Ready to use intra-articular hyaluronic acid (HA) injections for patients with knee osteoarthritis (OA)? Hold on, says new research from The University of Arkansas for Medical Sciences (UAMS).
HA for Knee OA Patients? Might Want to Wait
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Their work, “Comparative Effectiveness of Intra-Articular Hyaluronic Acid and Corticosteroid Injections on the Time to Surgical Knee Procedures,” appears in the December 2017 edition of The Journal of Arthroplasty.
The authors wrote, “A nested cohort of persons with knee OA [osteoarthritis] seeing a specialist was created using a 10% random sample of LifeLink Plus claims (2010-2015) to compare the risk of composite (any) knee surgical interventions, total (TKA [total knee arthroplasty]/unicompartmental knee arthroplasty (UKA) and TKA only among HA users and 2 comparison groups: corticosteroid (CS) users and HA/CS nonusers.”
“Among 13,849 patients, 797 were HA users, 5,327 were CS users, and 7,725 were HA/CS nonusers…the risk of composite surgical interventions did not differ between HA users and HA/CS nonusers.”
C. Lowry Barnes, M.D., chair of the University of Arkansas for Medical Sciences (UAMS) College of Medicine’s Department of Orthopaedic Surgery and co-author on the study, told OTW, “Like many institutions, ours has a real interest in big data. Use of databases such as LifeLink Plus allow us to study interventions and how they affect a large numbers of individuals over a period of time.”
“This study has not changed my practice as the data did not suggest a significant enough benefit of HA for me to begin providing these to patients with knee osteoarthritis. Certainly, we must take a host of factors and data into consideration as we make individual decisions about our patients, but large database studies such as this can help add to our knowledge regarding specific interventions.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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