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Efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study

  • Original Article • HIP - ARTHROPLASTY
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Viscosupplementation with hyaluronic acid (HA) is increasingly used for the treatment of hip osteoarthritis (OA). The purpose of this study was to compare the efficacy of intra-articular injections of an ultra-high molecular weight viscosupplement (UHMW-HA, Fermathron S) with a medium molecular weight hyaluronan (MMW-HA, Hyalubrix 60) in hip OA.

Methods

Fifty-four patients with hip OA grade 3 on the Kellgren/Lawrence scale were randomized. All infiltrations were performed under ultrasound guidance. Evaluation was performed preoperatively and at 1, 3, 6 and 12 months after infiltration. Patients were clinically evaluated using Lequesne index, VAS and WOMAC score.

Results

Fifty patients, including 27 in the MMW-HA group and 23 in the UHMW-HA group, completed the follow-up. No significant difference was found between the two groups in terms of VAS, WOMAC or Lequesne index preoperatively or at 1, 3, 6 and 12 months after viscosupplementation. A stratified analysis was performed to study the development over time of Lequesne index of patients aged ≤ 55 years, > 55 and, ≤ 70 years and > 70 years and Lequesne index was different between the three age-stratified subgroups only in the MMW-HA group. The subgroup of older patients showed a higher Lequesne index than the subgroups of younger patients (p < 0.05).

Conclusions

UHMW-HA is a safe and effective treatment for hip osteoarthritis. A single dose of UHMW-HA was as effective as two doses of MMW-HA resulting in similar reductions of pain and disability.

Study design

Multicenter, independent, prospective, randomized controlled trial with level of evidence 1.

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Authors and Affiliations

  1. Azienda Socio Sanitaria Territoriale Rhodense, Presido Ospedaliero di Rho, Unità Operativa Ortopedia e Traumatologia, Rho, Italy

    Daniele Clementi, Paride Bertocco & Graziella Giaffreda

  2. IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Riccardo D’Ambrosi

  3. Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy

    Riccardo D’Ambrosi

  4. Azienda Socio Sanitaria Territoriale Rhodense, Presido Ospedaliero di Garbagnate, Unità Operativa Ortopedia e Traumatologia, Garbagnate, Italy

    Miguel Simon Bucci & Paolo Ragni

  5. Azienda Socio Sanitaria Territoriale Rhodense, Presido Ospedaliero di Bollate, Unità Operativa Ortopedia e Traumatologia, Bollate, Italy

    Carlo Cardile

  6. IRCCS Policlinico San Donato, San Donato Milanese, Italy

    Vincenza Ragone

Authors
  1. Daniele Clementi
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  2. Riccardo D’Ambrosi
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  3. Paride Bertocco
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  4. Miguel Simon Bucci
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Correspondence to Riccardo D’Ambrosi.

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Human and animal participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Clementi, D., D’Ambrosi, R., Bertocco, P. et al. Efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study. Eur J Orthop Surg Traumatol 28, 915–922 (2018). https://doi.org/10.1007/s00590-017-2083-9

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  • DOI: https://doi.org/10.1007/s00590-017-2083-9

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