Abstract
Hip osteoarthritis is very common and costly. The European League Against Rheumatology Committee agenda asks for research to investigate treatments able to slow down the progression of hip osteoarthritis (OA), to delay joint replacement, and to determine the comparative effectiveness and cost-effectiveness of non-surgical and surgical treatment modalities as well as criteria relating to the indications for and timing of total hip replacement (THR). After publishing the results of a randomized controlled trial and a cohort study on the efficacy of Intra-articular sodium hyaluronate (MW 1,500–2,000 kDa) on symptomatic hip OA, we performed this retrospective study in patients suffering from hip OA treated with ultrasound-guided intra-articular injections of HyalOne (Hyalubrix 60 Italian brand name) involving a group of THR expert orthopedic surgeons to appraise whether or not considered eligible for THR and the frequency and timing of THR. Six orthopedists, not routinely performing hip intra-articular injections, each independently assessed whether 176 patients suffering from hip OA and treated with ultrasound-guided intra-articular injections of sodium hyaluronate (MW 1,500–2,000 kDa) were candidates for THR according to the clinical data (age, body mass index, Pain Visual Analog Scale, Lequesne Algofunctional Index, global patient assessment, global physician assessment, nonsteroidal anti-inflammatory drug intake, and hip X-ray) collected at the first intra-articular sodium hyaluronate injection visit and provided as anonymous electronic data. At 24 months, 159 out of 76 (90 %) patients did not undergo to THR. At 48 months, 82 % (N = 144) of the study population treated with intra-articular hyaluronic acid avoided THR. In the group of 93 patients considered candidates for THR (that is, in which 4, 5, or 6 orthopedic surgeons agreed that the patient was a suitable candidate for THR), only 17 had undergone THR, with survival results of 82 % at 24 months. At 48 months, this percentage reduced to 66 % in this group. In the other groups of patients (in which respectively 3, 2, 1 or no surgeons were in agreement that the patient was a candidate for THR) arthroplasty is not recorded. Sodium hyaluronate (MW 1,500–2,000 kDa) given by ultrasound-guided injection seems to delay THR in the real context of actual overall management of symptomatic hip OA patients. Although further studies are necessary to confirm these data and to identify outcome predictors, hip viscosupplementation should be considered as conservative treatment to perform before proposing patients for THR.
Similar content being viewed by others
Abbreviations
- ACR:
-
American College of Rheumatology
- BMI:
-
body mass index
- CI:
-
confidence interval
- NSAID:
-
nonsteroidal anti-inflammatory drug
- OA:
-
osteoarthritis
- RCT:
-
randomized controlled trial
- ROC:
-
Receiver Operating Characteristic
- VAS:
-
Visual Analog Scale
References
Lawrence RC, Helmick CG, Arnett FC et al (1998) Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 41(5):778–799
Zhang W, Doherty M, Arden N, et al (2005) EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). EULAR evidence-based recommendations for the management of hip osteoarthritis: report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 64(5):669–681. Available at: http://ard.bmj.com/content/64/5/669.full.pdf. Accessed Oct 7 2004
Sperati A, Picconi O, Tancioni V, Guasticchi G, Agabiti N (2008) Outcomes of hip replacement: a hospital-based longitudinal study in Lazio region. Ann Ig 20(2):141–157
Bagge E, Bjelle A, Valkenburg H et al (1992) Prevalence of radiographic osteoarthritis in two elderly European populations. Rheumatol Int 12:33–38
Goldberg VM, Kettelkamp DB, Colyer RA (1992) Osteoarthritis of the knee. In: Moskowitz RW, Howell DS, Goldberg VM, HJ Mankin HJ (eds) Osteoarthritis: diagnosis and medical/surgical management. WB Saunders, Philadelphia, pp 599–620
