Patient-reported Outcomes of Short-term Intra-articular Hyaluronic Acid for Osteoarthritis of the Knee: A Consecutive Case Series

Background Supartz FX (Seikagaku Corp., Tokyo, Japan) has been investigated as a therapeutic for knee osteoarthritis (OA) due to its claimed preservation of viscoelastic joint properties and improvement in pain and physical function. The US prescribing information suggests patients may experience benefit with as few as three of five injections administered once weekly. However, recommended guidelines from the American Academy of Orthopaedic Surgeons (AAOS) do not support injectable hyaluronate due to controversial results of randomized controlled trials. Objective Do patients experience statistically and/or clinically significant improvement in disability scores following three injections? Methods A total of 32 patients with a mean age of 66 +/- 14 years receiving Supartz FX were reviewed in a prospective, observational study. Functional outcome data via Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function were collected at 0, 1, 2 and 3 weeks, and means were analyzed via paired t-test. Results Three injections at one-week intervals resulted in statistically significant improvement across all sub scores (p<0.05). Confidence intervals (CIs) of treatment effects (ES, 95% CI) for pain (0.27, 95% CI 0.99, 1.26), stiffness (0.17, 95% CI 0.50, 0.67), and function (0.55, 95% CI 2.79, 3.35) were recorded and compared to published minimum clinically important improvement (MCII) thresholds. Conclusion Despite manufacturer recommendations, in this study short-term use of Supartz FX for knee OA does not meet clinically significant thresholds as the treatment effects for WOMAC sub scores fail to satisfy published MCII for pain (0.39), stiffness (0.39) and function (0.37). In light of these findings and in concordance with recommendations set forth by the AAOS, this study contributes to a preventative medicine database that encourages exploration of non-surgical and non-opiate modalities for the management of osteoarthritis.