Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jul;8(3):234-254.
doi: 10.1177/1947603516662503. Epub 2016 Aug 10.

Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

Arup K Bhadra  1 , Roy Altman  2 , Vinod Dasa  3   4 , Karen Myrick  5   6 , Jeffrey Rosen  7   8 , Vijay Vad  9 , Peter Vitanzo Jr  10 , Michelle Bruno  11 , Hillary Kleiner  11 , Caryn Just  11
Affiliations

Appropriate Use Criteria for Hyaluronic Acid in the Treatment of Knee Osteoarthritis in the United States

Arup K Bhadra et al. Cartilage. 2017 Jul.

Abstract

Objective: A workgroup of clinical experts has developed an Appropriate Use Criteria (AUC) for the use of hyaluronic acid (HA) in the treatment of osteoarthritis (OA) of the knee. The increasingly broad and varied use of HA injections, lack of published clinical guidance, and limited coverage for their use has created the imperative to establish appropriateness criteria.

Methods: The experts of this workgroup represent rheumatology, orthopedic surgery, physiatry, sports medicine, and nursing clinicians with substantive knowledge of intra-articular HA therapy. This workgroup utilized the results of a systematic review of evidence, expert clinical opinion, and current evidence-based clinical practice guidelines to develop appropriateness criteria for the use of intra-articular HA for knee OA in 17 real-world clinical scenarios.

Results: The workgroup scored the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as appropriate (7-9), uncertain (4-6), or inappropriate (1-3). Six scenarios were scored as appropriate, 10 scenarios were scored as uncertain, and 1 scenario was scored as inappropriate.

Conclusion: This article can assist clinicians in shared decision-making by providing best practices in considering HA injections for knee OA treatment. Moreover, this AUC article can aid payers and policy makers in determining reimbursement and preauthorization policies and more appropriately managing health care resources. It is clear that further research is still necessary-particularly in patient populations differentiated by OA severity-that may benefit the greatest from the use of HA injections for the treatment of knee OA.

Keywords: appropriate use criteria; hyaluronic acid; knee; osteoarthritis; viscosupplementation.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Roy Altman: Consultant for Oletec, Ferring, Teva, and SST Corporation. Dr. Jeffrey Rosen: Member of Ferring Pharmaceuticals’ Scientific Advisory Board. Dr. Vijay Vad: Owner of Vad Scientific, LLC and Vad Biolabs, LLC.

Figures

Figure 1.
Figure 1.
Literature flow diagram.
See this image and copyright information in PMC

References

    1. Lane NE, Schnitzer TJ. Osteoarthritis. In: Goldman L, Schafer A. editors. Goldman’s Cecil medicine. 24th ed. Philadelphia: Elsevier Saunders; 2011. p. 1672-6.
    1. Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum. 2008;58(1):26-35. - PMC - PubMed
    1. Centers for Disease Control and Prevention, The Arthritis Foundation. A national public health agenda for osteoarthritis 2010. Washington, DC: Centers for Disease Control and Prevention; 2010.
    1. Losina E, Thornhill TS, Rome BN, Wright J, Katz JN. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J Bone Joint Surg Am. 2012;94(3):201-7. - PMC - PubMed
    1. Murphy L, Helmick CG. The impact of osteoarthritis in the United States: a population-health perspective. Am J Nurs. 2012;112(3 suppl 1):S13-9. - PubMed

LinkOut - more resources