Viscosupplementation with Hyaluronic Acid in Hip Osteoarthritis (a review)

Abstract

Background: Viscosupplementation (VS) with hyaluronic acid (HA) is largely used for knee osteoarthritis therapy, but the evidences for its usefulness in hip osteoarthritis (OA) are limited. Methods: In this review, an extensive search of published trials on VS in hip OA was performed. From the selected papers the following data were extracted: sample size, inclusion / exclusion criteria, treatment procedures, evaluation methods, follow-up duration and clinical outcomes. Results: The level of evidence was low in quite all the trials (no placebo controlled groups). A reduction of pain and an improvement of function after 3 months, persistent in the long term (12 -18 months), was observed. Patients with mild morphological alterations responded better to therapy. Side effects were negligible, and were limited to pain and a sensation of heaviness in the injection site. No clear differences among Low (LMW) and High Molecular Weight (HMW) HA preparations were found in the clinical outcomes. However, for HMW-HA preparations, a lower number of injections was, in general, necessary in order to reach the therapeutic effect. Conclusions: Despite the initial promising results, some questions still remain open : 1) the characteristics of responders must be more precisely defined; 2) the treatment schedules, at present mainly based on the individual clinical experience, need a proper and accepted standardization. Finally, larger and placebo controlled trials are necessary to confirm the efficacy of VS in hip OA.

Hyaluronic Acid in the Treatment of Osteoarthritis: What is New

“…Besides the reduction of pain, also the articular function is improved. These positive effects have been observed using different evaluation scales : + 11 % in the Harris Hip Score, + 32 -45 % in Western Ontario and McMaster Universities Osteoarthritis Index score, + 45 % in Lequesne Index, and + 95 % in American Academy of Orthopaedic Association Lower Limb Core Scale (Abate et al, 2008). A further observation, which confirms the previous data, is the reduction of non steroidal anti -inflammatory drugs consumption (Migliore et al, 2011).…”

“…These effects were more frequent in studies performed in blind conditions compared to those performed under imaging guidance. No differences were observed in relation to hyaluronic acid preparation used or to the number of injections (Abate M, 2008). Side effects usually disappeared after 2 -7 days without any therapeutic intervention and did not limit basic or instrumental activities of daily living.…”

“…Only few studies report a precocious reduction of the pain : within a week, according to Brocq (Brocq et al, 2002) (-27 %), and within the first 2 -4 weeks according to Qvistgaard (Qvistgaard et al, 2001) (-14 % and -32 %, respectively). The positive effects on pain after 1 -3 months range from -16.1 % to -52.2 % (mean -37.2 %), whereas, overall, the mean Visual Analogic Scale score decreases about 49 % after 3 -6 months (range 31 -80 %) (Abate et al, 2008). Therefore, it seems that the benefit increases in the long term.…”

“…The characteristics of responders, at present, have not been clearly identified, but some authors claim that a greater benefit may be obtained in patients with low grade osteoarthritis (Dagenais et al, 2006). On the contrary, age does not influence the therapeutic response (Abate et al, 2008).…”

Pharmacokinetics and Pharmacodynamics of Hyaluronan Infused into Healthy Human Volunteers

“…for joint supplementation and tissue replacement, surgical adhesion prevention, regulation of inflammatory diseases, tissue healing/regeneration and tissue engineering) [17][18][19][20]. Future products of HA or modified HA are also being developed to enhance targeted drug delivery into traditionally inaccessible compartments such as tumors, peripheral lymph nodes, and bone marrow [21][22][23].…”