Intra-articular Hyaluronic Acid for Knee Osteoarthritis: Stabilizing Utilization Trends Amid Conflicting Clinical...

Area of Science:

• Orthopedics
• Rheumatology
• Pain Medicine

Background:

• Conflicting clinical practice guidelines (CPGs) exist regarding intra-articular hyaluronic acid (HA) efficacy for knee osteoarthritis.
• The American Academy of Orthopaedic Surgeons (AAOS) recommended against HA in 2013, impacting its use.
• Recent endorsements from OARSI and VA-DoD in 2019-2020 may have influenced current HA injection trends.

Purpose of the Study:

• To evaluate the contemporary utilization of HA knee injections.
• To analyze trends in HA injection rates following key clinical practice guideline changes.
• To examine variations in HA utilization across different healthcare provider specialties.

Main Methods:

• Analysis of 16,581,526 knee osteoarthritis patients from the PearlDiver database (2010Q1-2023Q1).
• Calculation of quarterly HA injection rates relative to diagnosed knee osteoarthritis cases.
• Linear regression analyses segmented by AAOS (2013) and OARSI/VA-DoD (2019) guideline inflection points, stratified by provider specialty.

Main Results:

• Overall HA injection utilization decreased post-2013 AAOS guidelines (-0.10% per quarter, p < 0.001).
• Following 2019 OARSI/VA-DoD endorsements, injection rates stabilized (-0.003% per quarter, p = 0.921).
• Utilization declined across most demographics and specialties, except for an increase among pain medicine physicians (p < 0.001).

Conclusions:

• Intra-articular HA injection use has stabilized after recent positive CPGs, contrasting with the decline post-2013 AAOS guidelines.
• Diverging practice patterns across specialties highlight variability in HA utilization for knee osteoarthritis.
• Further investigation into specialty-specific practice variations is warranted.