Hybrid Hyaluronic Acid versus High Molecular Weight Hyaluronic Acid for the Treatment of Hip Osteoarthritis in Overweight/Obese Patients

Abstract

Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500–2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patients.

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“…Fourth, the double size of particles (HMW has very good rheological properties due to LMW, which triggers endogenous HA production by stimulation of fibroblasts). Lastly, participants in previous studies showed very good tolerance of the product administered together with PRP and no cytotoxic effect [ 25 , 26 , 27 , 28 ].…”

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“…Indigenously, high-molecular-weight (HMW) HA is found, which is then degraded into smaller fragments of low molecular weight (LMW) depending on the environmental factors [ 48 , 49 ]. This degradation of HA is essential for a number of bodily functions, for instance, as a lubricant in the synovial fluid [ 48 , 50 ].…”

“…The manipulation of MW of HA in drug delivery systems can lead to analgesic, anti-inflammatory and immunostimulatory results [ 48 , 49 , 50 , 51 ]. Although there is a lack of detailed research on the specificity of the antinociceptive effects of HA of different MW, it is widely accepted that HMW HA inhibits the activation of lipopolysaccharide (LPS) by directly binding to the toll-like receptor-4 (TLR-4) under inflammatory conditions [ 52 ].…”

A scalable 12-week exercise and education programme reduces symptoms and improves function and wellbeing in people with hip and knee osteoarthritis

“…Surgical intervention also has much greater risks than other less invasive interventions. Evidence demonstrates that less invasive OA interventions such as intra-articular injections are effective at improving physical function, provide pain relief, and bolster quality of life ( 8 , 9 ).…”