Improvements in Hip Osteoarthritis With Lavage, Triamcinolone and Hylan G-F20

Abstract

Objective: To verify whether the use of Hylan G-F20 improves saline lavage and triamcinolone injection results in the treatment of hip osteoarthritis (HOA). Methods: 82 patients with HOA categorized as grades II and III severity, according to Kellgren and Lawrence criteria, were randomized into the groups: lavage and triamcinolone (G0); lavage, triamcinolone, and 2 mL of hylan G-F20 (G1); lavage, triamcinolone, and 4mL of hylan G-F20 (G2); lavage, triamcinolone, and 6mL of hylan G-F20 (G3). The VAS, range of motion (ROM), WOMAC, and Lequesne questionnaires were administered at baseline, one, three, six, and twelve months post-injection. Results: All groups showed clinically relevant improvements (> 20%) between baseline and first month post-injection, maintaining subjective results throughout the study period (p < 0.001). We found no differences between groups in any subjective evaluations (p > 0.05, for all). G2 and G3 obtained improved flexion results up to a year (p = 0.028). Hylan groups presented an improved external rotation since the first postoperative month and maintained the results up to a year (G1, p = 0.041; G2, p = 0.007), whereas G0 showed no improvement (p = 0.336). Conclusion: Hip lavage and triamcinolone injection, with or without the use of hylan, improves pain, function, and quality of life up to a year in HOA. Hylan may improve ROM up to one year. Level of Evidence IB, Randomized clinical trial.

State of art in intra-articular hip injections of different medications for osteoarthritis: a systematic review

“…Our data showed that the molecular HA weight was different in the papers selected. Two RCTs analysed the effects of high molecular weight HA, while all the other studies [ 1 , 27 – 29 , 31 – 33 ] used a mean molecular weight HA, except one [ 26 ], in which a lower molecular weight HA was employed. The comparison of their clinical effects is difficult for the considerable HA heterogeneity in term of molecular weight, concentration, elasticity, viscosity of products, in patients affected by different level of hip degenerations.…”

“…The effects of corticosteroids intra-articular hip injection in hip osteoarthritis are reported only in four studies selected. Authors used two different type of steroids: methylprednisone acetate [ 34 ] and triamcinolone from 40 mg to 80 mg [ 25 , 27 , 35 ], which is recommended over other steroids for osteoarthritis, due to a longer lasting and more effective pain relief [ 46 ].…”

“…Our results showed that the association of HA and CS gave a better improvement for pain, function and quality of life compared to HA alone until 1 year follow-up [ 27 ]. The combined use of HA and CS may be probably more effective than HA alone in longer-lasting analgesic effects.…”

“…Better WOMAC for LP-PRP until 24 months, between groups. De Rezende et al 2020 [ 27 ] CS (19) CS + 2 ml HA (19) CS + 4 ml HA (22) CS + 6 ml HA (22) 82 II-III Hylan G-F 20® (6000 kDa) 6 ml ± Triamcinolone acetonide 40 mg 2 ml 1 VAS ROM WOMAC Lequense T0: baseline T1: 1 month T2: 3 months T3: 6 months T4: 12 months Improvement in all groups for pain, function, and quality of life up to a year in HOA. CS+HA improve ROM up to one year.…”

Inyección intraarticular única ecoguiada de ácido hialurónico en la coxartrosis sintomática: estudio retrospectivo de la eficacia de dos presentaciones

“…En los últimos años se ha producido un progresivo aumento del uso de AH intrarticular como tratamiento para la coxartrosis, que tiene como objetivo restaurar las propiedades reológicas del líquido sinovial y, además, controlar la inflamación y estimular la producción de AH endógeno (6,7). Las fórmulas de AH difieren en su origen y métodos de producción, sus propiedades físico-químicas, su vida media en el espacio articular, así como su protocolo de administración y su coste.…”