Factors Associated with Knee Arthroplasty in a Knee Osteoarthritis Patient Cohort Treated with Intra-articular Injections of Hylan G-F 20

Abstract

Hylan G-F 20 viscosupplementation can be used to treat knee osteoarthritis pain. This study evaluated time to knee arthroplasty (KA), KA risk factors, and health care resource utilization in patients aged ≥18 years with claims in the Optum Clinformatics Data Mart database (2006–2016) for knee osteoarthritis treated with at least one course of hylan G-F 20. Kaplan–Meier analysis estimated KA risk from osteoarthritis diagnosis and first hylan G-F 20 treatment. KA risk factors were determined using multivariate Cox regression. Among 62,033 patients treated with hylan G-F 20 and/or hylan G-F 20 single intra-articular injection, 60 to 64% did not undergo KA 8 years following first injection. KA risk factors from time of osteoarthritis diagnosis and first hylan G-F 20 treatment were similar: increased age, fewer comorbidities, fewer hylan G-F 20 treatments, female sex, and no ultrasound/fluoroscopy for injection guidance. Patients who underwent KA versus those who did not had more office visits and claims for opioids, nonsteroidal anti-inflammatory drugs, and physical therapy. Patients less likely to undergo KA were younger (<40 years), had more comorbidities, received more courses of hylan G-F 20, were males, or received ultrasound/fluoroscopic injection guidance. Patients who did not receive KA versus those who did used fewer health care resources.

Keywords

knee arthroplasty - osteoarthritis - viscosupplementation - hyaluronic acid - hylan G-F 20

