Hyaluronic acid injections for osteoarthritis of the knee: predictors of successful treatment

摘要

Abstract Purpose This study aimed to identify patient and treatment factors that predict a favourable response to intra-articular hyaluronic acid (HA) treatment to better guide patient and treatment selection. Methods This prospective, observational study evaluated patients with mild-to-moderate (Kellgren–Lawrence grades 1–3) primary knee osteoarthritis treated between March 2013 and May 2016. Patient function and pain scores were assessed by the Western Ontario and McMaster Universities Arthritis Index/Knee Injury and Osteoarthritis Outcome Score (WOMAC/KOOS) and visual analogue scale (VAS) surveys, with response to treatment defined according to the Osteoarthritis Research Society International (OARSI) 2004 criteria. Surveys were completed at each injection and three?months post-treatment. Patients were followed an average of 27?months. Results Of 102 patients, 57% had a positive response. Those at least twice as likely to respond were patients with grades 1–2 osteoarthritis or a positive response to the first injection and those who were ≥60?years. Gender, race, body mass index (BMI), smoking status, HA brand, and initial VAS and WOMAC/KOOS scores were not significant predictors of success. Mean time to arthroplasty following injection series was 11?months (30% of nonresponders, 12% of responders). The VAS strongly correlated with KOOS pain scores and successful outcomes. Conclusion Patients with mild-to-moderate osteoarthritis (grades 1–2) and those responding positively to the first injection were twice as likely to respond positively to the injection series, as were patients ≥60?years. Patients who did not respond positively were more likely to proceed to arthroplasty. The VAS appears to be a reliable method of defining and monitoring treatment success. Judicious patient selection and counseling may improve outcomes associated with intra-articular HA injections.