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Pain and function were measured at or near 12\u2009weeks for efficacy. Gastrointestinal, cardiovascular, and central nervous system (CNS) adverse events (AEs), and withdrawals were measured for safety. Bayesian network meta\u2010analysis was conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six RCTs (3,611 participants) were included. Tramadol 100 mg\/day (standardized mean difference [SMD] \u20130.16 [95% confidence interval (95% CI) \u20130.34, 0.00]), 200 mg\/day (SMD \u20130.21 [95% CI \u20130.37, \u20130.06]), and 300 mg\/day (SMD \u20130.30 [95% CI \u20130.48, \u20130.14]) were statistically more effective than placebo in pain relief, but only tramadol 300 mg\/day was better than placebo in functional improvement (SMD \u20130.24 [95% CI \u20130.47, \u20130.03]). Tramadol 100 mg\/day (relative risk [RR] 2.29 [95% credible interval (CrI) 1.22, 4.25]), 200 mg\/day (RR 4.35 [95% CrI 2.31, 8.01]), and 300 mg\/day (RR 6.02 [95% CrI 3.22, 11.1]) involved a higher risk of gastrointestinal AEs. Similarly, tramadol 100\u2013300 mg\/day showed a higher risk of CNS AEs and withdrawals. However, the risk of cardiovascular AEs remained unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Only tramadol 300 mg\/day showed minimal improvement in pain and function but with increasing AEs compared with placebo. Tramadol may not be sufficiently recommended for knee or hip OA based on the presented evidence, especially in patients with the risk of gastrointestinal and CNS AEs.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.24750","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T08:44:49Z","timestamp":1626079489000},"page":"158-165","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Efficacy and Safety of Tramadol for Knee or Hip Osteoarthritis: A Systematic Review and Network <scp>Meta\u2010Analysis<\/scp> of Randomized Controlled Trials"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5033-2084","authenticated-orcid":false,"given":"Xiurui","family":"Zhang","sequence":"first","affiliation":[{"name":"Xiangya Hospital Central South University  Changsha Hunan 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