Poole AR (1995) Imbalances of anabolism and catabolism of cartilage matrix components in osteoarthritis. In: Kuettner K, Goldberg V (eds) Osteoarthritic disorders. American Academy of Orthopedic Surgeons, Rosemont, pp 247–260
American College of Rheumatology Subcommittee on Osteoarthritis Guidelines (2000) Recommendation for the medical management of osteoarthritis of hip and knee: 2000 update. Arthritis Rheum 43:1905–1915
Moskowitz RW (2001) Osteoarthritis: simple analgesics versus nonsteroidal anti-inflammatory drugs. J Rheumatol 28:932–934
Balazs EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol 20(39):2–9
Adams ME, Atkinson MH, Lussier AJ et al (1995) The role of viscosupplementation with Hylan G-F 20 (Synvisc) in the treatment of osteoarthritis of the knee: a Canadian multicenter trial comparing Hylan G-F 20 alone, Hylan G-F 20 with non-steroidal anti-inflammatory drugs (NSAIDs) and NSAIDs alone. Osteoarthr Cartil 3:213–226
Marshall KW (1997) The current status of hylan therapy for the treatment of osteoarthritis. Today’s Ther Trends 15:99–108
Gabriel SE (1996) Update on the epidemiology of the rheumatic diseases. Curr Opinion Rheum 8:96–100
Vinciguera C, Gueguen A, Revel M et al (1995) Predictors of the need for total hip replacement in patients with osteoarthritis of the hip. Rev Rhum (Engl Ed) 62:563–570
Qvistgaard E, Kristoffersen H, Terslev L et al (2001) Guidance by ultrasound of intra-articular injections in the knee and hip joints. Osteoarthr Cartil 9:512–517
Migliore A, Martin Martin LS, Alimonti A et al (2003) Efficacy and safety of viscosupplementation by ultrasound-guided intra-articular injection in osteoarthritis of the hip. Osteoarthr Cartil 11:305–306
Brocq O, Tran G, Breuil U et al (2002) Hip osteoarthritis: short term efficacy and safety of viscosupplementation by hylan G-F 20. An open-label study in 22 patients. Joint Bone Spine 69(4):388–391
Conrozier T, Bertin P, Mathieu P et al (2003) Intra-articular injections of hylan G-F 20 in patients with symptomatic hip osteoarthritis: an open label, multicentre, pilot study. Clin Exp Rheumato 21:605–610
Jaimes-Hernandez J, Suarez-Otero R, Rosas-Ramos R, et al Change in coxofemoral joint interlines after the application of hylan gf-20 in patients with coxarthrosis M., AB0454 ACR 2002
Kellgren JK, Lawrence JS (1957) Radiological assessment of osteoarthritis. Ann Rheum Dis 15:494–501
Altman RD, Hochberg MC, Moskowitz RW et al (2000) Recommendations for the medical management of osteoarthritis of the hip and knee. Arthritis Rheum 43:1905–1915
Lequesne MG (1997) The algofunctional indices for hip and knee osteoarthritis. J Rheumatology 24:779–781
Migliore A, Massafra U, Iannessi F, et al (2006) Efficacy and safety of Hyalubrix® administration in hip osteoarthritis: prospective cohort study. Ann Rheum Dis: 65
Migliore A, Bizzi E, Massafra U et al (2008) 18 months follow-up after intra-articular administration of hyalubrix® in 344 patients with symptomatic osteoarthritis of the hip. Osteoarthr Cartil 16:S118–S119
Migliore A, Massafra U, Bizzi E, et al (2009) Comparative, double-blind, controlled study of intra-articular hyaluronic acid (Hyalubrix) injections versus local anesthetic in osteoarthritis of the hip. Arthritis Res Ther 11(6):R183. http://www.ncbi.nlm.nih.gov/pubmed/20003205. Accessed Dec 9 2009. PMID: 20003205
Migliore A, Massafra U, Bizzi E et al. Intra-articular injection of hyaluronic acid (MW 1,500–2,000 kDa; HyalOne®) in symptomatic osteoarthritis of the hip: a prospective cohort study. Arch Orthop Trauma Surg 131(12):1677–1685
Altman R, Alarcon G, Appelrouth D et al (1991) The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip. Arthritis Rheum 34(5):505–514
Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16(4):494–502
Lequesne MG (1997) The algofunctional indices for hip and knee osteoarthritis. J Rheumatol 24(4):779–781
Van den Bekerom MP, Lamme B, Sermon A, et al (2008) What is the evidence for viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature. Arch Orthop Trauma Surg 128(8):815–823. http://www.ncbi.nlm.nih.gov/pubmed/17874246. Accessed Sep 15 2007. PMID: 17874246
