A retrospective claims analysis of a large commercial database was performed to assess the impact of single versus multiple rounds of high molecular weight biologically derived intra-articular hyaluronic acid (IA-BioHA) with respect to conversion to total knee arthroplasty (TKA). Patients were divided into a control group (n=563,103) who had not received an IA-HA, patients receiving a single IA-BioHA (n=19,004) and patients receiving multiple IA-BioHA injections (n=7,723). Additionally, a secondary analysis evaluating the impact of multimodal therapy was performed. Patients were divided into those receiving no IA-HA, IA-BioHA alone, IA-BioHA and knee bracing, IA-BioHA and corticosteroid injection, and all three treatments. Patients receiving multiple IA-BioHA injections had the greatest delay to TKA when compared to a single injection or no injections. With regards to multimodal treatments, patients who received all three treatments (bracing, corticosteroid and IA-BioHA) demonstrated the greatest delay to TKA.