Publication History

Received: 08 April 2019

Accepted: 10 November 2019

Article published online:
24 December 2019

• References

• 1 Cisternas MG, Murphy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey. Arthritis Care Res (Hoboken) 2016; 68 (05) 574-580
• 2 Murray CJ, Atkinson C, Bhalla K. et al; U.S. Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310 (06) 591-608
• 3 Salaffi F, Carotti M, Stancati A, Grassi W. Health-related quality of life in older adults with symptomatic hip and knee osteoarthritis: a comparison with matched healthy controls. Aging Clin Exp Res 2005; 17 (04) 255-263
• 4 Gore M, Tai KS, Sadosky A, Leslie D, Stacey BR. Clinical comorbidities, treatment patterns, and direct medical costs of patients with osteoarthritis in usual care: a retrospective claims database analysis. J Med Econ 2011; 14 (04) 497-507
• 5 Lawrence RC, Felson DT, Helmick CG. et al; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis Rheum 2008; 58 (01) 26-35
• 6 Turkiewicz A, Petersson IF, Björk J. et al. Current and future impact of osteoarthritis on health care: a population-based study with projections to year 2032. Osteoarthritis Cartilage 2014; 22 (11) 1826-1832
• 7 Vos T, Flaxman AD, Naghavi M. et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380 (9859): 2163-2196
• 8 Hochberg MC, Altman RD, April KT. et al; American College of Rheumatology. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken) 2012; 64 (04) 465-474
• 9 Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg 2013; 21 (09) 571-576
• 10 Jordan KM, Arden NK, Doherty M. et al; Standing Committee for International Clinical Studies Including Therapeutic Trials ESCISIT. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62 (12) 1145-1155
• 11 McAlindon TE, Bannuru RR, Sullivan MC. et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis Cartilage 2014; 22 (03) 363-388
• 12 Christensen R, Henriksen M, Leeds AR. et al. Effect of weight maintenance on symptoms of knee osteoarthritis in obese patients: a twelve-month randomized controlled trial. Arthritis Care Res (Hoboken) 2015; 67 (05) 640-650
• 13 Bhala N, Emberson J, Merhi A. et al; Coxib and traditional NSAID Trialists' (CNT) Collaboration. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382 (9894): 769-779
• 14 Finan PH, Remeniuk B, Dunn KE. The risk for problematic opioid use in chronic pain: What can we learn from studies of pain and reward?. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87 (Pt B): 255-262
• 15 Niinimäki TT, Eskelinen A, Ohtonen P, Junnila M, Leppilahti J. Incidence of osteotomies around the knee for the treatment of knee osteoarthritis: a 22-year population-based study. Int Orthop 2012; 36 (07) 1399-1402
• 16 Brignardello-Petersen R, Guyatt GH, Buchbinder R. et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: a systematic review. BMJ Open 2017; 7 (05) e016114
• 17 Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J 2015; 97-B [phone]
• 18 Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ 2017; 356: j1131
• 19 Skou ST, Roos EM, Laursen MB. et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
• 20 Bitton R. The economic burden of osteoarthritis. Am J Manag Care 2009; 15 (8, Suppl) S230-S235
• 21 Huddleston JI, Maloney WJ, Wang Y, Verzier N, Hunt DR, Herndon JH. Adverse events after total knee arthroplasty: a national Medicare study. J Arthroplasty 2009; 24 (6, Suppl) 95-100
• 22 Haynes J, Sassoon A, Nam D, Schultz L, Keeney J. Younger patients have less severe radiographic disease and lower reported outcome scores than older patients undergoing total knee arthroplasty. Knee 2017; 24 (03) 663-669
• 23 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 (03) 201-207
• 24 Julin J, Jämsen E, Puolakka T, Konttinen YT, Moilanen T. Younger age increases the risk of early prosthesis failure following primary total knee replacement for osteoarthritis. A follow-up study of 32,019 total knee replacements in the Finnish Arthroplasty Register. Acta Orthop 2010; 81 (04) 413-419
• 25 Ong KL, Anderson AF, Niazi F, Fierlinger AL, Kurtz SM, Altman RD. Hyaluronic acid injections in Medicare knee osteoarthritis patients are associated with longer time to knee arthroplasty. J Arthroplasty 2016; 31 (08) 1667-1673
• 26 Altman R, Fredericson M, Bhattacharyya SK. et al. Association between hyaluronic acid injections and time-to-total knee replacement surgery. J Knee Surg 2016; 29 (07) 564-570
• 27 Atamaz F, Kirazli Y, Akkoc Y. A comparison of two different intra-articular hyaluronan drugs and physical therapy in the management of knee osteoarthritis. Rheumatol Int 2006; 26 (10) 873-878
• 28 Berenbaum F, Grifka J, Cazzaniga S. et al. A randomised, double-blind, controlled trial comparing two intra-articular hyaluronic acid preparations differing by their molecular weight in symptomatic knee osteoarthritis. Ann Rheum Dis 2012; 71 (09) 1454-1460
• 29 Ammann EM, Goldstein LJ, Nagle D. et al. A dual-perspective analysis of the hospital and payer-borne burdens of selected in-hospital surgical complications in low anterior resection for colorectal cancer. Hosp Pract (1995) 2019; 47 (02) 80-87
• 30 Murugappan G, Li S, Lathi RB, Baker VL, Eisenberg ML. Increased risk of incident chronic medical conditions in infertile women: analysis of US claims data. Am J Obstet Gynecol 2019; 220 (05) 473.e1-473.e14
• 31 Ong KL, Runa M, Lau E, Altman R. Is intra-articular injection of synvisc associated with a delay to knee arthroplasty in patients with knee osteoarthritis?. Cartilage 2019; 10 (04) 423-431
• 32 Inacio MC, Chen Y, Paxton EW, Namba RS, Kurtz SM, Cafri G. Statistics in brief: an introduction to the use of propensity scores. Clin Orthop Relat Res 2015; 473 (08) 2722-2726
• 33 Waddell DD, Joseph B. Delayed total knee replacement with Hylan G-F 20. J Knee Surg 2016; 29 (02) 159-168
• 34 Boutefnouchet T, Puranik G, Holmes E, Bell KM. Hylan GF-20 viscosupplementation in the treatment of symptomatic osteoarthritis of the knee: clinical effect survivorship at 5 years. Knee Surg Relat Res 2017; 29 (02) 129-136
• 35 Petrella RJ, Wakeford C. Pain relief and improved physical function in knee osteoarthritis patients receiving ongoing hylan G-F 20, a high-molecular-weight hyaluronan, versus other treatment options: data from a large real-world longitudinal cohort in Canada. Drug Des Devel Ther 2015; 9: 5633-5640
• 36 Raynauld JP, Goldsmith CH, Bellamy N. et al. Effectiveness and safety of repeat courses of hylan G-F 20 in patients with knee osteoarthritis. Osteoarthritis Cartilage 2005; 13 (02) 111-119
• 37 Waddell DD, Bricker DC. Total knee replacement delayed with Hylan G-F 20 use in patients with grade IV osteoarthritis. J Manag Care Pharm 2007; 13 (02) 113-121
• 38 Maradit Kremers H, Larson DR, Crowson CS. et al. Prevalence of total hip and knee replacement in the United States. J Bone Joint Surg Am 2015; 97 (17) 1386-1397
• 39 Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop Relat Res 2005; (435) 232-238
• 40 Altman R, Lim S, Steen RG, Dasa V. Hyaluronic acid injections are associated with delay of total knee replacement surgery in patients with knee osteoarthritis: evidence from a large U.S. health claims database. PLoS One 2015; 10 (12) e0145776
• 41 Apold H, Meyer HE, Nordsletten L, Furnes O, Baste V, Flugsrud GB. Risk factors for knee replacement due to primary osteoarthritis, a population based, prospective cohort study of 315,495 individuals. BMC Musculoskelet Disord 2014; 15: 217
• 42 Wise BL, Felson DT, Clancy M. et al. Consistency of knee pain and risk of knee replacement: the multicenter osteoarthritis Study. J Rheumatol 2011; 38 (07) 1390-1395
• 43 Riddle DL, Kong X, Jiranek WA. Factors associated with rapid progression to knee arthroplasty: complete analysis of three-year data from the osteoarthritis initiative. Joint Bone Spine 2012; 79 (03) 298-303
• 44 Adams ME, Atkinson MH, Lussier AJ. et al. The role of viscosupplementation with hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing hylan G-F 20 alone, hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthritis Cartilage 1995; 3 (04) 213-225
• 45 Kemper F, Gebhardt U, Meng T, Murray C. Tolerability and short-term effectiveness of hylan G-F 20 in 4253 patients with osteoarthritis of the knee in clinical practice. Curr Med Res Opin 2005; 21 (08) 1261-1269
• 46 Lussier A, Cividino AA, McFarlane CA, Olszynski WP, Potashner WJ, De Médicis R. Viscosupplementation with hylan for the treatment of osteoarthritis: findings from clinical practice in Canada. J Rheumatol 1996; 23 (09) 1579-1585
• 47 Lee S, Park D, Chmell SJ. Viscosupplementation with hylan G-F 20 (Synvisc): pain and mobility observations from 74 consecutive patients. J Knee Surg 2004; 17 (02) 73-77
• 48 Weick JW, Bawa HS, Dirschl DR. 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; 98 (17) 1429-1435