IMPROVEMENTS IN HIP OSTEOARTHRITIS WITH LAVAGE, TRIAMCINOLONE AND HYLAN G-F20

MÁrcia UchÔa DE Rezende, Henrique Melo Campos Gurgel, Guilherme Pereira Ocampos, Gustavo Constantino DE Campos, Renato Frucchi, Alexandre FelÍcio Pailo, Thiago Pasqualin, JosÉ Ricardo Negreiros Vicente, Olavo Pires DE Camargo, MÁrcia UchÔa DE Rezende, Henrique Melo Campos Gurgel, Guilherme Pereira Ocampos, Gustavo Constantino DE Campos, Renato Frucchi, Alexandre FelÍcio Pailo, Thiago Pasqualin, JosÉ Ricardo Negreiros Vicente, Olavo Pires DE Camargo

Abstract

Objective: To verify whether the use of Hylan G-F20 improves saline lavage and triamcinolone injection results in the treatment of hip osteoarthritis (HOA).

Methods: 82 patients with HOA categorized as grades II and III severity, according to Kellgren and Lawrence criteria, were randomized into the groups: lavage and triamcinolone (G0); lavage, triamcinolone, and 2 mL of hylan G-F20 (G1); lavage, triamcinolone, and 4mL of hylan G-F20 (G2); lavage, triamcinolone, and 6mL of hylan G-F20 (G3). The VAS, range of motion (ROM), WOMAC, and Lequesne questionnaires were administered at baseline, one, three, six, and twelve months post-injection.

Results: All groups showed clinically relevant improvements (> 20%) between baseline and first month post-injection, maintaining subjective results throughout the study period (p < 0.001). We found no differences between groups in any subjective evaluations (p > 0.05, for all). G2 and G3 obtained improved flexion results up to a year (p = 0.028). Hylan groups presented an improved external rotation since the first postoperative month and maintained the results up to a year (G1, p = 0.041; G2, p = 0.007), whereas G0 showed no improvement (p = 0.336).

Conclusion: Hip lavage and triamcinolone injection, with or without the use of hylan, improves pain, function, and quality of life up to a year in HOA. Hylan may improve ROM up to one year. Level of Evidence IB, Randomized clinical trial.

Keywords: Hyaluronic Acid; Minimal Clinically Important Difference; Osteoarthritis, Hip; Randomized Controlled Trial; Triamcinolone; Viscosupplementation.

Conflict of interest statement

All authors declare no potential conflict of interest related to this article.

Figures

Figure 1. Procedure. A: fluoroscopic image of…
Figure 1. Procedure. A: fluoroscopic image of the hip showing needle positioning and contrast injection that skirted femoral neck and head; B: contrast removal by saline lavage. The fluoroscopic image shows hydraulic distention by distancing the femoral head from the acetabulum; C: fluoroscopic image after emptying, in preparation for D: drug injection.
Figure 2. Patients flow in the study.
Figure 2. Patients flow in the study.

References

    1. Mathers C. The Global Burden of Disease: 2004 Update. Geneva: World Health Organization; 2008.
    1. Bitton R. The economic burden of osteoarthritis. Am J Manag Care. 2009;15(8):S230–S235.
    1. Turdean SG, Jung I, Gurzu S, Zazgyva A, Fetyko A, Roman CO. Histopathological evaluation and expression of the pluripotent mesenchymal stem cell-like markers CD105 and CD44 in the synovial membrane of patients with primary versus secondary hip osteoarthritis. J Investig Med. 2017;65(2):363–369.
    1. Vad VB, Sakalkale D, Sculco TP, Wickiewicz TL. Role of hylan GF 20 in treatment of osteoarthritis of the hip joint. Arch Phys Med Rehabil. 2003;84(8):1224–1226.
    1. Young R, Harding J, Kingsly A, Bradley M. Therapeutic hip injections: is the injection volume important? Clin Radiol. 2012;67(1):55–60.
    1. McCabe PS, Maricar N, Parkes MJ, Felson DT. O'Neill TW The efficacy of intra-articular steroids in hip osteoarthritis: a systematic review. Osteoarthritis Cartilage. 2016;24(9):1509–1517.
    1. van Middelkoop M, Arden NK, Atchia I, Birrell F, Chao J, Rezende MU. The OA Trial Bank: meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids. Osteoarthritis Cartilage. 2016;24(7):1143–1152.
    1. Gomis A, Miralles A, Schmidt RF, Belmonte C. Intra-articular injections of hyaluronan solutions of different elastoviscosity reduce nociceptive nerve activity in a model of osteoarthritic knee joint of the guinea pig. Osteoarthritis Cartilage. 2009;17(6):798–804.
    1. Yasuda T. Hyaluronan inhibits prostaglandin E2 production via CD44 in U937 human macrophages. Tohoku J Exp Med. 2010;220(3):229–235.
    1. Garg HG, Hales CA. Garg HG, Hales CA. Chemistry and biology of hyaluronan. Amsterdam: Elsevier; 2004. Viscoelastic properties of hyaluronan and its therapeutic use; pp. 415–455.
    1. Schmidt-Braekling T, Waldstein W, Renner L, Valle AGD, Monsef JB, Boettner F. Ultrasound and fluoroscopy are unnecessary for injections into the arthritic hip. Int Orthop. 2015;39(8):1495–1497.
    1. Angst F, Aeschlimann A, Stucki G. Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis Rheum. 2001;45(4):384–391.
    1. Atchia I, Kane D, Reed MR, Isaacs JD, Birrell F. Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Ann Rheum Dis. 2011;70(1):110–116.
    1. Arden NK, Reading IC, Jordan KM, Thomas L, Platten H, Hassan A. A randomised controlled trial of tidal irrigation vs corticosteroid injection in knee osteoarthritis: the KIVIS Study. Osteoarthritis Cartilage. 2008;16(6):733–739.
    1. Campos GC, Rezende MU, Pailo AF, Frucchi R, Camargo OP. Adding triamcinolone improves viscosupplementation: a randomized clinical trial. Clin Orthop Relat Res. 2013;471(2):613–620.
    1. Vad VB, Bhat AL, Sculco TP, Wickiiewicz TL. Management of knee osteoarthritis knee lavage combined with hylan versus hylan alone. Arch Phys Med Rehabil. 2003;84:634–637.
    1. Vad VB, Sakalkale D, Sculco TP, Wickiewicz TL. Role of hylan G-F 20 in treatment of osteoarthritis of the hip joint. Arch Phys Med Rehabil. 2003;84(8):1224–1226.
    1. Spitzer AI, Bockow BI, Brander VA, Yates JW, McCarter DK, Gudger GK. Hylan G-F 20 improves hip osteoarthritis: a prospective, randomized study. Phys Sportsmed. 2010;38(2):35–47.
    1. Sherman SL, Khazai RS, James CH, Stoker AM, Flood DL, Cook JL. In vitro toxicity of local anesthetics and corticosteroids on chondrocyte and synoviocyte viability and metabolism. Cartilage. 2015;6(4):233–240.
    1. Tian J, Li Y. Comparative effects of vitamin C on the effects of local anesthetics ropivacaine, bupivacaine, and lidocaine on human chondrocytes. Braz J Anesthesiol. 2016;66(1):29–36.
    1. Lee YJ, Kim SA, Lee S-H. Hyaluronan suppresses lidocaine-induced apoptosis of human chondrocytes in vitro by inhibiting the p53-dependent mitochondrial apoptotic pathway. Acta Pharmacol Sin. 2016;37(5):664–673.

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