Breaking News
November 21, 2018 - Study explores individual and organizational risk factors for one-year mortality in ICU survivors
November 21, 2018 - Pulmonologists want more information on inhalation devices for COPD
November 21, 2018 - Cessation fatigue predicts relapse rate after attempts to quit smoking
November 21, 2018 - Special care should be taken with drugs that inhibit epigenetic factors, study suggests
November 21, 2018 - More than one in ten heavy cannabis users experience withdrawal after quitting cannabis
November 21, 2018 - Reflections on the California fires
November 21, 2018 - Donna Lynne Appointed to Key Leadership Role at CUIMC
November 21, 2018 - Smoke-free laws associated with reduced systolic blood pressure
November 21, 2018 - Achieving new guideline blood pressure goals may prevent 3 million cardiovascular events
November 21, 2018 - LDR brachytherapy for treating early-stage prostate cancer lacks conclusive data
November 21, 2018 - Purified omega-3 and aspirin reduce pre-cancerous bowel polyps, shows study
November 21, 2018 - Study warns that potential epigenetic therapy may boost lung cancer stem cells
November 21, 2018 - Noise pollution in hospital impact quality and safety of healthcare
November 21, 2018 - Higher Risk for Amputation, DKA With SGLT2 Inhibitors for T2DM
November 21, 2018 - Researchers stop ‘sneaky’ cancer cells in their tracks
November 21, 2018 - People who are afraid to draw their blood over-estimate the risk of fainting
November 21, 2018 - Personalized physical exercise reverses functional, cognitive deterioration in the elderly
November 21, 2018 - COPD linked to obesity in older women who have never smoked
November 21, 2018 - AHA: Cold-Weather Drinks Are Here, But Watch Out for the Calories
November 21, 2018 - Crowds line up at 1st East Coast pot shops
November 21, 2018 - Merck declares 2018 Life Science Award winners
November 21, 2018 - Many people underestimate the impact of sprains, say foot scientists
November 21, 2018 - Lower levels of protein make squamous carcinoma cells more invasive
November 21, 2018 - Study highlights a new predictor of type 2 diabetes
November 21, 2018 - NTU and TTSH join forces to improve doctor-patient communication
November 21, 2018 - New low-cost injectable hydrogel could help wounds heal faster
November 21, 2018 - Merck Announces Winners of 2018 Life Science Awards
November 21, 2018 - Check your medical records for dangerous errors
November 21, 2018 - Amount of weight regain after bariatric surgery helps predict health risks
November 21, 2018 - Heart failure patients with stronger hearts have more depressive symptoms, lower quality of life
November 21, 2018 - Women can be as resilient as men in undertaking arduous physical activity
November 21, 2018 - Receptor structure could be key to developing new osteoporosis drugs
November 21, 2018 - Researchers identify human white matter pathway associated with individual variability in human stereoacuity
November 21, 2018 - Vitamin D critical to early development of vertebrates, study suggests
November 21, 2018 - Myriad biological, societal factors that impact CKD severity for children of African descent
November 21, 2018 - Isofol Announces Initiation of a Pivotal Phase 3 Clinical Trial of arfolitixorin for the Treatment of Metastatic Colorectal Cancer
November 21, 2018 - Experts offer more clarity on managing common ankle fractures
November 21, 2018 - About 300 million bits of DNA are missing from basic reference genome, report scientists
November 21, 2018 - Study explores how the moving brain processes visual information
November 21, 2018 - Biomedical engineers stop cancer cells from moving and spreading
November 21, 2018 - Gut protein mutations protect against spikes in blood glucose levels
November 21, 2018 - First probabilistic atlas of thalamus nuclei to better understand the brain
November 21, 2018 - Peanut allergies could soon have a drug treatment
November 21, 2018 - Vanderbilt researchers isolate antibody that can neutralize West Nile virus
November 21, 2018 - KHN’s ‘What the Health?’ Health nerd books for the holidays
November 21, 2018 - MDMA could help gain trust but does not make one naive find researchers
November 21, 2018 - Study uncovers new mechanism controlling the master cancer regulator
November 21, 2018 - Online communication technologies could stave off depression among seniors, shows study
November 21, 2018 - FDA Approves Gamifant (emapalumab-lzsg) for Primary Hemophagocytic Lymphohistiocytosis
November 21, 2018 - Artificial intelligence predicts treatment effectiveness
November 21, 2018 - A bicyclist’s road to recovery after traumatic brain injury
November 21, 2018 - New research project to combat obesity, type 2 diabetes receives NIH funding
November 21, 2018 - Humans play key role in distribution and transmission of Bartonella bacteria
November 21, 2018 - First modeling system developed for testing age-specific human immune responses to vaccines
November 21, 2018 - FDA Alert: Gilenya (fingolimod): Drug Safety Communication
November 21, 2018 - Uric Acid Test: MedlinePlus Lab Test Information
November 21, 2018 - Researchers use genetics to predict response to antipsychotic medications
November 21, 2018 - Proposal to include the price of drugs in television ads is flawed, Stanford scholar writes
November 21, 2018 - Disrupting reproduction strategy of disease-causing parasites could help fight malaria
November 20, 2018 - ACAAI: Almost 2 Percent of Children Have Milk Allergy
November 20, 2018 - Congenital anomalies of kidney and urinary tract – Genetics Home Reference
November 20, 2018 - Can video games improve the health of older adults with schizophrenia?
November 20, 2018 - Can flicking a molecular switch restore the aging immune system’s competence?
November 20, 2018 - Restek launches new Oregon cannabis pesticide standards
November 20, 2018 - Health sector coalition urges Government to safeguard patients in future UK-EU relationship
November 20, 2018 - Study evaluates second-hand marijuana smoke exposure among children
November 20, 2018 - Scientists identify three genes responsible for recurrent molar pregnancies
November 20, 2018 - Researchers identify multisystem disorder caused by bi-allelic variants in CCDC47 gene
November 20, 2018 - Dining Out With Allergies Is Tough, But These Steps Can Help
November 20, 2018 - Breastfeeding protects infants from antibiotic-resistant bacteria
November 20, 2018 - AI matched, outperformed radiologists in screening X-rays for certain diseases | News Center
November 20, 2018 - Adolescents increasingly choose marijuana over cigarettes, alcohol
November 20, 2018 - World’s first medical imaging scanner produces diagnostic scan of the whole human body
November 20, 2018 - Cytocybernetics receives NIMH award to move into neuronal drug development
November 20, 2018 - Researchers discover new information on pathological mechanisms of Alzheimer’s disease
November 20, 2018 - ‘Unknown’ enzyme may be key to new treatment for inflammatory diseases
November 20, 2018 - Recreational drug may help people regain trust in others
November 20, 2018 - Researchers identify gene vital for post-stroke recovery
November 20, 2018 - Scientists identify novel target for neuron regeneration, functional recovery in spinal cord injury
November 20, 2018 - Potential new therapeutic approach developed for synovial sarcoma
Injections for knee osteoarthritis—’subtle but significant’ impact of revisions in clinical practice guidelines

