Efficacy and safety of viscosupplementation by ultrasound-guided intra-articular injection in osteoartrhitis of the hip

This study was aimed at investigating the safety and duration of benefit after the treatment of hip symptomatic osteoarthritis (OA) patients (pts) by US-guided intra-articular injections of hyaluronic acid.

212 pts whit OA (graded 2–3 according the Kellgren-Lawrence score was treated with US-guided intra-articular injection (USIAi) of 4ml of Jointex (sodic hyaluronan, molecular weight 800–1200 kDalton) repeatable after 3–6 month. Pts were esamined supine by anterior parasagittal approach, 3.5MHz convex trasducer whith sterilized biopsy guide. Treatment efficacy was assessed by Lequesne index, monthly non-steroidal anti-infiammatory drug (NSAID) intake, visual analogue scale (VAS) pain measurement, global patient assessment and global physician assessment;all these scores were recorded at baseline and, then, at visit 3, 6, 9, 12, 18 months after enrolment. All adverse events were reported.

29 pts had bilateral hip OA.65 pts received only 1 injection, 53 pts 2 injections,61 pts received 3 injections and 33 pts 4 injections. The results show that there are significant changes at the VAS and Lequesne index at all timepoints compared to baseline; the decrease in pain VAS and Lequesne index at 18 months was 43% and 36% respectively. As for NSAIDs, whithout the drop-out, both tests proved significant at all timepoints (all P values <0.05). Global patient evaluation and global physician evaluation had decresed at 18 months by 38% and 41% respectively. No infectious or sistemic complications were reported. 17 patients reported a sensation of heaviness and pain in his hip for two to five days after the injection, but did not require any medication or need to suspend daily activity.7 patients reported a transient haematoma of superficial tissue.

These data suggest that USIAi of hyaluronic acid in OA is able to reduce pain and to ameliorate joint function. Is well tolerated, economic and safe. The few adverse events were local and resolved spontaneously in a few days.