Total Knee Replacement Following Repeated Cycles of Intra-articular Sodium Hyaluronate (500-730 Kda) in Failed Conservative Treatment of Knee Osteoarthritis: A 54-Month Follow-up
Thana Turajane MD*, Tanawat Amphansap MD*, Viroj Labpiboonpong MD*, Samart Maungsiri MD*
Affiliation : * Department of Orthopedic Surgery, Police General Hospital, Bangkok, Thailand
Background : Treatment with repeated cycles of Intra-Articular Sodium Hyaluronate (IA-HA), from previous
study, can improve symptoms and delay surgical interventions in knee osteoarthritis patients who failed
conservative treatment within minimum 2-years follow-up. This is a continued study to follow-up responded
patients in the mentioned study whether continuing treatment with IA-HA could prolong time to surgery until
the end of follow-up.
Objective : To evaluate the incidence of total knee replacement (TKR) in patients receiving repeated cycles of
IA-HA during a 54-month follow-up period.
Material and Method: This was a prospective cohort study with 54-month follow-up period. All patients
received at least a single course of 3-weekly injections of IA-HA (500-730 Kilodalton, Hyalgan®). Patients
who well responded to the treatment were recommended to repeat the administration of a 3-weekly injections
every 6-12 months based on their symptoms. The incidence of TKR and time was recorded. Time to event
analysis using Kaplan-Meier survival analysis was performed.
Results : 183 patients were recruited during March 2001 and March 2004 and followed-up until October
2008. Patients were classified into three groups according to Ahlback radiological grading system. 46
patients were in group 1 (Ahlback grade I-II), 70 patients were in group 2 (Ahlback grade III-IV) and 67
patients were in group 3 (Ahlback grade V). The incidence of TKR was 28.4% with a mean time to TKR of 15.4
months (0.7-51.7 months). For the rest of patients who had no TKR during study period (80.4%, 64.3% and
73.1% for group 1, 2, and 3 respectively), their mean follow-up time was 45.6 months (19.0-53.1 months).
Mean survival time was 42.1 months (95% CI = 39.4-44.9 months).
Conclusion : The repeated cycles of intra-articular sodium hyaluronate treatment in delay time to TKR in
patients with knee osteoarthritis which failed conservative treatment was found efficacious during a 54-
month follow-up period.
Keywords : Sodium hyaluronate, Conservative treatment, Failure, Repeated doses, Total knee replacement
