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This paper aims to compare the results of single-joint knee vs hip hyaluronic acid (HA) injections in patients with osteoarthritis (OA) involving both the knee and hip joints. Thirty-eight patients who were diagnosed to have both hip and knee OA were enrolled. Patients were divided into two groups to receive HA injection three times at 1-week inter...
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... needle into the patello- femoral joint space by superolateral approach while the patients were in supine position. The hip joint injections were performed under sterile conditions on fluoroscopy by inserting an 18-gauge 90-mm needle close to the femoral neck 1 cm over the trochanter major while the patients were in lateral decubitis position (Fig. ...
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Background. The efficiency of modern drugs that modify the course of the disease is still doubtful, especially, their influence on the long-term effects of hip osteoarthritis. Besides, the following question remains controversial: what is more effective in treatment of osteoarthrosis — arthroscopy or drug therapy? The purpose was to evaluate and to...
Although intra-articular hyaluronic acid is well established as a treatment for osteoarthritis of the knee, its use in hip osteoarthritis is not based on large randomized controlled trials. There is a need for more rigorously designed studies on hip osteoarthritis treatment as this subject is still very much under debate.
Randomized, controlled tri...
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Citations
... In 2009, Diracoglu et al. showed that a single i.a. hip/knee injection (KLG I or II, fluoroscopy guided) showed significant improvement of VAS pain, global WOMAC and its subdomains when compared to pre-injection values but without reaching statistical significance [45]. ...
Background:
For knee OA, EULAR has included hyaluronic acid (HA) intra-articular injection in the 2003 recommendations, making the intra-articular injection a sound therapeutic option. The ultrasound-guided intra-articular injections (USGIAI) have been demonstrated to be more efficient and safe in comparison to the blind procedure. Our objectives were to evaluate the short- and medium-term efficacy and safety of USGIAI of HA in moderate hip OA and patients' additional NSAIDs/pain killer intake.
Patients and methods:
Patients with hip OA (KLG II/III), that failed standard of care therapy, received 3 consecutive HA-USGIAI (case group) while other patients (KLG II/III) treated according to current guidelines were chosen as a control group. Demographic data, comorbidities and medication intake were recorded. VAS pain scale and WOMAC score were performed at baseline and at 3 months. In the case group, they were additionally scored at 6 months. At baseline and at 6 months, hip X-ray assessment was also made. Ultrasound evaluation was made at each visit.
Results:
In the case group, 15 patients were enrolled and 28 hip joints were injected. The control group consisted of 17 hip OA patients. In the case group, pain evaluated by VAS score and WOMAC score were significantly and progressively decreased (p < 0.0001) from baseline up to 3 and 6 months, respectively. Indeed, the case group showed a significantly lower NSAIDs/pain killer median intake at 3 months from baseline (p < 0.05).
Conclusion:
Our data suggest that HA-USGIAI may be an effective and safe treatment for moderate hip OA with short- and medium-term benefits. Key Points • US hip evaluation before interventional maneuvers may identify capsular distension suggestive for concomitant septic involvement, microcrystal arthropathy or incipient hip osteonecrosis. • USGIAI may be fundamental to achieve an efficacious and safe injection. • HA-USGIAI may be an effective and safe treatment for moderate hip OA with short- and medium-term benefits.
... A visual analog scale (VAS) measured patient reported pain in 29 studies. [19][20][21][22][23][24][26][27][28][29][30][31][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] All studies indicated that VAS scores were reduced following HA administration. Specifically, 19 studies reported significant reductions at their respective follow-up periods [20][21][22][24][25][26][28][29][30][31][32][33]35,[37][38][39]41,46,48 (Table 5). ...
... [19][20][21][22][23][24][26][27][28][29][30][31][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] All studies indicated that VAS scores were reduced following HA administration. Specifically, 19 studies reported significant reductions at their respective follow-up periods [20][21][22][24][25][26][28][29][30][31][32][33]35,[37][38][39]41,46,48 (Table 5). ...
... The Among these, the pain (WOMAC-A) and function (WOMAC-C) subscales were reported on by 13 analyses. 26,35,36,39,40,42,46,[48][49][50][51][52][53] In addition to the extractable data available in Table 6 and Table 7 50 Total WOMAC scores were utilized by 10 studies 19,31,37,39,40,45,46,51,54 48 . All analyses demonstrated improvements in total WOMAC values, with 8 analyses reporting significant improvements following HA administration 31,37,39,45,46,48,51,54 (Table 8). ...
