What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature.
ABSTRACT Osteoarthritis (OA) is a disease of the synovial joints and is the most common cause of chronic pain in the elderly. One of the treatment modalities for OA of the hip is viscosupplementation (VS). Today there are several different formulations of viscosupplements produced by different manufactures of different molecular weights. The objective of this review is to asses the efficacy of VS treatment of hip OA osteoarthritis in the current literature.
The following databases were searched: Medline (period 1966 to November 2006), Cochrane Database of Systematic Reviews (1988 to November 2006), Cochrane Clinical Trial Register (1988 to November 2006), Database of Abstracts on Reviews and Effectiveness, Current Controlled Trials, National Research Register and Embase (January 1988 to November 2006). The search terms [osteoarthritis, hip (joint), viscosupplementation, hyaluronic acid, hyaluronan, sodium hyaluronate and trade names] were applied to identify all studies relating to the use of VS therapy for OA of the hip joint.
Sixteen articles concerning the efficacy of a total of 509 patients undergoing VS treatment for hip OA were included. Twelve European studies, three Turkish studies and one American study with Levels of Evidence ranging from I to IV evaluated the following products: Hylan G-F 20, Hyalgan, Ostenil, Durolane, Fermatron and Orthovisc. Heterogeneity of included studies did not allow pooled analysis of data.
Despite the relatively low Level of Evidence of the included studies, VS performed under fluoroscopic or ultrasound guidance seems an effective treatment and may be an alternative treatment of hip OA. Intra-articular injection of (derivatives of) HA into the hip joint appears to be safe and well tolerated. However, VS cannot be recommended as standard therapy in hip OA for wider populations, and therefore the indications remain a highly individualised matter.
SourceAvailable from: Michael T Cibulka[Show abstract] [Hide abstract]
ABSTRACT: Abstract Osteoarthritis (OA) of the hip is a common musculoskeletal problem. Often, hip pain begins as femoroacetabular impingement (FAI) that later develops into hip OA. Early symptoms of FAI include groin or greater trochanter pain, asymmetrical hip rotation, limited hip flexion, weakness of the hip flexors and abductor muscles, and the presence of pelvic obliquity. Later, symptoms and signs of clinical hip OA appear including hip stiffness lasting less than 1 hour, greater limitation of hip motions in all 3 body planes, increased weakness of most of the surrounding hip muscles, and eventually gait deviations. The purpose of this article was to describe the clinical diagnosis of both FAI and moderate hip OA in an attempt to start early conservative management in a patient who if not treated will likely develop hip OA. We emphasize that only by early recognition of FAI or of moderate hip OA will a conservative treatment program have potential for success. The conservative treatment of late hip OA is often ineffective, especially once the hip joint develops significant joint narrowing and other radiologic changes occur. Key words: acetabular retroversion, FAI, hip, osteoarthritisTopics in Geriatric Rehabilitation 10/2013; 29(4):227-238. DOI:10.1097/TGR.0b013e3182933e2d · 0.14 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) represent efficacious medical treatments for osteoarthritis (OA), although no comparative study on long-term efficacy in hip OA exists. The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age, sex, body mass index, and degree of OA on temporal clinical evolution. One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and randomly assigned to 1 of 2 groups: group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections. Patients were evaluated at baseline and after 1, 3, 6, and 12 months using the Harris Hip Score (HHS) and visual analog scale (VAS). An overall improvement was detected in both groups between 1- and 3-month follow-up. Despite a slightly progressive worsening between 6- and 12-month follow-up, the final clinical scores remained higher compared with baseline (P<.0005), with no significant differences between PRP and HA. Regarding clinical temporal evolution, multivariate analysis showed that HHS was not influenced by the type of infiltration, patient age, sex, body mass index, or degree of OA, whereas a significant association was detected between OA grade IV and VAS evolution (P<.0005). Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up.Orthopedics 12/2013; 36(12):e1501-8. DOI:10.3928/01477447-20131120-13 · 0.98 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: We present the diagnosis of bilateral granulomatous inflammation of the hip joints associated with Hylan G-F 20 viscosupplementation injections. Clinicians recommending therapeutic Hylan injections for the management of hip arthritis should maintain clinical awareness regarding this potential complication.08/2014; 2014:494073. DOI:10.1155/2014/494073