Original Research ARTICLE
Effectiveness and tolerability of repeated courses of viscosupplementation in symptomatic hip osteoarthritis: a retrospective observational cohort study of high molecular weight vs medium molecular weight hyaluronic acid vs no viscosupplementation
- 1Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, Istituto Ortopedico Gaetano Pini, Italy
- 2Department of Orthopedics, Sports Traumatology Unit, Istituto Ortopedico Gaetano Pini, Italy
- 3Immunorheumatology research laboratory, Italian Auxological Institute (IRCCS), Italy
- 4Department of Clinical and Experimental Medicine, Unit of Rheumatology, University of Messina, Italy
- 5DISCCO-Department of Clinical Science and Community Health, University of Milan, Italy
- 6Division of Internal Medicine and Cardiological Rehabilitation, Angelo Bellini Hospital, ASST Valle Olona, Italy
- 7Rheumatology Outpatient Clinic, ASST Nord Milano, Italy
- 8Department of Rehabilitation, ASST Lecco, Italy
Background: Nonsurgical management of symptomatic hip osteoarthritis needs real world evidence. We evaluated the effectiveness and tolerability of US-guided intra-articular treatment of two hyaluronic acids (HAs) commercially available in Italy and investigated predictors of response.
Methods: outpatient records including three cohorts: 122 subjects treated with medium (1,500-3,200 kDa; Hyalubrix®) molecular weight (MW) or high (HylanG-F20; Synvisc®) MW HAs and 20 controls taking NSAIDs/analgesics on demand were retrospectively analyzed. Pain VAS score, WOMAC, NSAIDs/analgesics consumption, causes of suspension were available at 1, 6, 12 and 24 months after first administration. As selection bias usually affects observational retrospective studies, a quasi-randomization process was attained by performing propensity score approach.
Results: Propensity score adjustment successfully allowed comparisons among balanced groups of treatments. VAS and WOMAC considerably decreased over time in treated groups independently of the radiological grade (p<0.001). On the other hand, the control group showed only a slight and rather uneven variation in VAS. Mean score changes were comparable in both HA cohorts from the earliest stages (VAS(HA1,500-3,200kDa)T1vsT0=-20%; VAS(HylanG-F20)T1vsT0=-23%/ WOMAC(HA1,500-3,200kDa)T1vsT0=-17%;WOMAC(HylanG-F20)T1vsT0=-19%), reaching a further substantial reduction after 12 months (VAS(HA1,500-3,200kDa)T12vsT0=-52%; VAS(HylanG-F20)T12vsT0=-53%/WOMAC(HA1,500-3,200kDa)T12vsT0=-45%; WOMAC(HylanG-F20)T12vsT0=-47%). Almost 11% (=13/122) of ineffectiveness and few moderate local side effects (3%=4/122) were detected.
Conclusions: Viscosupplementation in a real-life setting seems to provide a sound alternative in pain management in comparison to oral NSAIDs/analgesics, guaranteeing a reduced intake of pain killer medications. Analgesic effectiveness, functional recovery and reduced joint stiffness, extend and improve over 12 and 24 months, suggesting that repeated administrations achieve an additive effect.
Keywords: Hyaluronic Acid, Hip osteoarthritis (hip OA), Viscosuplementation, VAS (visual analogue pain scale), WOMAC (western ontario and McMaster universities) index, Hylan G-F 20, Joint injection, ultrasound
Received: 16 Nov 2018;
Accepted: 08 Aug 2019.
Copyright: © 2019 De Lucia, Pierannunzii, Pregnolato, Verduci, Crotti, Valcamonica, Pisoni, Comi, Lonati, Meroni and Murgo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Orazio De Lucia, Istituto Ortopedico Gaetano Pini, Department of Rheumatology and Medical Sciences, Clinical Rheumatology Unit, Milan, Italy, email@example.com