Introduction
Osteoarthritis of the hip is one of the leading causes of disability worldwide. There is lack of agreement among providers and governing agencies regarding the efficacy of hyaluronic acid (HA) for the management of hip osteoarthritis (OA). Therefore, the purpose of this systematic review was to determine how HA administration impacts 1) patient reported outcome measures (PROMs) and 2) rates of conversion to THA.
Methods
The PubMed, EBSCO host, and Google Scholar electronic databases were queried for all studies published between January 1st, 2000 and January 1st, 2020 that reported on outcomes following HA administration for treatment of hip OA. The following keywords were implemented with AND and OR Boolean operators: “hip”; “osteoarthritis”; “arthritis”; “viscosupplementation”; “hyaluronic acid.” Our final analysis included 39 studies and reported on a total of 5,864 patients receiving injections of HA.
Results
All studies reporting on visual analog scale (VAS), patient global assessment, and total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores demonstrated improvements following HA administration. For the Lequesne Index (LI), WOMAC pain, WOMAC function, and Harris Hip Score (HHS) values, a majority of studies reported that HA would prove beneficial, with one analysis suggesting a lack of improvement. There was inconsistent evidence across studies regarding the effectiveness of HA compared to other intra-articular injections. The formulation of the administered viscosupplementation did not appear to influence outcomes. Furthermore, rates of conversion to THA were relatively low when evaluating 1- to 4-year follow-up intervals.
Discussion
Non-comparative studies consistently demonstrated that HA can achieve satisfactory pain reduction and functional improvement. However, there was not enough evidence in the current literature regarding whether HA is superior to placebo or other types of intra-articular injections. Future studies should continue to compare HA to other treatment modalities in randomized controlled trials with larger sample sizes.
... Як альтернативу вищенаведеним методам розглядають природні полімери, такі як полісахариди, як носії для доставки лікарських засобів у суглобовий хрящ та синовіальну рідину завдяки їх біосумісності, біодеградації та широкого розповсюдження у природі [3]. Близько 15 років назад було розроблено препарати для внутрішньосуглобового (інтрасинавіалього) введення на основі гіалуронової кислоти, які наразі вважають одним із найбільш ефективних та безпечних методів лікування артрозів як колінних, так і тазостегнових суглобів [4,5,6]. ...
Osteoarthrosis is the most widespread disease of musculoskeletal system, which leads to different level of disability in 10–30% of cases. The age of the person is one of the key risk factors for the development of such disease. The most effective resolution is a surgery in which joints are replaced, but this method is very risky and expensive especially for elderly people. That is why development of the composition and research in new technological aspects of biotechnological medication is an actual course in pharmacy.
The aim of research: development of the composition and production technology of injection solution of hyaluronic acid as sodium hyaluronate for the therapy of degenerate inflammatory disease of articulation.
The object of the study is an injection with sodium hyaluronate for intra-articular administration.
Evaluation of the test results when choosing the optimal technology for preparing the injection solution was carried out by the visual method (description, transparency), and by the method of rotational viscometry (viscosity). The suitability of the sterilization regime was determined by physicochemical methods (appearance, transparency, viscosity, pH of the solution) and microbiological method (sterility) according to the requirements of SPhU. The quantitative content of sodium hyaluronate was determined by spectrophotometry (SPhU, 2.2.25) using a carbazole reagent.
The results of the studies has been developed the optimal composition of the drug based on stabilized sodium hyaluronate by the excipient BDE. The resulting solution in its physical-chemical properties are a clear, highly viscous aqueous solution. The developed composition contains (in %): Sodium hyaluronate with a molecular weight of ~ 2 MDA (in terms of 100% substance) – 1.0; BDE – 0.75; sodium chloride – 0.85; phosphate buffer – up to pH from 5.0 to 8.5; water for injection – up to 100%.
The critical parameters of the technological stages for the production of a drug with sodium hyaluronate are determined experimentally. Specific critical parameters are the degassing of a viscous solution, filtration and the conditions of the sterilization mode of the injection solution. It was experimentally established that the optimal parameters for the filtration stage are the use of a Durapore hydrophilic membrane made of polyvinyl difluoride (PVDF), the temperature of the solution is 50 ± 0.5 °C and the use of back pressure mode to reduce the volume wich is filtered per unit time. It was determined that the sterilization mode with saturated steam at a temperature of 121 °C for 8 min is optimal and ensures the quality of the solution in quality criterion of «Sterility».
