CLINICAL QUESTION

In patients with osteoarthritis (OA) of the knee, do intraarticular hyaluronic acid injections decrease costs and delay the need for total knee arthroplasty (TKA)?

EVIDENCE-BASED ANSWER

Intra-articular hyaluronic acid injections delay TKA by 299 to 370 days, with multiple courses delaying surgery up to 59 months. Approximately 84% of patients receiving these injections do not undergo TKA within 2 years. (Strength of Recommendation [SOR]: B, a systematic review and meta-analysis and a systematic review without quality measures.) Among patients with knee OA, intra-articular hyaluronic acid injections decrease use of nonsteroidal anti-inflammatory drugs, steroid injections, and opioid medications. This can potentially save patients thousands of dollars and the health care system billions of dollars. (SOR: B, systematic review of economic retrospective reviews.)

EVIDENCE SUMMARY

A 2022 systematic review and meta-analysis of 22 retrospective and three prospective cohort studies (N = 2,824,401; patients ages 55.1 ± 12.8 to 70.5 ± 9.2 years) evaluated whether intraarticular hyaluronic acid injections delayed TKA. In seven studies that included the primary outcome of time from diagnosis of knee OA to TKA, the median time was 16 to 30 months for those who received intra-articular hyaluronic acid injection vs 4 to 12 months for those who did not (P < .001). The meta-analysis included four studies showing a mean time of 614 ± 456 days from knee OA diagnosis to TKA for those receiving intra-articular injections vs 234 ± 377 days for those who did not. The mean difference was 299 days (95% CI, 250–348 days). The effect size for intra-articular hyaluronic acid injection was 0.57 (95% CI, 0.38–0.76), which is considered a moderate treatment effect.¹