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Guezmil M, Bensalah W, Mezlini S. Tribological behavior of UHMWPE against TiAl6V4 and CoCr28Mo alloys under dry and lubricated conditions. J Mech Behav Biomed Mater 2016; 63:375-385. [DOI: 10.1016/j.jmbbm.2016.07.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/29/2016] [Accepted: 07/03/2016] [Indexed: 10/21/2022]
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Conrozier T, Bozgan AM, Bossert M, Sondag M, Lohse-Walliser A, Balblanc JC. Standardized Follow-up of Patients with Symptomatic Knee Osteoarthritis Treated with a Single Intra-articular Injection of a Combination of Cross-Linked Hyaluronic Acid and Mannitol. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:175-9. [PMID: 27688712 PMCID: PMC5036533 DOI: 10.4137/cmamd.s39432] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/29/2016] [Accepted: 05/31/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The objective of this study is to obtain pilot data from daily practice conditions of a viscosupplement made of a cross-linked high-molecular-weight hyaluronic acid (HA) combined with mannitol in patients with knee osteoarthritis (KOA). METHODS The data of 40 consecutive patients, 29 women and 11 men, who were prospectively followed up for 6 months, using a standardized procedure, were retrospectively analyzed. All patients have received a single intra-articular injection of HAnox-M-XL (4.4 mL), viscosupplement made of a cross-linked HA (16 mg/mL) + mannitol (35 mg/mL), in the target knee. The primary outcome was safety. The secondary end points included 3- and 6-month change in the WOMAC pain (0–50) and WOMAC total (0–240) and patient’s global assessment (PGA). Patient’s self-assessment of treatment efficacy (0–3) and analgesic consumption were obtained at months 3 and 6. An intent-to-treat analysis was performed. RESULTS Mean (SD) age was 60.7 (13.9) years, and mean BMI was 28.6 (5.0). Kellgren–Lawrence radiological grade was I/II and III/IV in 13 and 27 of the subjects, respectively. The average WOMAC pain and WOMAC total scores at baseline were 21.5 (9.8) and 89.9 (42.8), respectively. Thirty-nine patients completed the follow-up. HAnox-M-XL was well tolerated; two patients experienced knee pain after injection, which resolved within three days. No treatment-related severe adverse event was reported. Mean (SD) variations in WOMAC pain and WOMAC total scores were −8.2 (8.9) and −38.4 (35.6), respectively, at month 6 (P = 0.001). PGA decreased from 5.5 (2.0) to 3.0 (2.2) (P = 0.006). Efficacy was rated as good or very good in 76.9% of the cases. Most of the regular analgesics users decreased their consumption. CONCLUSION Treatment with one injection of 4.4 mL HAnox-M-XL is effective to alleviate KOA symptoms over six months, without safety concern. Controlled trials are needed to confirm these pilot data.
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Affiliation(s)
- Thierry Conrozier
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Ana-Maria Bozgan
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Marie Bossert
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
| | - Maxime Sondag
- Department of Rheumatology, Hôpital Nord Franche-Comté, Belfort, France
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Messina C, Sconfienza LM. Do we still need to take fluoroscopical guidance into account when injecting joints? Semin Arthritis Rheum 2016; 46:e16. [PMID: 27642157 DOI: 10.1016/j.semarthrit.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, via Festa del Perdono, 7, Milano 20122, Italy.
