Predictors of successful viscosupplementation in osteoarthritis of the knee

BACKGROUND: Knee osteoarthritis (OA) is a common cause of disability among older adults. Common treatments include intra-articular corticosteroids (IACS) and viscosupplementation (VS). However, many insurance carriers either decline to cover VS or require prior IACS failure. Limited data exist on whether IACS response can guide VS use. OBJECTIVE: To determine whether response to IACS predicts subsequent response to VS, and whether age, gender, body mass index (BMI), and OA severity are associated with VS outcomes. DESIGN: Retrospective cohort study. SETTING: Outpatient physical medicine and rehabilitation clinics at a tertiary-care academic medical center. PARTICIPANTS: Four hundred sixty three adult patients (≥18 years) with primary knee OA who received both IACS and VS injections. INTERVENTIONS: Primary independent variable was response to IACS. Additional variables were age, gender, BMI, and OA severity. MAIN OUTCOME MEASURES: Primary outcome was pain relief following VS, categorized as favorable (>33% relief) or unfavorable (≤ 33% relief ). RESULTS: , 95% CI: 0.77-1.01, p = .08; age: OR = 0.95 per 5 years, 95% CI: 0.87-1.04, p = .24). No significant associations were observed for gender or OA severity. CONCLUSIONS: Response to IACS predicts subsequent response to VS in patients with knee OA. These findings may help guide treatment selection, though prospective studies are needed.