Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis – A Cox model analysis

Abstract

Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden.ObjectivesThis study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups.Materials and methodsPatients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros.ResultsA total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-values<0.001) for hyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs.ConclusionThis is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee replacement and show that patients treated with hyaluronic acid have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.

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.…”

Effect and mechanism of total alkaloids of strychnine on papain induced rabbit knee osteoarthritis

“…The most representative injection was hyaluronic acid (HA) or corticosteroid which has been approved by United States Food and Drug Administration (US FDA) and European Medicines Agency (EMA) for the treatment of knee osteoarthritis (KOA). The clinical practice confirmed that the therapy can reduce joint pain and improve joint function, reduce the dosage of non-steroidal antiinflammatory drugs (NSAIDs) and delay the total knee replacement [3][4][5][6][7]. However, there are also problems such as short duration of curative effect, increased cost, and inappropriate use of patients in advanced stage and increased risk of infection in multiple articular cavities [8][9][10][11].…”

Management of Early Osteoarthritis

“…Multiple courses of IAHA can cause long-term beneficial outcomes, including reduction in analgesics used and delay in the need for joint replacement surgeries [19] still found regarding the risk benefit of IAHA. However, controversy about lack of agreement among international guidelines regarding the use of IAHA for the management of symptomatic knee OA still exists [20].…”