| | - Luca M Sconfienza
- Radiologia/Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi, 4, 20161 Milano, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133 Milano, Italy
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Gross A, Muir JM. Identifying the procedural gap and improved methods for maintaining accuracy during total hip arthroplasty. Med Hypotheses 2016; 94:93-8. [PMID: 27515211 DOI: 10.1016/j.mehy.2016.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/10/2016] [Indexed: 11/16/2022]
Abstract
Osteoarthritis is a ubiquitous condition, affecting 26 million Americans each year, with up to 17% of adults over age 75 suffering from one variation of arthritis. The hip is one of the most commonly affected joints and while there are conservative options for treatment, as symptoms progress, many patients eventually turn to surgery to manage their pain and dysfunction. Early surgical options such as osteotomy or arthroscopy are reserved for younger, more active patients with less severe disease and symptoms. Total hip arthroplasty offers a viable solution for patients with severe degenerative changes; however, post-surgical discrepancies in leg length, offset and component malposition are common and cause significant complications. Such discrepancies are associated with consequences such as low back pain, neurological deficits, instability and overall patient dissatisfaction. Current methods for managing leg length and offset during hip arthroplasty are either inaccurate and susceptible to error or are cumbersome, expensive and lengthen surgical time. There is currently no viable option that provides accurate, real-time data to surgeons regarding leg length, offset and cup position in a cost-effective manner. As such, we hypothesize that a procedural gap exists in hip arthroplasty, a gap into which fall a large majority of arthroplasty patients who are at increased risk of complications following surgery. These complications and associated treatments place significant stress on the healthcare system. The costs associated with addressing leg length and offset discrepancies can be minor, requiring only heel lifts and short-term rehabilitation, but can also be substantial, with revision hip arthroplasty costs of up to $54,000 per procedure. The need for a cost-effective, simple to use and unobtrusive technology to address this procedural gap in hip arthroplasty and improve patient outcomes is of increasing importance. Given the aging of the population, the projected increases in the volume of procedures over the coming decades and the economic pressures associated with downward pricing pressure and bundled payments, the need to address this gap is underscored.
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Affiliation(s)
- Allan Gross
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Mount Sinai Hospital, 600 University Ave., Suite 476(A), Toronto, ON M5G 1X5, Canada.
| | - Jeffrey M Muir
- Intellijoint Surgical, Inc., 60 Bathurst Dr., Suite 6, Waterloo, ON N2V 2A9, Canada
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Piccirilli E, Oliva F, Murè MA, Mahmoud A, Foti C, Tarantino U, Maffulli N. Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis. Muscles Ligaments Tendons J 2016; 6:293-299. [PMID: 28066733 PMCID: PMC5193518 DOI: 10.11138/mltj/2016.6.3.293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hip joint diseases are common in adult population and their prevalence increases with age. Osteoarthritis, rheumatoid arthritis and femoroacetabular impingement are the most common chronic diseases in the hip joint. Viscosupplementation with exogenous hyaluronic acid (HA) is one of the most widely used conservative treatment aiming to improve synovial fluid properties and to decrease pain. There is no global consensus on the type of HA, method of injection and frequency, or on its efficacy in hip joint. METHODS We selected published data in English in the PubMed and Google Scholar electronic databases up to March 2016 about hyaluronic acid injections in hip disorders. RESULTS 26 articles were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. CONCLUSION There is a lack of standardization of HA injections for hip conditions. Our results suggest that this is the best conservative therapy before surgery and it can act on pain relief and function however there is no evidence to prove its ability to modify the morphological structure of the pathological hip and the natural history of the disease. There are few data about the use of HA in other hip disorders rather than osteoarthritis. The most relevant evidence seems to show the utility of HA injections in improving synovial inflammation, but only a few studies have been conducted. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Eleonora Piccirilli
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | | | - Asmaa Mahmoud
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
- Physical medicine, Rheumatology and rehabilitation department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Calogero Foti
- Department of Physical and Rehabilitation Medicine, School of Medicine, University of Rome “Tor Vergata”, Italy
| | - Umberto Tarantino
- Department of Orthopaedics and Traumatology, University of Rome “Tor Vergata”, Italy
| | - Nicola Maffulli
- Head of Department of Orthopaedics and Traumatology, Azienda Ospedaliera San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Italy; Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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106
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Nguyen C, Lefèvre-Colau MM, Poiraudeau S, Rannou F. Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Ann Phys Rehabil Med 2016; 59:184-189. [DOI: 10.1016/j.rehab.2016.02.008] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 12/13/2022]
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Strand V, Lim S, Takamura J. Evidence for safety of retreatment with a single intra-articular injection of Gel-200 for treatment of osteoarthritis of the knee from the double-blind pivotal and open-label retreatment clinical trials. BMC Musculoskelet Disord 2016; 17:240. [PMID: 27250845 PMCID: PMC4888617 DOI: 10.1186/s12891-016-1101-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 05/27/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Gel-200 is a cross-linked hyaluronate single-injection device for treatment of osteoarthritis pain in the knee. This report summarizes new analyses of the safety of retreatment with Gel-200 from the 13-week, pivotal, multicenter, randomized controlled trial (RCT) followed by an open-label extension trial (OLE). METHODS 379 patients were enrolled in the RCT [Gel-200; phosphate-buffered saline (PBS)]. Safety of retreatment with Gel-200 was assessed by comparing adverse events (AEs) and device-related AEs reported through Week 4 following retreatment with Gel-200 to those reported in patients receiving their first injection in the OLE. RESULTS 350 patients completed the initial RCT (231 Gel-200; 119 PBS); 258 patients enrolled in the OLE (162 Gel-200; 96 PBS). In total, 202 patients (125 Gel-200; 77 PBS) qualified for retreatment, while 56 (37 Gel-200; 19 PBS) did not. There were no significant demographic or disease characteristic differences between Gel-200 patients who were and were not retreated; those who were not eligible for retreatment experienced greater pain relief from Gel-200 in the RCT by all effectiveness endpoints (all p < 0.001), without differences in their safety profile. In the OLE, the safety of Gel-200, including percentages of patients who experienced any AEs (p = 0.547) and device-related AEs (p = 0.521), did not significantly differ between those receiving a second versus a first injection of Gel-200 following PBS in the RCT. CONCLUSION In the OLE, the safety of a second injection of Gel-200 was comparable to that of a first injection and effectiveness was similar, as previously reported. TRIAL REGISTRATION ClinicalTrials.gov identification numbers NTC 00449696 and NTC 00450112.