Samples of the experimental series of injection solution, obtained by the developed technology, comply with the requirements of SPhU for drugs for parenteral use according to physical-chemical and biological quality criteria as appearance, transparency, viscosity, pH of the solution, sterility, assay sodium hyaluronate.
... Viscosupplementation is considered one of the best conservative treatment of the knee while only in recent years has its use in the treatment of osteoarthritis of the hip increased [1,2]. Dıraçoğlu supported the use of viscosupplementation for hip osteoarthritis by demonstrating that clinical results were comparable to those of viscosupplementation of the knee [17]. ...
Background:
Viscosupplementation with hyaluronic acid (HA) is increasingly used for the treatment of hip osteoarthritis (OA). The purpose of this study was to compare the efficacy of intra-articular injections of an ultra-high molecular weight viscosupplement (UHMW-HA, Fermathron S) with a medium molecular weight hyaluronan (MMW-HA, Hyalubrix 60) in hip OA.
Methods:
Fifty-four patients with hip OA grade 3 on the Kellgren/Lawrence scale were randomized. All infiltrations were performed under ultrasound guidance. Evaluation was performed preoperatively and at 1, 3, 6 and 12 months after infiltration. Patients were clinically evaluated using Lequesne index, VAS and WOMAC score.
Results:
Fifty patients, including 27 in the MMW-HA group and 23 in the UHMW-HA group, completed the follow-up. No significant difference was found between the two groups in terms of VAS, WOMAC or Lequesne index preoperatively or at 1, 3, 6 and 12 months after viscosupplementation. A stratified analysis was performed to study the development over time of Lequesne index of patients aged ≤ 55 years, > 55 and, ≤ 70 years and > 70 years and Lequesne index was different between the three age-stratified subgroups only in the MMW-HA group. The subgroup of older patients showed a higher Lequesne index than the subgroups of younger patients (p < 0.05).
Conclusions:
UHMW-HA is a safe and effective treatment for hip osteoarthritis. A single dose of UHMW-HA was as effective as two doses of MMW-HA resulting in similar reductions of pain and disability.
Study design:
Multicenter, independent, prospective, randomized controlled trial with level of evidence 1.
... It appears that, at least in some individuals, aberrant knee structure and function do not inevitably lead to changes in extremity function so severe that they affect the ankle. On a purely speculative level, however, it is likely that this protection would not be observed at the hip as the hip is much more highly prone to OA than the ankle, and the coexistence of hip and knee OA is well documented [28,29]. Survival analyses suggested that even mild degeneration (grade 1) occurs more slowly in the ankle than in the knee, and severe (grades 3 and 4) degeneration rarely occurs in the ankle. ...
Osteoarthritis (OA) is a progressive degenerative condition of synovial joints in response to both internal and external factors. The relationship of OA in one joint of an extremity to another joint within the same extremity, or between extremities, has been a topic of interest in reference to the etiology and/or progression of the disease.
The prevalence of articular cartilage lesions and osteophytes, characteristic of OA, was evaluated through visual inspection and grading in 1060 adult knee/tali pairs from 545 cadaveric joint donors.
Joint degeneration increased more rapidly with age for the knee joint, and significantly more knee joints displayed more severe degeneration than ankle joints from as early as the third decade. Women displayed more severe knee degeneration than did men. Severe ankle degeneration did not exist in the absence of severe knee degeneration. The effect of weight on joint degeneration was joint-specific whereby weight had a significantly greater effect on the knee. Ankle grades increasingly did not match within a donor as the grade of degeneration in either the left or the right knee increased.
Gender and body type have a greater effect on knee joint integrity as compared to the ankle, suggesting that knees are more prone to internal causative effects of degeneration. We hypothesize that the greater variability in joint health between joints within an individual as disease progresses from normal to early signs of degeneration may be a result of mismatched limb kinetics, which in turn might lead to joint disease progression.
Background
Hip injections of hyaluronic acid (HA) have been used off-label to treat osteoarthritis (OA). The purpose of this retrospective cohort study of adults with OA was to review predictive factors and duration of action for patients who responded to HA hip injections.
Methods
After institutional review board (IRB) approval, patients who had HA hip injections from 2014 to 2018 were retrospectively reviewed. Visual analog scale (VAS) scores obtained 1 mo after three injections were collected. Patients were classified into two groups: positive outcome (50% or greater reduction of VAS) and negative outcome (less than 50% reduction of VAS). Comparison of demographics, functional status, OA severity on Kellgren-Lawrence Grading Scale (KL), previous treatments, type of HA, and procedure techniques were performed. Continuous variables were summarized in mean and standard deviation (SD), and compared using two-sample t -test. Categorical variables were summarized in frequency and proportion, then compared using chi-square test or Fisher exact test.
