Association between Hyaluronic Acid Injections and Time-to-Total Knee Replacement Surgery

Abstract

This study assessed the association between hyaluronic acid (HA) injections and time-to-total knee replacement (TKR) surgery for patients with knee osteoarthritis (OA). Patients 18 to 64 years of age who had TKR surgery between January 1, 2006 and December 31, 2011 were identified from the MarketScan Commercial claims database. All patients had 6 years or more of continuous enrollment prior to TKR surgery. There were two cohorts (1) patients with HA injections prior to TKR surgery and (2) patients who did not have HA injections prior to TKR surgery. Time-to-TKR was defined as the total days from the date of diagnosis of knee OA on the patient's first visit to an orthopedic surgeon to the date of TKR surgery. Results included 22,555 patients who had TKR surgery: 14,132 in the non-HA and 8,423 in the HA cohort. In this retrospective analysis of patients undergoing TKR, the median Time-to-TKR surgery was 326 days for the non-HA and 908 days for the HA cohort, a difference of 582 days. Those receiving HA injections had a median 1.6-year longer Time-to-TKR surgery versus those who did not receive HA injections. These results have both clinical and economic implications.

Rethinking Viscosupplementation: Ultrasound‐ Versus Landmark‐Guided Injection for Knee Osteoarthritis

“…Our data are also consistent with studies of large‐claim databases that showed a delay in knee arthroplasty associated with HA injection . Given that these studies did not distinguish between the methods of HA injection (US versus landmark guided), it is likely that greater delays to surgery may have been observed in the subset of patients receiving US‐guided HA.…”

Use of Intraarticular Hyaluronic Acid in the Management of Knee Osteoarthritis in Clinical Practice

“…The study including only those younger than age 65 years showed an increase in time to surgery of 1.6 years . All studies showed increased time to surgery with increased series of IAHA, and 2 studies suggested additional benefit from higher molecular weight (MW) HA products . The consistency of results from the 3 studies suggests both clinical and economic benefits to IAHA.…”

“…Two studies including 65‐year‐old subjects showed a 1‐year increase in time to surgery . The study including only those younger than age 65 years showed an increase in time to surgery of 1.6 years . All studies showed increased time to surgery with increased series of IAHA, and 2 studies suggested additional benefit from higher molecular weight (MW) HA products .…”

“…Three recent retrospective studies examined the time from diagnosis of KOA to TKA and whether this time would be influenced by the use of IAHA . Large populations of insured subjects were screened and about 250,000 TKAs were reviewed after exclusions.…”

Letter to the Editor on ‘Hyaluronic Acid Injections in Medicare Knee Osteoarthritis Patients Are Associated With Longer Time to Knee Arthroplasty’

“…We read with great interest the study by Ong et al [1] regarding the association of intraarticular hyaluronic acid (IA HA) injection use and delay in knee arthroplasty (KA). This is 1 of the 3 studies recently published from Altman et al using different data sources with similar approaches [1][2][3]. The results of all 3 studies suggest that IA HA use compared to its nonuse was associated with an increased time-to-KA, ranging from 9 months to 3.6 years [1][2][3].…”