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Affiliation(s)
- Vibeke Strand
- Division of Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sooyeol Lim
- North American Business Unit, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan
| | - Junko Takamura
- Clinical Development Department, Research & Development Division, Seikagaku Corporation, Chiyoda-ku, Tokyo, Japan.
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Migliore A, Bizzi E, De Lucia O, Delle Sedie A, Bentivegna M, Mahmoud A, Foti C. Differences among Branded Hyaluronic Acids in Italy, Part 1: Data from In Vitro and Animal Studies and Instructions for Use. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2016; 9:89-101. [PMID: 27257398 PMCID: PMC4881871 DOI: 10.4137/cmamd.s38857] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/31/2016] [Accepted: 03/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of hyaluronic acid (HA) for intra-articular (IA) injection is widespread around the world for patients affected by osteoarthritis. AIM The aim of this study is to identify scientific evidence from in vitro and in vivo studies supporting the use of IA HAs marketed in Italy. We also evaluated the accuracy of indications and contraindications reported in the leaflets of such HAs compared with the available scientific evidence. MATERIALS AND METHODS An extensive literature search was performed to identify all in vitro and in vivo model studies reporting on the effects of various HAs marketed in Italy for IA use. Data reported in the leaflets of different HA-based products for IA use were extracted and analyzed alongside evidence from in vitro and in vivo model studies. RESULTS Nine in vitro studies and 11 studies on animal models were examined. Comparing results with what is reported in the leaflets of HAs marketed in Italy, it was observed that many branded formulations are introduced in the market without any reporting of basic scientific evidence. Only 12.82% and 17.95% of branded products had been shown to be effective with scientific evidence from in vitro and in vivo studies, respectively. The rationale of use of these products is based on their nature, as if a class effect existed such that all HAs would yield similar effects. CONCLUSIONS Data on HAs deriving from in vitro and in vivo studies are scarce and relate to only a small percentage of products marketed in Italy. Many indications and contraindications are arbitrarily reported in Italian HA leaflets without the support of scientific evidence. Larger and brand-specific studies are necessary and should be reported in the leaflets to guide clinicians in making an appropriate choice regarding HA-based IA therapy.
