Gambling establishments issue warnings about potential hip and knee ailments due to intensive games
In Germany, a growing concern has been raised about the use of Hyaluronic Acid (HA) injections for knee and hip osteoarthritis. The Medical Service of Health Funds (Medizinischer Dienst der Krankenversicherung, or MDK) generally does not recommend these injections as a covered standard treatment.
This decision is based on the limited or inconsistent clinical evidence for significant benefit, as well as the temporary nature of the therapeutic effect, which often requires repeat injections. The benefits are modest and often debated in clinical guidelines and by insurers.
Instead, German insurers tend to prefer alternative non-surgical interventions such as physical therapy and exercise programs, pain management with NSAIDs or corticosteroid injections, and in some cases, regenerative therapies like platelet-rich plasma (PRP) injections. Surgical interventions like arthroscopy are limited in use and often not fully covered unless specific indications exist.
Out of 60 examined Individual Health Services (IGeL) offering HA injections, 31 were negatively assessed. Only 3 self-pay services had a tendency towards a positive assessment. This growing use of image-guided intra-articular injections of existing options and advanced therapies is noted in Germany, but HA remains often a secondary or non-reimbursed option by statutory health insurance (Gesetzliche Krankenversicherung, or GKV) due to insufficient cost-benefit proof.
The demand for these injections is due to the widespread prevalence of arthritis and the lack of a curative therapy. Every year, statutory health insured individuals spend at least 2.4 billion euros on IGeL Services.
Stefan Gronemeyer, the chairperson of the Medical Service of the Health Funds, attributes the continued use of IGeL services to inadequate patient information in many practices. He criticized promises of benefit through practice flyers and TV, stating that settled physicians need to provide facts instead of advertising in waiting rooms.
Gronemeyer is concerned that patients in medical practices are often not informed about the risk of harm from IGeL services. Potential harm includes joint inflammation, heart problems, and minimal or clinically insignificant pain reduction. He demands that practices should be obligated to regularly offer independently created, science-based assessments and information.
Moreover, Gronemeyer also demands that IGeL should not be provided on the same day they are offered, allowing time for consideration. He emphasized that the head of the Medical Service also demands that IGeL should not be provided on the same day they are offered, allowing time for consideration.
Orthopedics, ophthalmology, and gynecology are the three most profitable specialties in the IGeL market. The high demand for these services, coupled with the lack of a curative therapy for arthritis, has led to a significant financial burden for the health insurance system.
This cautious approach towards HA injections for osteoarthritis aligns with the broader European trend of focusing on evidence-based approaches and cost containment. It is a reminder for both patients and healthcare providers to carefully consider the benefits and risks of any treatment before making a decision.
