Intra-articular Oxygen-ozone Versus Hyaluronic Acid in Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials

Objective: Knee osteoarthritis (OA) is a common disease, imposing a great burden through pain and decreased function. Numerous methods have been tested for pain management in knee OA and the optimal method is currently still under debate. We performed a meta-analysis from randomized controlled trials (RCTs) to compare the efficacy and safety of intra-articular hyaluronic acid (HA) and oxygen-ozone in the treatment of knee OA.

Methods: Electronic databases included PubMed, Embase, web of science and the Cochrane Library. High quality RCTs comparing HA with oxygen-ozone in the treatment of knee OA were selected. We assessed statistical heterogeneity for each RCT with the use of a standard Chi2 test and the I statistic. Quality assessment was performed by using Cochrane Collaboration's tool. All data were carried out with Stata 14.0 software.

Results: A total of four RCTs including 289 patients were included. The present meta-analysis indicated that there was a significant difference between groups regarding the visual analog scale (VAS) and WOMAC stiffness and function. The improvements in WOMAC pain were similar. No significant difference in adverse events occurrence was observed.

Conclusion: Intra-articular injection of HA was associated with a significantly reduction in VAS score at 1st month compared to oxygen-ozone. And there was significant differences in WAMAC stiffness, and function at 6-month follow-up between groups. Based on the current evidence available, more RCTs are needed for further investigation.