Allan S. Brett, MD reviewing Weick JW et al. J Bone Joint Surg Am 2016 Sep 7.

Despite their limited efficacy, these injections are used widely for patients with osteoarthritis.

Double-blind, placebo-controlled trials show that intraarticular hyaluronic acid injections are largely ineffective in treating patients with knee osteoarthritis (NEJM JW Gen Med Jan 15 2016 and J Bone Joint Surg Am 2015; 97:2047). Researchers analyzed an insurance claims database to determine how often these injections were given during the year before total knee arthroplasty (TKA) in U.S. patients with osteoarthritis who underwent TKA from 2005 to 2012.

Among 244,000 patients in the database, 15% received at least one hyaluronic acid knee injection; among patients who received injections, the mean number of injections was 3.6. The annual rate of injections remained similar throughout the 8-year observation period. The mean payment was US$310 per individual injection and $1128 per patient (covering the 3.6 injections per patient). During the year before TKA, hyaluronic acid injection was the largest treatment expenditure for osteoarthritis (25% of payments). On multivariate analysis, recipients of hyaluronic acid injections were also significantly more likely than nonrecipients to receive corticosteroid injections (odds ratio, 4.2), narcotic and nonnarcotic prescription analgesics (ORs, 2.2 and 2.5, respectively), and physical therapy (OR, 2.2).

CITATION(S):

Weick JW et al. Hyaluronic acid injections for treatment of advanced osteoarthritis of the knee: Utilization and cost in a national population sample. J Bone Joint Surg Am 2016 Sep 7; 98:1429. 

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