Hyaluronic Acid Injections May Delay Total Knee Replacement in Osteoarthritis

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The restricted mean survival time without total knee replacement surgery was higher in the patients who received the hyaluronic acid injections vs those who did not.
The restricted mean survival time without total knee replacement surgery was higher in the patients who received the hyaluronic acid injections vs those who did not.

The use of intra-articular hyaluronic acid (HA) injections in patients with osteoarthritis (OA) of the knee has shown efficacy in delaying total knee replacement (TKR) surgery in a recent retrospective, longitudinal study published in PLoS One.

The investigators sought to compare the delay from diagnosis to TKR surgery in patients with knee OA who received intra-articular HA injections vs those who did not. All patients studied were treated in France between 2006 and 2013. A second objective of the study was to compare direct medical costs associated with ambulatory care between the 2 groups.

A total of 14,782 patients were treated for knee OA (ages ≥50 years; mean age, 68±10 years; 67% women). Annual incidence rates of knee OA were estimated to be 0.52% in women and 0.92% in men. Of the 14,782 patients, 1662 individuals (11.2%) underwent TKR surgery before the end of 2013.

At each point evaluated, restricted mean survival time without TKR surgery was higher in the HA treatment vs no injection group (from 51 days at 1 year after diagnosis to 217 days at 7.5 years, respectively; P <.001). In the year before TKR, the means for total direct medical costs were similar between the 2 treatment groups (€744 for HA vs €805 for control). Intra-articular injections accounted for <10% of the total costs.

This is the first retrospective longitudinal study involving patients with knee OA that used medico-administrative databases in France. The investigators concluded that "the results support the effectiveness of [HA] injections in delaying [TKR] surgery and show that patients treated with [HA] have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only." Further cost-effective analyses are warranted to explore the ability of HA injections to delay TKR surgery for a longer period of time.

Reference

Delbarre A, Amor B, Bardoulat I, et al. Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis. PLoS One. 2017;12(11):e0187227.

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