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.

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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.


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.