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Time to Total Knee Arthroplasty (TKA) Post Intra-Articular Injection.

Martin G Gesheff1,2, David A Scalzitti2, Sandeep S Bains1

  • 1Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, LifeBridge Health, Baltimore, MD 21215, USA.

Journal of Clinical Medicine
|July 13, 2024
PubMed
Summary

Intra-articular corticosteroids (CS) and hyaluronic acid (HA) injections for knee osteoarthritis (KOA) showed similar timing before requiring total knee arthroplasty (TKA). This study compared injection types to inform KOA treatment decisions.

Keywords:
corticosteroidhyaluronic acidintra-articular injectionplatelet-rich plasmatime to total knee arthroplastytotal knee arthroplasty

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Area of Science:

  • Orthopedics
  • Regenerative Medicine
  • Biomedical Data Science

Background:

  • Knee osteoarthritis (KOA) lacks disease-modifying treatments targeting its root causes.
  • Intra-articular (IA) injections like corticosteroids (CS), hyaluronic acid (HA), and platelet-rich plasma (PRP) are used for symptomatic KOA relief.
  • Total knee arthroplasty (TKA) serves as an endpoint to assess treatment efficacy.

Purpose of the Study:

  • To evaluate the time from the first IA injection to TKA in patients receiving CS or HA.
  • To compare the efficacy of IA CS and HA injections in delaying TKA using a large national claims database.

Main Methods:

  • Retrospective analysis of a national all-payer claims database (2016-2022).
  • Three cohorts (PRP, HA, CS) were created, with PRP excluded due to small sample size.
  • Kaplan-Meier survival analysis and log-rank tests compared TKA-free survival between HA and CS groups.

Main Results:

  • The corticosteroid (CS) cohort had 5.9% TKA incidence, while the hyaluronic acid (HA) cohort had 8.0%.
  • Mean time to TKA was 370.0 days for CS and 377.8 days for HA.
  • No significant difference in TKA-free survival at 4 years between CS and HA groups (p=0.05).

Conclusions:

  • IA corticosteroids and IA hyaluronic acid injections result in similar timeframes before patients require total knee arthroplasty.
  • Findings offer valuable insights for clinicians and patients considering non-surgical injection options for KOA.
  • Further research is warranted to explore potential healthcare cost reductions for KOA management prior to TKA.