For patients undergoing TKA, diagnosis of rheumatoid arthritis (RA) or ankylosing spondylitis (AS) was independent risk factor for HA administration regardless pre-ALB < 35 g/L or ≥ 35 g/L when compared with those patients with osteoarthritis (OR 3.67, 95% CI 1.60–8.40, P = 0.002; OR 2.06, 95% CI 1.38–3.07, P < 0.001). Here, ALB is linked to osteoarthritis.