy at follow-up compared to baseline. However, the difference in efficacy between HA and placebo never reaches the minimal clinically important difference at any of the follow-up points. We are not able to give clear recommendations for the use of IA CS injections in patients with GH-OA. In future research, we recommend focusing on sufficiently powered randomized trials to compare the efficacies of HA, CS, placebo and other IA treatment options in patients with GH-OA.

Keywords: Anesthetics; corticosteroid; hyaluronan; hyaluronic acid; osteoarthritis; shoulder; sodium hyaluronate; systematic review; viscosupplementation.

Conflict of interest statement

Conflict of Interest: There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart summarizing the selection of relevant articles
Figure 2
Figure 2
Pooled effect sizes and standard deviations hyaluronic acid
Figure 3
Figure 3
Pooled effect sizes and standard deviations placebo
Figure 4
Figure 4
Effect sizes corticostroids

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