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Affiliation(s)
- A Migliore
- Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - E Bizzi
- Operative Unit of Rheumatology, S. Pietro Fatebenefratelli Hospital, Rome, Italy
| | - O De Lucia
- Division and Chair of Rheumatology, Gaetano Pini Institute, Milan, Italy
| | | | - M Bentivegna
- Rheumatology Provincial Network Coordinator, ASP 7, Scicli Hospital, Ragusa, Italy
| | - Asmaa Mahmoud
- Physical Medicine, Rheumatology and Rehabilitation Department, Ain Shams University, Cairo, Egypt.; Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - C Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, Rome, Italy
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Richards MM, Maxwell JS, Weng L, Angelos MG, Golzarian J. Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to products of regenerative medicine. PHYSICIAN SPORTSMED 2016; 44:101-8. [PMID: 26985986 PMCID: PMC4932822 DOI: 10.1080/00913847.2016.1168272] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Knee osteoarthritis (OA) is a debilitating condition that may ultimately require total knee arthroplasty (TKA). Non-operative treatments are bracing, oral analgesics, physical therapy, and intra-articular knee injection (IAKI). The objective of this paper is to provide a systematic literature review regarding intra-articular treatment of knee OA and insight into promising new products of regenerative medicine that may eventually have a substantial effect on treatment. METHODS A literature search was executed using Medline, Cochrane, and Embase with keywords "knee osteoarthritis" and "injection." Specifically, 45 articles that discussed intra-articular knee injection using corticosteroids, hyaluronic acid, analgesics, local anesthetics, and newer products of regenerative medicine, such as platelet-rich plasma (PRP) and mesenchymal stem cells (MSC), were analyzed. Of these, eleven were level 1, three were level 2, twelve were level 3, two were level 4, and seventeen were level 5 evidence. Papers included animal models. RESULTS Local anesthetics have potential side effects and may only be effective for a few hours. Morphine and ketorolac may provide significant pain relief for 24 hours. Corticosteroids may give patients weeks to months of effective analgesia, but complications may occur, such as systemic hyperglycemia, septic arthritis, and joint degradation . Hyaluronic acid is a natural component of synovial fluid, but efficacy with respect to analgesia is controversial. Platelet-rich plasma formulations, autologous conditioned serum, autologous protein solution, and mesenchymal stem cell injections contain anti-inflammatory molecules and have been proposed to attenuate joint destruction or potentially remodel the joint. CONCLUSIONS Currently, knee OA treatment does not address the progressively inflammatory environment of the joint. More investigation is needed regarding products of regenerative medicine, but they may ultimately have profound implications in the way knee OA is managed.
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Affiliation(s)
- Masters M. Richards
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
| | - Joshua Shane Maxwell
- University of Minnesota-School of Medicine, Department of Family Medicine and Community Health, 420 Delaware St. SE, MMC 381, Minneapolis, MN 55455, Ph. (612)625-0646
| | - Lihui Weng
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
| | - Mathew G. Angelos
- University of Minnesota-School of Medicine, Department of Hematology, Oncology, and Transplantation, 401 East River Parkway, Suite 131, MMC 194, Minneapolis, Minnesota 55455, Ph. (612)625-3654
| | - Jafar Golzarian
- University of Minnesota-School of Medicine, Department of Vascular and Interventional Radiology 420 Delaware St. SE, Minneapolis, MN 55455, Ph. (612)626-5388
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Conrozier T, Patarin J, Mathieu P, Rinaudo M. Steroids, lidocain and ioxaglic acid modify the viscosity of hyaluronic acid: in vitro study and clinical implications. SPRINGERPLUS 2016; 5:170. [PMID: 27026867 PMCID: PMC4766165 DOI: 10.1186/s40064-016-1762-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 02/12/2016] [Indexed: 01/18/2023]
Abstract
Background Viscosupplementaion by intra-articular injection of hyaluronic acid (HA) is a therapeutic modality for treating osteoarthritis of the knee, of the hip and less frequently of other joints. During viscosupplementation, it is usual to inject other drugs, without knowing whether this association may have a deleterious effect thereon. The rheological properties of a viscosupplement are highly dependent on the product [molecular weight × concentration] of HA. Therefore, any reduction of its viscoelastic properties is related either to a decrease of its concentration or/and of its molecular weight. The presence of other molecules can create favorable or unfavorable molecular interactions with HA. The objective of the study was to investigate the effect of products, that are commonly associated with HA (corticosteroids, lidocain, iodinated contrast media), on the rheological behavior of HA, then to try drawing practical conclusions. Methods The rheological behavior of both a linear and a cross-linked HA, was studied before and after mixing with different volumes (ratio 1:0.5–1:4) of the following compounds: phosphate buffered saline (PBS, as a control), cortivazol, triamcinolone hexacetonide, lidocain chlorhydrate and meglumine ioxaglate. The flow curve of the different samples was obtained using a measuring method based on a constant shear rate. Results Whatever the dilution and the added molecule were, viscosity of the cross-linked viscosupplement remained much higher than that of the linear one. Addition of PBS at a ratio 1:1 caused a dramatic decrease (up to 97.5 %) of HA viscosity. Cortivazol and lidocain had a similar effect than PBS on linear HA. Both were much deleterious on cross-linked HA viscosity. Among corticosteroids, triamcinolone decreased much less HA viscosity than cortivazol. The effect of meglumine ioxaglate was dose-dependent. Up to a ratio 1:1 viscosity of the linear HA remained above the dilution effect. On the cross-linked HA, the deleterious effect of the contrast agent was evident as soon as a ratio 1:1 and became very marked at 1:2. Conclusion HA viscosity varies widely in presence of other molecules. These changes are due to both dilution and molecular interactions. This study suggests that addition of other molecules with HA can lead to a major decrease of its viscosity. However, provided to respect a maximum ratio of 1:1, the contrast medium and triamcinolone seem to have no major deleterious effect on the viscosity level, especially on crosslinked HA. The study also suggests a deleterious effect of lidocain on the cross-linked HA. These in vitro data suggest that drugs associations must be avoided when they are not essential. However, clinical trials are needed to determine whether these rheological changes may have a significant impact on the clinical outcome.
