Hyaluronic acid in management of advanced osteoarthritis of the knee: retrospective analysis

Intra-articular hyaluronic acid injections is an accepted therapeutic alternative in the symptomatic management of knee osteoarthritis; however there are hardly any studies documenting possible benefit of hyaluronan in delaying the need for TKR. It was this intent our study was conducted. This was a retrospective chart analysis of 130 patients (75 females and 55 males) with varying degree of knee osteoarthritis treated over a 5-year period. The average age was 59.4 (range 15-92). Fifty-three patients had left knee involvement, right knee in 45 patients with 32 with bilateral involvement. Of the patients, 85% had advanced arthritis (grade A3/4). All 130 patients had received hyaluronic acid injections. The total number of courses per knee was 1.604. In patients who had more than one course, the minimum interval between courses was 6 months with the longest interval being 36 months. Three patients (2.3%) developed toxic synovitis. Seventeen patients had a poor response at 6 months. Forty-five patients were advised surgery, but only 29 patients underwent surgery. All patients who underwent surgery had Grade 3/4 changes at the initial presentation. Of 109 patients, 65 (58.7%) patients with advanced arthritis did not undergo surgery and were doing well at final follow-up. Thus, hyaluronic acid injections can delay the need for total knee replacement.