Comparative Effectiveness of Intra-Articular Hyaluronic Acid and Corticosteroid Injections on the Time to Surgical Knee Procedures

Shewale, Anand R.; Barnes, C. Lowry; Fischbach, Lori; Ounpraseuth, Songthip; Painter, Jacob T.; Martin, Bradley C.

doi:10.1016/j.arth.2017.07.007

Cited by 19 publications

(15 citation statements)

References 38 publications

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“…Lastly, we did not compare the effectiveness of HA injections over other interventions (for example, intra-articular corticosteroid injections) or no intervention, which by itself remains a controversial question. [18] In spite of these limitations, our study findings may help clinicians and payers choose between different HA injections based on the other product attributes (for example, one-dose injections versus multi-dose injections) and cost; given that there is no difference in their effectiveness to delay knee surgeries.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Shewale

Barnes

Fischbach

et al. 2017

The Journal of Arthroplasty

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Background We compared the effectiveness of low molecular weight (LMWHA), moderate molecular weight (MMWHA), and high molecular weight (HMWHA) hyaluronic acid for prevention or delay of knee surgery in patients with knee osteoarthritis (OA). Methods An observational cohort study using Lifelink Plus claims (2006-2015) was used. The primary outcome measure of the study included all surgical interventions of the knee. The secondary outcome measures were 1) unicompartmental (UKR) or total knee replacement (TKR) and 2) TKR only. A high dimensional propensity score (hdPS) using 1:1 matching was used to adjust for confounding. The likelihood of each outcome was assessed using Cox proportional hazard models. Results A cohort of 30,417 incident HA users with knee OA met our inclusion-exclusion criteria. There was no difference in the likelihood of composite surgical events between LMWHA users (HR: 0.939; 95%CI: 0.870-1.013) and MMWHA users (HR: 1.032; 95%CI: 0.952-1.119) when compared to HMWHA users in a matched hdPS analysis. However, a significantly lower likelihood for all outcome measures was demonstrated in LMWHA and MMWHA users compared to HMWHA users when hdPS was not used. Conclusion There was no significant difference in the likelihood of surgical interventions between LMWHA, MMWHA and HMWHA users after accounting for empirically derived confounders.

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Section: Discussionmentioning

confidence: 99%

“…The rationale for choosing these as outcome measures has been described previously. [18] The operational definitions were based on previously published studies[19–23] or reimbursement codes used by insurance companies. (Appendix B) A licensed medical coder at our university hospital verified the definitions used for the outcome measures.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Shewale

Barnes

Fischbach

et al. 2017

The Journal of Arthroplasty

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“…To date, there are no definitive treatment options for OA. Current guidelines aim to delay joint replacement surgery as much as possible with the use of conservative treatment modalities 1 . Non-pharmacological options include life-style changes such as weight loss and low impact physical exercises however these tend to have low patient compliance.…”

Section: Introductionmentioning

confidence: 99%

Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis

Vitali

Ometti

Drossinos

et al. 2020

Journal of Drug Assessment

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Objective: The purpose of this study was to investigate the potential ability of autologous conditioned serum (ACS) to decrease pain and improve joint functionality in patients affected by knee osteoarthritis (OA). Methods: Fifteen patients with clinical and radiological signs of OA of the knee were recruited for this study. Each patient received 4 injections of ACS (Orthokine; orthogen, Dusseldorf, Germany) at the site of OA once per week for 4 weeks. Clinical and functional evaluation was performed using the VAS scale for pain, WOMAC scale and KSS functional and clinical scores before the first injection, at one week, at two weeks, at three weeks, at one month and at six months. Statistical analysis was done with the Wilcoxon Signed-Rank Test. Results: Our results show an improvement of all the evaluation scales at 6 months follow-up. Particularly, VAS scales among all patients decreased by 35.8% (p ¼ .00148), KSS functional scores improved by 38.2% (p ¼ .00148), KSS clinical scores improved by 28.9% (p ¼ .00236) and WOMAC scores were reduced by 19.8% (p ¼ .00188). Few adverse effects were observed in our sample. The most common complaint was pain and swelling in the subsequent days after performing the intraarticular injection. Only one patient reported rigidity following the injection of the ACS. Conclusion: Our results, in conjunction with preexisting studies in the medical literature regarding ACS, demonstrate the viability of this therapy for the treatment of knee OA, showing positive influence on pain and joint function without significant adverse effects.

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“…19,20 For the latter group, intra-articular injections are a common strategy for providing symptomatic relief while potentially postponing the need for TKA because roughly 30% of TKA patients receive knee injections before their procedure. [21][22][23][24][25][26] Despite their popularity, the use of injections to prevent disease progression has been driven more so by dogma than contemporary evidence-based literature because neither CS nor HA injections have been consistently shown to prevent conversion to or delay TKA. In fact, in the 2013 guidelines for the nonsurgical treatment of osteoarthritis, the AAOS issued a strong recommendation against the use of HA injections, 27 finding that the current literature was unable to demonstrate a clinically effective response to HA injections.…”

Section: Discussionmentioning

confidence: 99%

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

Pirkle

Seidel²,

Bhattacharjee³

et al. 2022

JAAOS Glob Res Rev

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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.

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Comparative Effectiveness of Intra-Articular Hyaluronic Acid and Corticosteroid Injections on the Time to Surgical Knee Procedures

Cited by 19 publications

References 38 publications

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Comparison of Low-, Moderate-, and High-Molecular-Weight Hyaluronic Acid Injections in Delaying Time to Knee Surgery

Autologous conditioned serum: clinical and functional results using a novel disease modifying agent for the management of knee osteoarthritis

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

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