title: Clinicians' Perspectives on the Use of Intra-Articular Hyaluronic Acid as a Treatment for Knee Osteoarthritis: A North American, Multidisciplinary Survey.
abstract: BACKGROUND
  This study aims to describe the perceptions of orthopedic surgeons on the efficacy of intra-articular hyaluronic acid (IA-HA), the influence of IA-HA product characteristics on its efficacy, and to identify patterns and factors related to the use of IA-HA. Additionally, this study examines factors that influence IA-HA brand selection, focusing on Euflexxa(®) (1% sodium hyaluronate).
  
  
  METHODS
  We developed survey questions by reviewing the current literature and consulting with experts on the use of IA-HA in the management of knee osteoarthritis (OA). The survey included questions on demographics, previous experience with knee OA treatment, opinions on different treatment methods, and where information regarding treatments is obtained. Additionally, questions specific to opinions regarding IA-HA and the reasoning behind these opinions were asked.
  
  
  RESULTS
  A total of 117 orthopedic surgeons and physicians completed the survey. IA-HA is most frequently prescribed to patients with early-stage (82%) or mid-stage (82.8%) OA, while fewer orthopedic surgeons and physicians use IA-HA for patients with late-stage OA (57.4%). Respondents were generally uncertain of the effects that intrinsic characteristics, such as molecular weight, cross-linking, and production process, had on patient outcomes. Respondents typically use their own clinical experience and results as a deciding factor in utilizing IA-HA treatment, as well as in choosing an IA-HA brand.
  
  
  CONCLUSIONS
  Uncertainty regarding the efficacy of IA-HA treatments is likely due to inconsistency within clinical guidelines and the current literature. Additional research investigating the efficacy of IA-HA treatment and how product characteristics affect outcome and safety is required to provide clarity to the controversy surrounding IA-HA treatment for knee OA.
authors.affiliation: Department of Orthopaedics and Rehabilitation, NewYork-Presbyterian/Queens, Flushing, NY, USA.; Associate Professor, Clinical Orthopaedic Surgery, Weill Medical College, Cornell University, New York, NY, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Rosen
authors.affiliation: Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Avram
authors.affiliation: Ferring Pharmaceuticals Inc., Parsippany, NJ, USA.
authors.forename: Anke
authors.initials: A
authors.lastname: Fierlinger
authors.affiliation: Ferring Pharmaceuticals Inc., Parsippany, NJ, USA.
authors.forename: Faizan
authors.initials: F
authors.lastname: Niazi
authors.affiliation: Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India.
authors.forename: Parag
authors.initials: P
authors.lastname: Sancheti
authors.affiliation: Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Asheesh
authors.initials: A
authors.lastname: Bedi
keywords: hyaluronic acid; knee; osteoarthritis; survey