Zhang W, Moskowitz RW, Nuki G et al (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16:137–162
Leopold SS, Battista V, Oliverio JA (2001) Safety and efficacy of intra-articular hip injection using anatomic landmarks. Clin Orthop (391):192–197
Diraçoğlu D, Alptekin K, Dikici F, Balci HI, Ozçakar L, Aksoy C (2009) Evaluation of needle positioning during blind intra-articular hip injections for osteoarthritis: fluoroscopy versus arthrography. Arch Phys Med Rehabil 90(12):2112–2115
Gonçalves B, Ambrosio C, Serra S, Alves F, Gil-Agostinho A, Caseiro-Alves F (2011) US-guided interventional joint procedures in patients with rheumatic diseases—When and how we do it? Eur J Radiol 79(3):407–414
Chevalier X, Henrotin Y (2009) Osteoarthritis Committee of the French Society for Rheumatology. OARSI recommendations on knee and hip osteoarthritis: use with discernment. Joint Bone Spine 76(5):455–457
Zhang W, Nuki G, Moskowitz RW et al (2010) OARSI recommendations for the management of hip and knee osteoarthritis Part III: changes in evidence following systematic cumulative update of research published through January 2009. Osteoarthr Cartil 18:476–499
Straube S, Tramèr MR, Moore RA et al (2009) Mortality with upper gastrointestinal bleeding and perforation: effects of time and NSAID use. BMC Gastroenterol 9:41
Oliveria SA, Felson DT, Reed JI et al (1995) Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization. Arthritis Rheum 38:1134–1141
Acknowledgments
The authors are grateful to Nicola Giordan for his help in the preparation of this manuscript and to Ilaria Panni for her precious assistance. Data collection and analysis, reporting, and writing of this study were supported by a grant from Fidia Farmaceutici S.p.A. No equipment or other supplies were provided by Fidia Farmaceutici S.p.A.
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Appendices
Appendix
What is already known about this subject
-
Osteoarthritis is a major cause of disability worldwide. Over the past years, interest has grown among the scientific community, pharmaceutical companies, and regulatory agencies in the development of drugs that might influence the natural history of structural changes in OA by preventing, retarding, or reversing cartilage breakdown and the often related THR.
-
THR may still have potential—even important—consequences: infections, thromboembolism, implant dislocation, and damaged nerves and vessels.
-
In addition, THR is further complicated by a certain mortality rate: reported rate in Italy is >2 % in the 3 months following surgery. In addition to the direct consequences of the surgical procedure, another relevant, influencing factor is the time and activities required to achieve complete functional recovery.
-
The published data suggest that viscosupplementation may be effective in the symptomatic treatment of Hip OA.
What this study adds
-
Thanks to this study among patients with hip OA pain, being treated with intra-articular injection of HA and evaluated by orthopedic surgeons, we can confirm that viscosupplementation with hyaluronic acid seems to be a valuable technique for the management of painful OA of the hip that may delay the need for surgical intervention.
-
The results show that the treatment with hyaluronic acid (MW 1,500–2,000 kDa) is the most favorable option, from a clinical and economic perspective and also considering the social impact, since it helps preserve the survival rate to THR, and it helps provide the foundation for significant cost-savings.
Rights and permissions
About this article
Cite this article
Migliore, A., Bella, A., Bisignani, M. et al. Total hip replacement rate in a cohort of patients affected by symptomatic hip osteoarthritis following intra-articular sodium hyaluronate (MW 1,500–2,000 kDa) ORTOBRIX study. Clin Rheumatol 31, 1187–1196 (2012). https://doi.org/10.1007/s10067-012-1994-4
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-012-1994-4