Conservative management of patients with knee osteoarthritis on the total knee arthroplasty waiting list: Clinical profile and the role of single injection viscosupplementation
Abstract. Knee osteoarthritis (KOA) is a major cause of chronic pain and disability. Many patients with indications for total knee arthroplasty (TKA) must wait on waiting lists. The aim: to describe the clinical profile of KOA patients awaiting TKA and evaluate efficacy and safety of a single intra-articular cross-linked bionic hyaluronate injection (Flexotron® Cross). Material and methods. A retrospective and prospective study was conducted at the «DEMA-Sever Medical Center» (Severodvinsk, 2025). At the retrospective stage, based on the medical records of 86 patients with KOA included in the waiting list for TKA, a clinical portrait of this category of patients was formed. At the prospective stage, patients were divided into two groups: the main group (n = 37) received a single intra-articular injection of cross-linked bionic sodium hyaluronate (Flexotron® Cross, 60 mg/3 ml) in combination with basic therapy (SYSADOA, aceclofenac 100 mg on demand), the comparison group (n = 40) received only basic therapy. Assessment of patients’ condition using VAS, WOMAC index, SF-36 questionnaire, measuring pain-free walking distance and NSAID consumption were carried out at 7 control points (weeks 0, 4, 8, 12, 16, 20 and 24). Results. In the main group, by the 24th week of observation, the median pain according to VAS decreased by 53.7% from 67.0 [59.5; 76.0] to 30.0 [24.5; 39.0] mm (p <0.001), with a significant superiority over the comparison group starting from the 8th week (p <0.001). The total WOMAC index decreased by 47.4% from 73.0 [63.5; 84.0] to 38.0 [31.0; 47.5] points (p < 0.001). NSAID consumption (aceclofenac) significantly decreased already from the 4th week of observation (p <0.05): from 6.0 [5.0; 7.0] to 2.0 [1.0; 2.0] doses per week. In the comparison group, changes in VAS and WOMAC scores were minimal (-12.6 and -10.9%, respectively). Adverse events in the main group were reported in 8.1% of patients, all of which were mild and transient. Conclusion. In the presented study, a single intra-articular injection of cross-linked bionic sodium hyaluronate (Flexotron® Cross) provided a clinically and statistically significant reduction in pain, improved functional status in patients with KOA over 24 weeks of observation, significantly reduced NSAID consumption, and was characterized by a favorable safety profile. It gives grounds to consider viscosupplementation with a bionic cross-link hyaluronic acid as a justified component of patient management during the period of awaiting TKA.A.A. Shokhin, A.I. Surov, Е.А. Trofimov, A.S. Trofimova
Keywords
knee osteoarthritis
viscosupplementation
hyaluronic acid
cross-linked bionic hyaluronate
total knee arthroplasty
symptomatic slow acting drugs for osteoarthritis (SYSADOA)
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About the Authors
Andrei A. Shokhin, MD, rheumatologist, applicant at the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University; rheumatologist at “Dema-Sever Medical Center” LLC (Severodvinsk), Saint Petersburg, Russian Federation.E-mail: andra.11@yandex.ru
ORCID: https://orcid.org/0009-0000-5440-237X
Anatoly I. Surov, MD, therapist, applicant at the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University; therapist at Saint Petersburg City Polyclinic No. 60, Pushkinsky District, Saint Petersburg, Russian Federation.
E-mail: dr.surov.a.i@yandex.ru
ORCID: https://orcid.org/0009-0008-2908-0928
Evgeniy A. Trofimov, MD, Dr. Sci. (Medicine), head of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
E-mail: Evgeniy.trofimov@szgmu.ru
ORCID: https://orcid.org/0000-0003-3236-4485
Anna S. Trofimova, MD, PhD (Medicine), associate professor of the Department of therapy and rheumatology named after E.E. Eichwald, I.I. Mechnikov North-Western State Medical University, Saint Petersburg, Russian Federation.
E-mail: Anna.Trofimova@szgmu.ru
ORCID: https://orcid.org/0000-0001-5926-7912
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