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A 2013 guideline from the American Academy of Orthopaedic Surgeons recommended strongly against hyaluronic acid injections (viscosupplementation) for patients with knee osteoarthritis, given the lack of benefit in randomized trials (NEJM JW Gen Med Jan 15 2016 and J Bone Joint Surg Am 2015; 97:2047). Did clinicians pay attention to that recommendation? To find out, researchers used a large U.S. insurance claims database to examine trends in use of hyaluronic acid injections. Two thirds of injections were provided by orthopedic surgeons.
Between 2007 and 2013, rates of hyaluronic acid injection increased from roughly 7.0 to 8.5 per 100 patients with knee osteoarthritis per quarter. During the 2 years after the guideline was issued, rates drop…