Analysis of the Cost and Efficacy of Intra-Articular Knee Injections

Abstract

Introduction: Intra-articular joint injections have been used with the goal of providing patients with symptomatic relief. Recently, however, the efficacy of corticosteroid (CS) and hyaluronic acid (HA) injections in the management of knee osteoarthritis (OA) is questionable. In this analysis, we investigated the costs associated with injections by assessing overall use, conversion and average time to total knee arthroplasty (TKA), and reimbursement. Methods: Patients aged 50 to 70 years with a knee-related diagnosis of pain, effusion, or OA were identified in the Humana insurance national data set. Patients who received intra-articular injections were stratified by the type and number of injection(s) received. The subsequent rates of TKA were compared with Kaplan-Meier curves for patients who underwent CS injections, HA injections, and a benchmarking cohort of patients with OA and no history of knee injections in the medical record. Average time to TKA was determined from index diagnosis, and total cost was compared using Wilcoxon rank sum analyses. Results: A total of 778,686 patients were identified. Of these, 637,112 had no knee injection history, while 124,129 received CS and 17,445 received HA injections. The 10-year conversion to TKA was highest in HA cohort (31.6%), followed by the CS cohort (24.0%) and the noninjection cohort (7.3%) (P , 0.001). Time to TKA increased with number of injections for both injection types. For patients who underwent TKA, median cost was greater in HA ($16,687) and CS ($15,563) cohorts relative to noninjection cohort ($14,733) (P , 0.001). Discussion: Compared with the noninjection cohort, both HA and CS cohorts experienced increased costs and increased time to TKA. However, while the cost incurred in HA cohort was greater than that in CS cohort, no appreciable benefit was demonstrated for conversion or time to TKA. Therefore, if intra-articular knee injections are indicated for the nonsurgical management of knee OA, the results of this study support CS over HA.

Recent Developments and Current Applications of Hydrogels in Osteoarthritis

“…One analysis found that while both corticosteroids and HA reduced the risk of surgery for patients within 10 years, the risk of surgery and the cost of treatment were slightly higher in the HA cohort than in the It should be noted that the efficacy of HA is limited. One analysis found that while both corticosteroids and HA reduced the risk of surgery for patients within 10 years, the risk of surgery and the cost of treatment were slightly higher in the HA cohort than in the corticosteroid cohort [36]. Another clinical trial found that corticosteroids and HA were able to alleviate OA progression, but patients treated with HA injections were at a higher risk of total knee replacement [37].…”

“…corticosteroid cohort [36]. Another clinical trial found that corticosteroids and HA were able to alleviate OA progression, but patients treated with HA injections were at a higher risk of total knee replacement [37].…”

Do intra-articular corticosteroid injections help delay knee replacement surgery in patients with knee osteoarthritis?

“…A 2022 retrospective analysis of a national claims database investigated time to TKA after CSI or HAI. 3 Patients who underwent an intra-articular knee injection on the same day as a diagnostic code for knee-related pain, effusion, or OA (n5141,574) were compared with patients with the same knee-related diagnostic codes without a history of intra-articular knee injection (n5637,112). Eligible patients were 50 to 70 years old at the time of their first injection or knee-related diagnosis.…”

In Vitro Effects of Triamcinolone and Methylprednisolone on the Viability and Mechanics of Native Articular Cartilage

“…Osteoarthritis continues to be a prevalent issue causing joint pain and dysfunction, with knee osteoarthritis affecting >9 million adults and costing the health care system $27 billion annually in the United States. 25 Intra-articular (IA) injection of corticosteroids is commonly performed for the nonoperative management of joint arthritis. 34 Two of the most commonly used corticosteroids for therapeutic IA injection are methylprednisolone acetate (MP) and triamcinolone acetonide (TA).…”