Intra-Articular Hybrid Hyaluronic Acid Injection Treatment in Overweight Patients with Knee Osteoarthritis: A Single-Center, Open-Label, Prospective Study

Abstract

Background: A BMI > 25 is the most decisive, albeit modifiable, risk factor for knee osteoarthritis (KOA). This study aimed at assessing the efficacy of intra-articular injections of hybrid hyaluronic acid (HA) complexes (Sinovial® H-L) for the treatment of KOA in overweight patients in terms of disease severity, cardiocirculatory capacity, and quality of life. Materials: In this single-site, open-label, prospective trial, 37 patients with symptomatic knee OA were assessed at baseline and 3 months after ultrasound-guided intra-articular injection of hybrid HA complexes (Sinovial® H-L). Results: Primary variables displaying a statistically significant improvement after treatment were pain (VAS), disease severity (WOMAC), and cardiopulmonary capacity (6 min walk test). Among secondary variables, quality of life (SF-12) improved significantly, as did analgesic intake for pain control. No statistically significant difference was observed in body fat and muscle mass percentage measured by bioelectrical impedance analysis. Conclusions: Intra-articular hybrid HA injections are significantly effective in improving OA-related disease severity, cardiopulmonary function, and analgesic intake. This supports the role of hybrid HA viscosupplementation as a nonpharmacological treatment to relieve pain, reduce disability, improve quality of life, and limit the risk of polypharmacy in overweight patients with knee OA.

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

“…Our results are in line with other studies in the literature that have evaluated the efficacy of hybrid HA in the treatment of OA [31][32][33]. The reasons for these results could derive from the characteristics of HA [29,31,32].…”

A Review of the Clinical Effectiveness and Safety of Hybrid Cooperative Complexes in Intra-articular Viscosupplementation

“…The use of HA-HL has been investigated in OA of the knee, hip, and hand, calcific tendinopathies, femoroacetabular impingement syndrome, and other conditions involving articular cartilage damage (Table 3 ). To date, most clinical evidence has come from patients with knee OA [ 51 – 55 ]. However, the first study reporting the use of a hybrid complex of high and low hyaluronic acids in OA was, in fact, conducted in 20 patients with radiologically confirmed moderate-to-severe hip OA [ 30 ].…”

“…HA-HL + PRP significantly better than HA-HL alone at 3 and 6 months (KOOS) and 3 and 12 months. (VAS) Manciameli (2018) [ 51 ] Prospective Knee 35 (59 knees) 59 HA-HL 2 6 VAS pain and WOMAC pain and HR-QoL improved by 1 month and kept stable through 6 months Papalia (2017) [ 53 ] RCT Knee 48 obese patients 61.5 60 HA-HL HMW HA 2 6 VAS pain, IKDC and KOOS significantly improved at 3 and 6 months in both groups HA-HL was more effective than HMW HA Scaturro (2021) [ 55 ] Prospective Knee 37 overweight patients 63 (45–75) HA-HL 2 3 Pain, WOMAC, 6MWT and QoL improved significantly at 3 months Abate (2017) [ 30 ] Prospective/retrospective Hip 20 63.6 63.3 HA-HL HMW HA 4 6 VAS pain scores at rest and during activities improved at 3 and 6 months HA-HL significantly better than HMW HA at 6 months La Paglia (2017) [ 56 ] Retrospective Hip 32 18–55 years HA-HL + PRP HMW HA 2 6 Combined treatment was more effective that HMW HA at 2 and 6 months, particularly in mild-to high grade arthropathy Conforti (2020) [ 59 ] …”

“…Knee OA has particular implications for overweight patients. Two studies have been conducted on overweight/obese patients with symptomatic knee OA [ 53 , 55 ]. In the first, a randomized study in 48 obese patients [body mass index (BMI) > 30] with OA, HA-HL was significantly more effective than i.a.…”

A Computer-Assisted Approach Regarding the Optimization of the Geometrical Planning of Medial Opening Wedge High Tibial Osteotomy

“…More than this, projections show that this incidence will increase due to the ageing population [16]. Considering the quality of life impairment and the economic impact of knee replacement, the benefits of conservative treatment and knee-preserving surgery should be further analyzed [17].…”