Appropriate use criteria for hyaluronic acid in the treatment of knee osteoarthritis in the United States
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2021;9(22):21 Cartilage. 2017;8(3):234-54What this means for my practice?
The use of IA-HA injections is inappropriate for symptomatic adults who have active local or intra-articular infection of the knee. The use of IA-HA injections is uncertain in symptomatic adults with severe OA who have not received, incomplete, failed or are intolerant to other therapies for the knee. It is also uncertain whether IA-HA is beneficial for individuals with mechanical meniscus pathology, active inflammatory arthritis, synovitis of the knee or who are at high risk of adverse reaction to HA or pharmacological agents for the knee. The use of IA-HA injections is appropriate for symptomatic adults with mild to moderate OA who have not received, incompleted, failed or are intolerant to other therapies for the knee.
Study Summary
A multidisciplinary panel of seven experts was convened by an independent organization, Avalere Health, to develop appropriate use criteria (AUC) for the use of hyaluronic acid (HA) injections for knee osteoarthritis (OA). The process for AUC development included a systematic review of 100 full-length articles that addressed one or more key questions and used the Delphi process to support the assessment of various clinical scenarios. Key questions used to guide the review addressed the effectiveness of HA versus placebo, the effectiveness of HA versus other therapies, the harms of HA use, the effectiveness of HA as a part of a multi-modal approach and the effectiveness of different HA doses and formulations.
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