Results
The 157 patients who were reviewed had the following levels of OA severity: 24.3% mild (KL grade II), 25% moderate (KL grade III), 50.7% severe (KL grade IV). Positive outcomes were reported in 29.3% of patients, and 70.7% had “negative” outcomes. The positive outcome group had a mean duration (for 50% or greater decrease of VAS) of 4.24 mo (SD 3.62). The positive outcome group had milder OA (KL grades II to III) ( P <0.001) and younger age ( P =0.03). No difference was noted among the two groups for other variables.
Conclusions
Injections of HA for hip OA using the full recommended dosage regimen of commercially available HA products can be beneficial in select patients. The main predictors of significant response were younger age and mild to moderate (KL grade II to III) OA.
Level of Evidence
Level III.
This study investigated the short-term effects of Kinesio taping (KT) on various types of pain, active range of motion (AROM), and proprioception in patients with knee osteoarthritis.
Forty-six older participants (mean [SD], 57.9 [4.4] yrs) with osteoarthritis were randomly allocated to two groups: the KT group or the placebo-KT group. Taping with tension (KT application) or without tension (placebo-KT application) was applied to the quadriceps of the participants in both groups. Before and after intervention, pain intensity was measured using a visual analog scale at rest and during walking, and pressure pain thresholds (PPTs) were assessed using an algometer in the quadriceps and the tibialis anterior. In addition, pain-free AROM and proprioception were measured.
The KT group showed attenuation of pain during walking (effect size [ES], 1.97), PPT in the quadriceps (ES, 2.58), and PPT in the tibialis anterior (ES, 2.45). This group also showed significantly improved AROM (ES, 2.01) and proprioception (ES, 1.73-1.89; P < 0.05). However, the placebo-KT group did not show significant changes in pain, AROM, or proprioception. There were significant differences between the two groups in pain during walking and PPT. In addition, pain during walking showed a significant correlation with AROM and proprioception, and a significant correlation was found between PPT and AROM.
These results demonstrated that KT application with proper tension to the quadriceps effectively attenuates various types of pain and improves AROM and proprioception in osteoarthritis patients. Thus, KT may be a suitable intervention to improve pain, AROM, and proprioception in patients with osteoarthritis in clinics.
Hyaluronic acid (HA) injections are used to treat osteoarthritis of the hip but their efficacy has not been clearly established. The purpose of this meta-analysis was to determine the effect of HA injections on hip pain. There were twenty-three studies that met our criteria and the mean decrease in visual analog scores (VAS) was -1.97 (95% CL, 2.83 to -1.12, P<0.0001). However, the clinical relevance of this change is difficult to determine since the decrease in VAS was only -0.27 in the six randomized trials in the study and the duration of follow-up in most studies was less than six months. Multicenter randomized trials are needed to determine the true efficacy of HA injections in decreasing pain associated with hip osteoarthritis.
Copyright © 2014 Elsevier Inc. All rights reserved.
Osteoarthritis is the most common age-related degenerative joint disease. It affects all the joints containing hyaline cartilage. Knee osteoarthritis is the most cumbersome in terms of prevalence and disability. The aim of this study to evaluate the efficacy of intra-articular hyaluronic acid in patients with knee osteoarthritis with regard to joint pain and function, as well as patient satisfaction, assessed at one month and at one year, and by age group.
In this prospective randomised study, 172 patients who were diagnosed knee OA and who received three consecutive intra-articular injections of HA weekly were included. Patients 65 years of age or older were accepted as the "elderly group", and those under 65 were accepted as the "middle-aged group". Clinical evaluations of efficacy and safety were conducted at the beginning of the study, one month after the third injection, and one year after the third injection.
In the two groups, the intragroup analysis revealed significant improvements following injection when compared with preinjection values. According to the last followup controls (after 12 months) in the middle-aged group, VAS activity pain, VAS rest pain, WOMAC physical function, and WOMAC pain values were found to be statistically lower when compared with pre-injection values. In the elderly group, no statistically significant differences were found between pre-injection and after 12 months.
We can conclude that intra-articular joint HA injections are effective in both young and old patients with OA with regard to pain and functional status over a short-term period. Further, HA injections in patients younger than 65 years can be planned for a one-year period.