Injections for knee osteoarthritis—’subtle but significant’ impact of revisions in clinical practice guidelines

image_pdfDownload PDFimage_print

Recent updates in evidence-based recommendations have led to changes in the use of steroid and hyaluronic acid injection for patients with osteoarthritis of the knee, reports a study in the May 16, 2018 issue of The Journal of Bone & Joint Surgery. The journal is published in partnership in the Lippincott portfolio by Wolters Kluwer.

Although guideline revisions based on new evidence have stopped or reversed trends towards increased use of injections for knee osteoarthritis, these treatments remain commonly used, according to the new research by Nicholas A. Bedard, MD, of University of Iowa Hospitals and Clinics, Iowa City, and colleagues.

Guideline Changes Reflect Questions on Injections for Knee Arthritis

The researchers evaluated the impact of updated guidelines for nonsurgical treatment of knee osteoarthritis, issued by the American Academy of Orthopaedic Surgeons (AAOS) in 2008 and 2013. The study focused on two common treatments to reduce knee pain: corticosteroid (steroid) injection, intended to reduce inflammation; and hyaluronic acid, intended to supplement the natural fluids within the knee joint.

Dr. Bedard and colleagues analyzed an insurance database of more than 1 million patients with knee osteoarthritis treated between 2007 and 2015. Overall, about 38 percent of patients received at least one steroid injection and 13 percent had at least one hyaluronic acid injection.

Before the first clinical practice guideline, the rate of steroid injections was rising steadily. In the 2008 guideline, the AAOS suggested that steroid injection could be given for short-term pain relief of knee. After this “Grade B” recommendation—reflecting some limitations of the evidence—the rate of increase in steroid injection slowed significantly.

By 2013, there was new conflicting evidence on effectiveness of steroid injection. In response, the AAOS stated that it could not make any recommendation for or against the use of steroid injection. After this revision, the trend in steroid injection leveled off. Use of steroid injection continued to increase in patients under age 50—perhaps reflecting attempts to avoid total knee replacement surgery in this younger age group.

Recommendations for injection of hyaluronic acid were also revised during the study period. In 2008, the AAOS stated that there was no evidence on which to base a recommendation on hyaluronic acid injection, either for or against. This recommendation slowed a previous trend toward increased use of hyaluronic acid.

By 2013, there was new evidence showing no benefit of hyaluronic acid compared to inactive placebo, prompting a strong recommendation against the use of this treatment. After this revision, the rate of hyaluronic acid injection declined significantly.

There was a significant decrease in hyaluronic acid injections performed by orthopaedic surgeons and pain specialists—but not by primary care physicians (such as general internal medicine doctors) or non-surgeon musculoskeletal specialists (such as rheumatologists or sports medicine physicians). Overall, orthopaedic surgeons performed two-thirds of hyaluronic acid injections. Trends in steroid injection did not differ by specialty.

Evidence-based guidelines play an important role in ongoing evaluation of medical treatments. The new findings suggest that guideline updates for knee osteoarthritis have had a “subtle but significant” impact on clinical practice. Rates of steroid injection leveled off after the AAOS concluded that no recommendation could be made, while the rate of hyaluronic acid injection decreased in response to a recommendation against this procedure.

Some of the same studies that questioned the effectiveness of these treatments also reported that they account for a large proportion of treatment costs for knee osteoarthritis. Injections given shortly before total knee replacement surgery may even increase the risk of infection. Dr. Bedard comments, “We hope that this project helps to shed light on the important clinical practice guidelines created by AAOS and further encourages providers to follow these recommendations, share them with their patients, and utilize them as a guide to improve the value of care provided to patients with knee osteoarthritis.”


Explore further:
Hyaluronan combined with exercise versus exercise alone to relieve knee arthritis

More information:
Nicholas A. Bedard et al. Impact of Clinical Practice Guidelines on Use of Intra-Articular Hyaluronic Acid and Corticosteroid Injections for Knee Osteoarthritis, The Journal of Bone and Joint Surgery (2018). DOI: 10.2106/JBJS.17.01045

Journal reference:
Journal of Bone and Joint Surgery

Provided by:
Wolters Kluwer Health

Tagged with:

About author

Related Articles