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Affiliation(s)
- Thierry Conrozier
- Service de rhumatologie, Hôpital Nord Franche-Comté, 14 rue de Mulhouse, 90000 Belfort, France
| | - Jeremy Patarin
- Rhéonova, Domaine Universitaire, 363, rue de la chimie, 38400 Saint Martin d'Hères, France
| | - Pierre Mathieu
- Laboratoire de Rhumatologie Appliquée, 19 place Tolozan, 69001 Lyon, France
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111
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Rivera F. Single intra-articular injection of high molecular weight hyaluronic acid for hip osteoarthritis. J Orthop Traumatol 2015; 17:21-6. [PMID: 26449357 PMCID: PMC4805628 DOI: 10.1007/s10195-015-0381-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background Intra-articular (IA) injection of hyaluronic acid (HA) into the hip joint appears to be safe and well tolerated but only a small number of randomized clinical trials in humans has been published. The objective of this prospective study was to evaluate the efficacy and safety of a single IA injection of high-molecular-weight (2800 kDa) HA (Coxarthrum) for hip osteoarthritis. Materials and methods All patients received a single IA administration of 2.5 % sodium hyaluronate (75 mg/3 mL) of high molecular weight. Fluoroscopy requires an iodized contrast medium (iopamidol, 1 ml) which highlights the capsule before administering HA. Patients were evaluated before IA injection (T0), after 3 months, after 6 months and after 1 year from injection. Results were evaluated by the Brief Pain Inventory (BPI II), Harris Hip Score and a visual analog scale of pain (pain VAS). All treated patients were considered for statistical analysis. Results Two hundred seven patients were included at T0. The mean age was 67 years (range 46–81). Regarding BPI severity score, changes in pain between T0 and the three following visits were statistically highly significant (p < 0.001). Changes in pain score compared to the previous visit were statistically significant for the worst pain in the second quarter post-intervention (p = 0.037) and for mean pain in the second semester post-intervention (p = 0.043) The evolution of the Harris Hip Score was statistically highly significant (p < 0.001) between T0 and the following visits (T0 + 3 months, T0 + 6 months and T0 + 12 months); after a significant change between T0 and T0 + 3 months, the score remained stable. The evolution of the pain VAS showed a statistically highly significant improvement (p < 0.001) between T0 and T0 + 3 months; thereafter it remained stable from the first quarter post-intervention. No serious adverse event was noted; 12 cases (0.5 %) of pain associated with transient synovitis are noteworthy. Conclusion This study shows that a single IA injection of Coxarthrum is effective from the third month and that the results are stable or continue to improve up to 1 year. Level of evidence IV.
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Affiliation(s)
- Fabrizio Rivera
- Department of Orthopedic Trauma, SS Annunziata Hospital, Via Ospedali 14, 12038, Savigliano (CN), Italy.
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Abstract
This article presents the spectrum of indications for the use of hyaluronic acid (HA) based on the recommendations of the European League Against Rheumatism (EULAR), the American College of Rheumatology (ACR), the Osteoarthritis Research Society International (OARSI), the International Institute for Health and Clinical Excellence (NICE) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) taking the reality of patient care in Europe into account.
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Affiliation(s)
- J Jerosch
- Klinik für Orthopädie, Unfallchirugie und Sportmedizin, Johanna Etienne Krankenhaus, Am Hasenberg 46, 40416, Neuss, Deutschland.
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