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Safety, efficacy and predictive factors of efficacy of a single intra-articular injection of non-animal-stabilized-hyaluronic-acid in the hip joint: results of a standardized follow-up of patients treated for hip osteoarthritis in daily practice

  • Orthopaedic Outcome Assessment
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Abstract

Aim

To evaluate, in daily clinical practice, the efficacy and tolerability of a single intra-articular injection of non-animal-stabilized hyaluronic acid (NASHA) in patients treated for symptomatic hip OA (HOA).

Methods

Standardized follow-up (FU). Patients: forty patients suffering from HOA treated by a single intra-articular injection of NASHA in the painful hip under fluoroscopy. Evaluation: patient global assessment (PGA) and walking pain (WP) on a 100 mm visual analogue scale, WOMAC index, Lequesne index at each visit. Statistics: last observation carried forward. Treatment efficacy was assessed using OMERACT-OARSI response criteria, minimal clinically important improvement (MCII), patient acceptable symptom state (PASS) obtained from PGA, WOMAC and WP. Predictive factors of efficacy were also studied.

Results

Efficacy evaluation: 34 patients were assessable (mean FU 159 days). All clinical variables (WP, PGA, WOMAC, Lequesne index) decreased significantly between baseline and last evaluation. Twenty-two patients (71%) were classified OMERACT-OARSI responders, 25 subjects (75.8%) were classified PASS+, and 19 (61.3%) fulfilled criteria for MCII. Out of clinical and radiological variables only Lequesne index (p = 0.04) and WOMAC (p = 0.04) at baseline were found to be predictive of treatment efficacy. Safety evaluation: the treatment was well tolerated. There were no severe adverse events related to the treatment or to the procedure. However 15 of the 28 assessable patients experienced transient increase of pain in the target hip during the first week after injection.

Conclusion

Viscosupplementation of the hip with NASHA is easily feasible in daily clinical practice, safe and well tolerated despite a frequent increase of pain the days following injection. Prospective controlled trials are needed to confirm these data and to evaluate both safety and efficacy of a second course of treatment.

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Acknowledgments

The authors would like to thank Richard Gradin and Martine Guirlinger from Q-Med laboratories for supplying the NASHA samples, Eric Noel and Monique Bonjean for their clinical contribution and Marie Conrozier, Sylvie Conrozier and Christelle Szatanek for their assistance in the data collection.

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Authors and Affiliations

  1. Department of Rheumatology (Pr VIGNON), University hospital Lyon-Sud, 165 chemin du grand revoyet, 69495, Pierre Benite Cedex, France

    Thierry Conrozier, Pierre Mathieu, Florence Merle-Vincent, Muriel Piperno, Fabienne Coury, Veronique Belin, Jacques Tebib & Eric Vignon

  2. Pôle Information médicale Evaluation Recherche, Hospices Civils de Lyon, Universite de Lyon, Lyon, France

    Chantal Marie Couris

  3. Université Claude Bernard, Lyon, France

    Eric Vignon

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  1. Thierry Conrozier
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  2. Chantal Marie Couris
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Correspondence to Thierry Conrozier.

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Conrozier, T., Couris, C.M., Mathieu, P. et al. Safety, efficacy and predictive factors of efficacy of a single intra-articular injection of non-animal-stabilized-hyaluronic-acid in the hip joint: results of a standardized follow-up of patients treated for hip osteoarthritis in daily practice. Arch Orthop Trauma Surg 129, 843–848 (2009). https://doi.org/10.1007/s00402-008-0778-4

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