Intra-articular injections of ozone versus hyaluronic acid for knee osteoarthritis: a level I meta-analysis
Migliorini F, Giorgino R, Mazzoleni MG, et al. European Journal of Orthopaedic Surgery & Traumatology, 2024.
- Study type
- Systematic review / meta-analysis
- People studied
- 424 people, pooled from the included trials
- Population
- Patients with knee osteoarthritis, pooled from randomized trials comparing ozone with hyaluronic acid
- Published
- 2024, European Journal of Orthopaedic Surgery & Traumatology
- Identifiers
- PMID 39579218, DOI 10.1007/s00590-024-04135-x
What the authors reported
A level-I meta-analysis pooling 424 patients from randomized trials found intra-articular ozone injections produced pain scores (visual analogue scale) statistically similar to hyaluronic acid injections at 4-6 months follow-up.
What limits this result
Restricted to studies with 4-6 month follow-up, so longer-term comparative efficacy is unknown; only ozone-versus-hyaluronic-acid comparisons were analyzed, with no placebo arm.
Other ozone methods, such as major autohemotherapy, that clinics cite in support of EBO2. A result for one method does not transfer automatically to another. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Meta-analysis comparing intra-articular injections of hyaluronic acid (HA) versus ozone in patients with knee osteoarthritis
- Setting
- Department of Orthopaedic and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy (first-listed affiliation)
- Read from
- Read from the abstract only; where this page says nothing about an item, the abstract does not report it. Read on September 28, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Intra-articular ozone injections | Not reported | Ozone injection arm of the randomised controlled trials pooled in the meta-analysis |
| Intra-articular hyaluronic acid injections | Not reported | Hyaluronic acid (HA) injection arm of the randomised controlled trials pooled in the meta-analysis |
| All patients pooled across both arms | 424 | Intra-articular ozone or hyaluronic acid injections |
Source: Abstract on PubMed
What it measured
- Visual analogue scale (VAS) at follow-up, ozone versus HA
- No difference was found (P = 0.4)
- Baseline comparability of the pooled patients
- Compatibility found in mean age, mean BMI, PROMs, and the percentage of women
- Authors' conclusion on pain control at 4 to 6 months
- Ozone and HA intra-articular injections achieve similar pain control between 4 and 6 months of follow-up
Source: Abstract on PubMed
Follow-up
Trials with follow-up shorter than 4 months or longer than 6 months were not included
Source: Abstract on PubMed
Funding and conflicts
Conflict of interest statement on PubMed, as worded there: the authors declare that they have any competing interests for this article (no specific interest is named)
Source: Abstract on PubMed
Where we cite this study
Does EBO2 (EBOO) Work? The Evidence, Study by Study
Every study in our EBO2 (EBOO) library in one place: design, size, what was measured and found, its limits, and a check for any study a clinic cites.