Hyaluronic Acid Injections for Treatment of Advanced Osteoarthritis of the Knee: Utilization and Cost in a National Population Sample

J Bone Joint Surg Am. 2016 Sep 7;98(17):1429-35. doi: 10.2106/JBJS.15.01358.


Background: The prevalence of knee osteoarthritis is increasing in the aging U.S.

Population: The efficacy and cost-effectiveness of the use of hyaluronic acid (HA) injections for the treatment of knee osteoarthritis are debated. In this study, we assessed the utilization and costs of HA injections in the 12 months preceding total knee arthroplasty (TKA) and evaluated the usage of HA injections in end-stage knee osteoarthritis management in relation to other treatments.

Methods: MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases (Truven Health Analytics) were reviewed to identify patients who underwent TKA from 2005 to 2012. The utilization of patient-specific osteoarthritis-related health care (including medications, corticosteroid injections, HA injections, imaging, and office visits) and payment information were analyzed for the 12 months preceding TKA.

Results: A total of 244,059 patients met the inclusion criteria. Of those, 35,935 (14.7%) had ≥1 HA injection in the 12 months preceding TKA. HA injections were responsible for 16.4% of all knee osteoarthritis-related payments, trailing only imaging studies (18.2%), and HA injections accounted for 25.2% of treatment-specific payments, a rate that was higher than that of any other treatment. Patients receiving HA injections were significantly more likely to receive additional knee osteoarthritis-related treatments compared with patients who did not receive HA injections.

Conclusions: Despite numerous studies questioning the efficacy and cost-effectiveness of HA injections for osteoarthritis of the knee, HA injections are still utilized for a substantial percentage of patients. Given the paucity of data supporting the effectiveness of HA injections and the current cost-conscious health-care climate, decreasing their use among patients with end-stage knee osteoarthritis may represent a substantial cost reduction that likely does not adversely impact the quality of care.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Knee / economics
  • Cost-Benefit Analysis
  • Female
  • Health Care Costs
  • Humans
  • Hyaluronic Acid / administration & dosage
  • Hyaluronic Acid / economics
  • Hyaluronic Acid / therapeutic use*
  • Injections, Intra-Articular / economics
  • Injections, Intra-Articular / statistics & numerical data*
  • Knee Joint / surgery
  • Male
  • Medicare
  • Middle Aged
  • Osteoarthritis, Knee / drug therapy*
  • Osteoarthritis, Knee / economics
  • United States
  • Viscosupplements / administration & dosage
  • Viscosupplements / economics
  • Viscosupplements / therapeutic use*


  • Viscosupplements
  • Hyaluronic Acid