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Osteoarthritis (OA) of
knee refers to a disabling condition causing progressive joint pain and
dysfunction.
One cycle of five intra-articular knee injections
of sodium hyaluronate given in a single 8-week knee osteoarthritis treatment
program efficiently reduces symptoms and is highly cost-effective.
Osteoarthritis (OA) of knee refers to a disabling condition causing progressive joint pain and dysfunction. It occurs as a result of damage to the articular cartilage, subchondral bone, synovitis, and osteophytes formation and is known to affect about 12% of population aged ≥60 years. Different conservative measures such as analgesics, aerobic training, and muscle strengthening were adopted initially to alleviate the symptoms of joint pain and dysfunction. Also, some surgical options for treating OA such as total knee arthroplasty (TKA) or unicompartmental knee arthroplasty are also available. Alternative nonsurgical choices for patients who failed to respond to conservative therapies are available that could decrease the knee pain, rebuild joint function, and likely limits the necessity for arthroplasty. One such nonsurgical measure is the use of intra-articular injections of hyaluronic acid (HA) or viscosupplementation. The recent meta-analysis has established the effectiveness of this nonsurgical treatment for knee OA over a follow-up period of 6 months. The clinical benefits of HA using conventional meta-analytic techniques are still undervalued due to differences occurring in control group effect sizes as suggested by the accumulated evidence. Intra-articular injections of exogenous HA replace OA-induced reductions in the concentration and molecular weight of endogenous HA, through postulated mechanisms including inhibition of chondrodegradative enzymes and inflammatory processes, stimulation of chondrocyte metabolism, and synthesis of articular cartilage matrix components. The major risk factor for knee OA development was chronic joint overload and while the treatment programs based on the synergy of joint uploading therapy and viscosupplementation can yield better results.
Rationale behind the research:
The clinical benefits of hyaluronate injections are undervalued. The present study was carried to address this great unmet need.
Objective:
To assess the efficacy and safety of nonsurgical intervention such as intraarticular injections of HA in patients with knee OA
Study outcome measures:
The study outcomes included:
Time Points:
Study outcomes
Figure 1: Decrease of knee pain NPRS from baseline over a 8
week treatment period
In patients with knee OA participated in a single 8-week program involving one cycle of five intra-articular knee injections of sodium hyaluronate given at weekly intervals, structured physical therapy, knee bracing, and patient education showed a clinical reduction in knee OA symptoms maintained over 3.7 years mean follow-up. This multimodal program was highly cost-effective over long range.
It was postulated that the economic burden due to knee OA would increase 50% by 2025, and the cost of knee procedures will increase by 3 million annually. The ideal therapy of OA should provide clinically meaningful improvements in pain and function, delay the need for TKA, and yield an ICER below the willingness-to-pay threshold and the establishment of pay-for-performance initiatives. All patients in this study lack functional improvement following >3 months conservative therapy before participating in the multimodal knee OA treatment program. This represents a protracted period between conservative care failure and TKA, defined as "knee OA treatment gap". In this gap phase, patient experienced debilitating pain, reduced quality of life, and significant financial burden. Non-surgical procedures like intra-articular injections once in a week for 5 weeks was considered as a viable therapeutic strategy to address the treatment gap in knee OA. The novel aspect of this study was clinical benefit, cost effectiveness and long follow up period in real-world settings.
The study confers that one cycle of five
intra-articular knee injections of sodium hyaluronate given at weekly intervals
is highly cost-effective and provides clinically significant reductions in
symptoms of OA.
J Pain Res. 2017; 10: 1045–1054
Long-term clinical benefit and cost-effectiveness of an 8-week multimodal knee osteoarthritis management program incorporating intraarticular sodium hyaluronate (Hyalgan) injections
Larry E Miller et al.
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