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. 2021 Dec;13(1_suppl):1696S-1701S.
doi: 10.1177/19476035211053827. Epub 2021 Oct 25.

Retreatment with Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis: Agreement between EUROVISCO Guidelines and Current Medical Practice

Yves Henrotin  1 , Cedric Tits  2 , Jérôme Paul  2 , Pierre Gramme  2 , Thibault Helleputte  2 , Alberto Migliore  3 , Pascal Richette  4 , Xavier Chevalier  5 , Jordi Monfort  6 , Demirhan Diracoglu  7 , Hervé Bard  8 , Jörg Jerosch  9 , Dominique Baron  10 , Raman Raghu  11 , Thierry Conrozier  12
Affiliations

Retreatment with Hyaluronic Acid Viscosupplementation in Knee Osteoarthritis: Agreement between EUROVISCO Guidelines and Current Medical Practice

Yves Henrotin et al. Cartilage. 2021 Dec.

Abstract

Objectives: This work studied if and how current clinical practice agrees with European Viscosupplementation Consensus Group (EUROVISCO) recommendations and how this agreement might be different according to physician's specialization. In addition, this work aimed to identify key decision factors that practitioners consider in their decision to retreat or not a patient with hyaluronic acid viscosupplementation.

Methods: Practitioners have been invited by e-mail to participate in an online exercise on viscosupplementation retreatment. They received a fictional patient case at random among a set of predefined fictional cases. The platform asked the practitioner if he/she would retreat the patient with viscosupplementation or not. To take a decision, the practitioner could select questions among a list of predefined questions. Among them, some were related to criteria used in the EUROVISCO decision tree and others served as confounding factors.

Results: A total of 506 practitioners participated to the exercise, of which 399 gave their decision about the case assigned to them by the platform. The observed agreement between practitioner decisions and EUROVISCO recommendations was 58.89 ± 4.95% (95% confidence interval [CI]). Overall, the decision to retreat was taken in 47.87% of the cases, while the EUROVISCO guidelines follow-up would have led to 55.89% retreatment for the same cases (P = 0.03).

Conclusions: In current practice, physicians tended to reinject their patients less than recommended, although EUROVISCO guidelines for viscosupplementation retreatment consider decision criteria that clearly correspond to those of practitioners in real life. These include the patients' willingness to be treated or the patients' perception of the effectiveness of the treatment.

Keywords: guidelines; hyaluronic acid; knee; osteoarthritis; viscosupplementation.

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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: Cedric Tits, Jérôme Paul, and Pierre Gramme are employees of DNAlytics; Thibault Helleputte is a shareholder of DNAlytics; Thierry Conrozier is a consultant of LABRHA, SANOFI, and MEDAC; and Alberto Migliore, Pascal Richette, Xavier Chevalier, Jordi Monfort, Demirhan Diracoglu, Hervé Bard, Jörg Jerosch, Dominique Baron, Raman Raghu, and Yves Henrotin declared no conflict of interests.

Figures

Figure 1.
Figure 1.
The confusion matrix. Columns correspond to the European Viscosupplementation Consensus Group algorithm recommendations. Rows represent individual decisions by the participants. The bottom row corresponds to missing answers.
See this image and copyright information in PMC

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