A Search for Factors that Predict the Efficacy of Viscosupplementation in Knee Osteoarthritis

R. Michelle Koolaee^1,2*, H. Ralph Schumacher¹, Michael Shoemaker³, Sarah Mooar¹, Sally Pullman-Mooar¹

¹Division of Rheumatology, Philadelphia Veterans Affairs Medical Center and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
²Division of Rheumatology, Keck School of Medicine at the University of Southern California, Los Angeles, USA.
³Grand Valley State University Department of Physical Therapy, Grand Rapids, MI, USA.

DOI: 10.4236/oalib.1100700                

Abstract

Objective: Previous research demonstrates inconsistent effects of hyaluronate (HA) viscosupplementation on patients with knee osteoarthritis (OA). The purpose of this study was to evaluate factors that predict clinical response to a single intra-articular injection of Hylan GF-20. Methods: This was an observational study of 55 patients with knee OA, scheduled to receive intra-articular injections of Hylan GF-20. These patients met the institution’s guidelines for use of viscosupplementation, which entails failure/intolerance of medical management of OA. At baseline, patients completed a series of questionnaires, including the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Patient Health Questionnaire (PHQ-9) depression score. Questionnaires were repeated at three months post-injection. A clinical responder was someone with a change in KOOS score which exceeded the mean minimal detectable change (MDC) values calculated based on test-retest reliability coefficients reported in four prior studies. Hypothesized predictors of response included PHQ-9 score, baseline visual analog scale (VAS) pain score, age, body mass index (BMI), and Kellgren score. Results: There were 35 responders and 20 non-responders. There were no statistically significant differences between responders and non-responders for any of the primary predictors. There were no differences for secondary predictors, including history of knee injury or smoking, prior HA injection, prior intra-articular corticosteroid injection, or location of OA. There was a moderate negative correlation between age and change in total KOOS score (r = —0.32, p = 0.01). Conclusions: Our research did not confirm previous predictors of response to hyaluronate injections, and highlighted the need for prospective studies in order to answer this question.

Keywords

Hyaluronic Acid, Viscosupplementation, Osteoarthritis, Knee Osteoarthritis, Efficacy, Hyaluronate

Conflicts of Interest

The authors declare no conflicts of interest.

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