Cost and Use of Hyaluronic Acid Knee Injections in USA 2023

Osteoarthritis of the knee can affect anyone, but it usually develops in people over age 65. It’s a progressive disease, meaning it becomes more painful and difficult to move your knee over time.

Your doctor will probably prescribe oral medications and suggest lifestyle modifications before recommending knee injections. Before you turn to surgery, weigh the pros and cons of injections.

Osteoarthritis of the knee is a very common musculoskeletal disease affecting over 10 percent of the adult population and is a leading cause of disability within the United States. It’s estimated that more than 60 per cent of the worldwide population aged 65 and above has some form of the disease.

knee injection


TREATING THE KNEE PAIN

Medication for osteoarthritis is usually painkillers. You are also asked to take supplements, glucosamine sulphates and chondroitin sulphates, to help build new cartilage.

You can also opt for knee injections. These are the main types of knee injections used in the treatment of osteoarthritis.

Hyaluronic acid (viscosupplements)

If you have osteoarthritis, you probably don’t have enough hyaluronic acid in your knees. This substance helps to coat your cartilage and acts as a lubricant and shock absorber so your knee can move freely.

This thick medication serves to supplement your own hyaluronic acid and keep the bones from scraping against each other. It may also help decrease inflammation and ease pain.

The following medications are types of hyaluronic acid injections:
  • sodium hyaluronate (Euflexxa, Hyalgan, Supartz)
  • high-molecular-weight hyaluronan (Monovisc, Orthovisc)
  • hylan G-F 20 (Synvisc, Synvisc One)
  • cross-liked hyaluronate (Gel-One)
You might need around 3 to 4 injections.

Corticosteroids

Corticosteroids are designed to be similar to cortisol, a hormone that is naturally produced in the body. The main purpose is to reduce inflammation.

Although oral corticosteroids are used to treat rheumatoid arthritis, which is a systemic disease, this isn’t an option for osteoarthritis.

If you have osteoarthritis in your knee, corticosteroids are most effective when injected directly into the joint. It’s a targeted treatment to reduce inflammation so bone doesn’t rub on bone as you move your knee.

The following medications are types of corticosteroids:
  • methylprednisolone
  • triamcinolone acetonide (Kenalog, Triesence, Zilretta)
  • triamcinolone hexacetonide (Aristospan)

Platelet Rich Plasma (PRP) for Knee Osteoarthritis

Platelet-rich plasma (PRP) is a novel treatment for managing pain related to osteoarthritis (OA) of the knee. Some PRP preparations have approval from the US Food and Drug Administration (FDA), but approval does not yet cover the use of PRP in OA of the knee. Nevertheless, some clinics may offer it “off-label”.
Despite its use, there has been conflicting evidence about the effectiveness of PRP in treating knee OA. A meta-analysis (Source) from 2017 reviewed 14 randomized controlled trials with a total of 1,423 participants. It found that PRP appears to be effective in managing pain associated with knee OA. Researchers noted that, compared with placeboes, PRP injections significantly reduced pain scores at 3-, 6-, and 12-month follow-ups. And compared with controls, PRP significantly improved physical function at these follow-ups. The study did not see a significant improvement in postinjection adverse events.
While those results are promising, 10 of the 14 studies in the meta-analysis were at high risk of bias and 4 were at moderate risk of bias. More studies are needed to determine the efficacy of using RPR to manage pain from OA of the knee.

PRP vs Hyaluronic Acid vs Steroid Injections

There are 20 PRP studies that show superiority over hyaluronic acid (source) and 5 PRP studies that show superiority over steroid injections (source).

Stem Cell Therapy for Knee Osteoarthritis

Some doctors and media channels argue that there is very little evidence to support the use of stem cells to treat orthopaedic conditions. However, there are more than 450 publications related to the use of stem cells in treating knee orthopaedic conditions alone.

There are currently more than 100 studies on stem cell treatment for knee osteoarthritis 
alone, under the U.S. Clinical Trial Registry.

A systematic review (Yubo 2017) of 11 RCTs (randomised controlled trials) concluded that MSCs (mesenchymal stem cells) transplantation treatment was shown to be safe and has great potential as an efficacious clinical therapy for patients with knee Osteoarthritis.

Regenexx, the largest provider of stem cell therapy for orthopaedic conditions in the United States alone, have treated 30,000 patients with stem cell therapy for various joint conditions including knee pain. According to Regenexxcommon regenerative medicine treatments
used in common orthopedic problems have better research evidence than orthopedic surgery.
www.onedaymd.com
Several other comparative studies have demonstrated good evidence in the treatment of osteoarthritis. However, there are several approaches and cell lines used. More well-designed and randomised controlled trials are needed to evaluate the best approach and universal consensus. As studies continue, the methods, forms and combinations of stem cell preparations are improving, and outcomes are expected to improve as well.

Fluid aspiration (arthrocentesis)

Rather than injecting something into the knee, this procedure takes fluid out of the knee. Removing excess fluid may provide immediate relief from pain and swelling. This is sometimes done prior to receiving an injection of corticosteroids or hyaluronic acid.

KNEE GEL INJECTION COST IN USA

The NBC News reported that hyaluronic acid injections cost $822 per patient, physical therapy cost $405 and a knee brace cost $344. (Source)
According to a study published on the NEJM Journal Watch, the mean payment for knee gel injection was US$310 per individual injection and $1128 per patient (covering the 3.6 injections per patient). During the year before TKA, hyaluronic acid injection was the largest treatment expenditure for osteoarthritis (25% of payments). (Source)

Knee gel injections covered by insurance?

Yes, if you are covered by Medicare. Medicare will cover knee injections that are approved by the FDA. This includes hyaluronan injections. Medicare does require that the doctor took x-rays to show osteoarthritis in the knee.The coverage is good for one injection every 6 months. Hyaluronan is Hyaluronic Acid, it’s naturally occurring in the body. While this solution may not be best for everyone, it should be something to consider before resorting to a knee-replacement. This treatment is also called Viscosupplementation. (Source)

Does Blue Cross Blue Shield cover knee injections?

Blue Cross Blue Shield of North Carolina do cover knee injections for knee osteoarthritis but subject to various criteria. For details on the eligibility criteria, check out the document HERE.

Whereas Blue Shield of California has notified doctors that, beginning in June 2018, it will no longer cover the knee injections. “These services are considered NOT medically necessary based upon review of evidence and guidelines of professional societies such as the American Academy of Orthopaedic Surgeons,” it says. (Source).

Please contact your healthcare insurance plan provider for details.

What are the side effects of gel injections in the knee

Common side effects may include:
  • warmth, redness, pain, stiffness, swelling, or puffiness where the medicine was injected;
  • muscle pain, trouble walking;
  • fever, chills, nausea;
  • prickly feeling in your skin;
  • headache, dizziness; or.
  • itching or skin irritation around the knee.

HOW TO PREVENT KNEE PROBLEMS AND TO STRENGTHEN THE KNEES


KEY TAKEAWAY

It’s important to speak with your doctor if you’re already taking non-steroidal anti-inflammatory drugs (NSAIDs) that suppress the immune system, blood thinners, or blood pressure drugs.

Check with your doctor before taking any other alternative or complementary remedies. They should be able to advise you about any potential drug interactions.

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