Readers React: Insurers that refuse to pay for an injection to treat arthritic knees have a point

To the editor: Although I agree that it’s generally accurate to put the words “insurer” and “insanity” together, the case for hyaluronic acid injection in patients with osteoarthritis is not a good illustration of this madness. (“The insanity of covering a $50,000 knee operation but not a relatively cheap injection,” April 20)

In questioning my own patients who have received this treatment, I have found that the decrease in pain has mostly been very transient, often lasting less than a month. Considering many patients pay more than $1,000 extra out of pocket for plasma growth factor (obtained from one’s own plasma) or amniotic fluid for a procedure that is marginally effective and requires repeated injections, the insurers may be right in declining to pay for it.

I also know that total knee replacement usually does not cost close to $50,000. Yes, our healthcare payment system is insane, but this is likely one of those rare cases in which the insurers have taken a sane stance.

John T. Chiu, MD, Newport Beach

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To the editor: I am 74, have been active my whole life, and wore out both knees and a hip. Over the last 10 years I’ve had hyaluronic acid injections, cortisone injections and, finally, replacement surgery on those joints.

The injections have their place in treatment, and they definitely delay surgery. But eventually they quit working and you have to bite the bullet of surgery.

I don’t debate the thrust of David Lazarus’ column, but I think it’s important to note that injections delay, rather than prevent, surgery.

Louise Jones, San Marino

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