Breaking News
February 20, 2019 - Over Half of Hip Replacements Expected to Last 25 Years
February 20, 2019 - Microscopic eye movements affect how we see contrast
February 20, 2019 - Computer vs. patient: Fighting for residents’ attention | News Center
February 20, 2019 - New “Smart Drug” Shows Promise for Metastatic Triple-Negative Breast Cancer
February 20, 2019 - Researchers develop large-scale window material for high-efficiency PM2.5 capture
February 20, 2019 - Widespread confusion among consumers on food date labels lead to unnecessary discards
February 20, 2019 - Researchers unlock plant’s secret of producing specialized metabolites
February 20, 2019 - Newly released national framework identifies obstacles to improving EMS systems
February 20, 2019 - Exercise can shift human body clock depending on time when people work out
February 20, 2019 - Female adolescent blood donors more likely to have iron deficiency and related anemia
February 20, 2019 - Rubicon level linked to inhibition of autophagic process
February 20, 2019 - Researchers find potential therapeutic strategy to treat Alzheimer’s
February 20, 2019 - New forms of older anti-cancer agent appear to enhance immune response to fight melanoma
February 20, 2019 - Health Tip: Eat Less Saturated Fat
February 20, 2019 - Sleeping in contact lenses puts you at risk of dangerous infection
February 20, 2019 - “We should study that!”: How a nurse-scientist found her passion
February 20, 2019 - Cervical microbiome may influence HPV infection more than previously thought
February 20, 2019 - Sausage mislabeling in Canada is down, new study finds
February 20, 2019 - Study shows blood pressure benefits of morning exercise for older overweight/obese adults
February 20, 2019 - New screening method could catch organ rejection much earlier without a biopsy needle
February 20, 2019 - Study may have important implications for refining parenting during child’s adolescence
February 20, 2019 - Study sheds new light on how antibiotic resistance genes are transferred between bacteria
February 20, 2019 - Chronic Wasting Disease may soon spread to humans, warns CDC
February 20, 2019 - Scientists identify new genetic causes linked to abnormal pregnancies and miscarriages
February 20, 2019 - Using LyoSpeed technology to avoid residual solvent when drying HPLC fractions
February 20, 2019 - Scientists join forces to identify a new approach to fight African sleeping sickness
February 20, 2019 - New screening tool more likely to identify sexual and labor exploitation of youth
February 20, 2019 - Newly licensed nurses work for long hours, also have a second paid job
February 20, 2019 - Physicists identify simple mechanism used by deadly bacteria to fend off antibiotics
February 20, 2019 - FDA Grants Priority Review to Genentech’s Personalized Medicine Entrectinib
February 20, 2019 - Exposure to chemicals before and after birth is associated with a decrease in lung function
February 20, 2019 - Neuroscientists reveal that simple brain region can guide complex feats of mental activity
February 20, 2019 - Study finds new link between food allergies and multiple sclerosis
February 20, 2019 - First gene therapy operation for macular degeneration is a success
February 20, 2019 - Physicians graduated outside the U.S. offer better care for Medicare patients with complex needs
February 20, 2019 - Study shows therapeutic potential of VEGF-A mRNA for regenerative angiogenesis in humans
February 20, 2019 - FDA Approves Keytruda (pembrolizumab) for the Adjuvant Treatment of Patients with Melanoma with Involvement of Lymph Node(s) Following Complete Resection
February 20, 2019 - Study identifies brain cells that modulate behavioral response to threats
February 20, 2019 - Researchers take closer look at how viruses bind cells and cause infection
February 20, 2019 - Newly developed gene therapy helps decelerate aging process
February 20, 2019 - Study suggests new treatment strategy for deadly brain cancer
February 20, 2019 - Scientists develop unique hybrid implant that imitates bone structure
February 20, 2019 - Push-ups can be tailored to meet specific needs of individuals
February 20, 2019 - Early-career job loss has long term health implications
February 20, 2019 - CVD Does Not Modify Depression-Mortality Link in Elderly
February 20, 2019 - Electrical activity early in fruit flies’ brain development could shed light on how neurons wire the brain
February 20, 2019 - Machine learning technique helps predict which asthma patients respond to corticosteroid therapy
February 20, 2019 - Self-reported sleep duration is a useful tool to measure sleep in children, study suggests
February 20, 2019 - T-cells play key role in how the body fights follicular lymphoma
February 20, 2019 - Study shows how 3D organization of genetic material helps perpetuate the species
February 20, 2019 - Researchers engineer stem cell with ‘suicide genes’ to induce cell death in all but beta cells
February 20, 2019 - Study reveals major sex differences in management of cardiovascular risk factors among U.S. adults
February 20, 2019 - Health Tip: Get Your Child to School on Time
February 20, 2019 - Shortcut strategy for screening compounds with clinical potentials for drug development
February 20, 2019 - Common acid reflux drugs tied to elevated risk for kidney disease
February 20, 2019 - Microbiome could be culprit when good drugs do harm
February 20, 2019 - Prenatal exposure to forest fires causes stunted growth in children
February 20, 2019 - Gene therapy restores hearing in mice with congenital genetic deafness
February 20, 2019 - First molecular test predicts treatment response for kidney cancer
February 20, 2019 - New method for improved visualization of single-cell RNA- sequencing data
February 20, 2019 - Researchers capture altered brain activity patterns of Parkinson’s in mice
February 20, 2019 - A possible blood test for detecting Alzheimer’s disease before symptoms show
February 20, 2019 - Primary care physicians associated with longevity, new research finds
February 19, 2019 - New study identifies many key lessons to establish sanctioned safe consumption sites
February 19, 2019 - Single CRISPR treatment can safely and stably correct genetic disease
February 19, 2019 - Multinational initiative to study familial primary distal renal tubular acidosis
February 19, 2019 - Breakthrough study highlights the promise of cell therapies for muscular dystrophy
February 19, 2019 - Subsymptom Threshold Exercise Speeds Concussion Recovery
February 19, 2019 - Midline venous catheters – infants: MedlinePlus Medical Encyclopedia
February 19, 2019 - Searching for side effects
February 19, 2019 - Humanity is all right, probably, although human extinction remains quite possible, researcher says
February 19, 2019 - Having Anesthesia Once as a Baby Does Not Cause Learning Disabilities, New Research Shows
February 19, 2019 - Anti-cancer immunotherapy could be used to fight HIV
February 19, 2019 - Customized Micropatterning for Improved Physiological Relevance
February 19, 2019 - Unique gene therapy approach paves new way to tackle rare, inherited diseases
February 19, 2019 - Activating gene that helps excite neurons reverses depression in male mice
February 19, 2019 - Science Puzzling Out Differences in Gut Bacteria Around the World
February 19, 2019 - Cells that destroy the intestine
February 19, 2019 - On recovery, vulnerability and ritual: An exhibit in white
February 19, 2019 - Scientific Duo Gets Back To Basics To Make Childbirth Safer
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