Hyaluronic Acid Injections in Medicare Knee Osteoarthritis Patients Are Associated With Longer Time to Knee Arthroplasty

Abstract Background Few nonoperative treatment options for knee osteoarthritis (OA) are available, but there is ongoing debate about the effectiveness of intra-articular (IA) hyaluronic acid (HA) injections. We investigated whether the formulation of IA HA, or its combined use with IA corticosteroid...

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Bibliographic Details
Published in:The Journal of arthroplasty 2016-08, Vol.31 (8), p.1667-1673
Main Authors: Ong, Kevin L., PhD, PE, Anderson, Allen F., MD, Niazi, Faizan, PharmD, Fierlinger, Anke L., MD, Kurtz, Steven M., PhD, Altman, Roy D., MD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Arthroplasty, Replacement, Knee
corticosteroid
Female
Glucocorticoids - administration & dosage
Humans
hyaluronic acid
Hyaluronic Acid - administration & dosage
Injections, Intra-Articular
intra-articular injections
knee arthroplasty
knee osteoarthritis
Male
Medicare Part B
Orthopedics
Osteoarthritis, Knee - drug therapy
Osteoarthritis, Knee - surgery
Propensity Score
Retrospective Studies
United States
Viscosupplements - administration & dosage
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Summary:Abstract Background Few nonoperative treatment options for knee osteoarthritis (OA) are available, but there is ongoing debate about the effectiveness of intra-articular (IA) hyaluronic acid (HA) injections. We investigated whether the formulation of IA HA, or its combined use with IA corticosteroid (CS), may be contributing to some of the reported variation in clinical outcomes. Methods The 5% Part B Medicare data (2005-2012) were used to identify knee OA patients who underwent knee arthroplasty (KA). The time from diagnosis of OA to KA was compared between patients with (HA) and without (no HA) IA HA use, using quantile regression with propensity score adjustment. These were further stratified by type of IA HA. Patient factors associated with time to KA were also assessed using Cox regression. Results The “HA” cohort was associated with a longer time to KA of 8.7 months (95% confidence interval: 8.3-9.1 months; P < .001) compared with the “no HA” cohort, with extended time to KA in the bioengineered Euflexxa IA HA cohort. Patient factors associated with longer time to KA included women, younger patients, minority patients, patients with fewer comorbidities, and IA CS injection use. Patients with both IA HA and IA CS had an additional 6.3 months (95% confidence interval: 5.5-7.0 months; P  
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2016.01.038