Hyaluronic Acid Injections for Knee Osteoarthritis?

[Argirios Argiriou]

December 29, 2015
Hyaluronic Acid Injections for Knee Osteoarthritis?
Allan S. Brett, MD reviewing Jevsevar D et al. J Bone Joint Surg Am 2015 Dec 16.

A meta-analysis suggests that this commonly used intervention is largely ineffective.

Patients with knee osteoarthritis often are treated with viscosupplementation (intra-articular injections of hyaluronic acid [HA]). HA injections are expensive, and their efficacy is controversial. In this meta-analysis, researchers identified randomized trials of viscosupplementation that had at least 4 weeks of follow-up and at least 30 patients per treatment group; trials were included if either the WOMAC osteoarthritis index or a visual analog pain scale was used to assess outcomes. The minimum important differences for pain and function are 8 points on the 100-point WOMAC scale, and 20 mm on a 100-mm visual analog scale.

Nineteen trials met inclusion criteria. In double-blind, sham-controlled trials, HA reduced mean pain scores and function scores significantly, compared with placebo, but the treatment effects were only 29% of the minimum important difference for pain, and only 48% of the minimum important difference for function. In contrast, in nonblinded trials that compared HA with usual care, the treatment effect exceeded the minimum important differences for both pain and function.

Comment

This meta-analysis strongly suggests that a placebo effect is largely responsible for the purported benefit of HA injections for knee osteoarthritis, because clinically important improvement was not observed in double-blind trials. Several of the authors of this analysis are employed by the American Academy of Orthopaedic Surgeons (AAOS), whose 2013 AAOS guideline on knee osteoarthritis recommends against the use of HA injections (J Am Acad Orthop Surg 2013; 21:571).

Editor Disclosures at Time of Publication

Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

    Jevsevar D et al. Viscosupplementation for osteoarthritis of the knee: A systematic review of the evidence. J Bone Joint Surg Am 2015 Dec 16; 97:2047. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

    Abstract/FREE Full Text

- See more at: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Η ενέσεις αυτές δεν είναι και τόσο φθηνές. Π.χ. μια ένεση Hyalart έχει Λιανική Τιμή (Λ.Τ.) 19,42 €

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

και μια συνηθισμένη δοσολογία είναι 5 τέτοιες ενέσεις ετησίως οπότε σε ετήσια βάση κοστίζουν τότε 100 € για το κάθε γόνατο ή 200 € και για τα δύο γόνατα.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Οπότε τίθεται και το ερώτημα κατά πόσο θα πρέπει να τις αποζημιώνει ο ΕΟΠΥΥ.

[Argirios Argiriou]

Use and Cost of Hyaluronic Acid Knee Injections in the U.S.

Allan S. Brett, MD Reviewing Weick JW et al., J Bone Joint Surg Am 2016 Sep 7; 98:1429

Despite their limited efficacy, these injections are used widely for patients with osteoarthritis.


Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος