Use of intra-articular hyaluronic acid (HA) injections to manage knee osteoarthritis (OA) remains controversial because of weak and conflicting evidence. The primary objective of our work was to evaluate the effectiveness of intra-articular HA injections for knee OA management. We also characterized the utilization pattern of different interventions used for management of knee OA. A 10% random sample of Lifelink Plus claims (2010-2015) with a cohort design framework was used to answer the study questions. We compared the risk of composite (any) knee surgical interventions, total (TKR) / unicompartmental knee replacement (UKR) and TKR only among HA users and two comparison groups: corticosteroid (CS) users and HA/CS non-users. Same outcome measures were used to compare the effectiveness of low, moderate and high molecular weight HA formulations. A high dimensional propensity score (hdPS) was used to account for potential residual confounding, which may not be accounted by predefined confounders.
We found a considerable variation in the strategies used for management of knee OA. Guideline recommendations for management of knee OA are often not followed in the real world. Procedural interventions especially intra-articular CS injections are commonly used despite their short-term benefit. We also found that opioids, which are associated with addiction problems and adverse events, are the most commonly used pharmacological agents.
We found no significant benefit in the risk of surgical interventions, TKR/UKR, and TKR among HA users compared to CS users or to non-users. These findings were robust over all but one of our sensitivity analyses, which excluded persons that did not undergo a knee surgery in the follow up period. These findings are also consistent with guideline reviews of HA and clinicians and payers should be judicious when considering HA managing knee OA. Also, we did not find any significant difference between high, moderate and low molecular weight hyaluronic acid injections when we accounted for high dimensional propensity score to partially control for known confounders and a broad range or empirically derived confounders. However, our study findings should be interpreted in the light of observational database inability to adequately control potential unmeasured confounding.
|Advisor:||Martin, Bradley C.|
|Commitee:||Barnes, C. Lowry, Fischbach, Lori A., Painter, Jacob T., Songthip, Ounpraseuth|
|School:||University of Arkansas for Medical Sciences|
|School Location:||United States -- Arkansas|
|Source:||DAI-B 78/11(E), Dissertation Abstracts International|
|Subjects:||Pharmacy sciences, Epidemiology, Health care management|
|Keywords:||Comparative effectiveness, Hyaluronic acid injections, Knee osteoarthritis, Total knee replacement|
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