Abstract
Objective: To date, there are no studies addressing the efficacy of hyaluronic acid (HA) injections at the trochanteric bursa in patients with greater trochanteric pain syndrome (GTPS). The objective of the study was to compare the efficacy and safety of HA to corticosteroid injections for the treatment of the GTPS. Methods: This prospective, randomized, two-arm trial involved 47 patients with unilateral or bilateral GTPS. Patients received an intra-bursal injection of 40 mg triamcinolone acetonide plus 1mL lidocaine, or of 60 mg HA. Patients completed visual analog scales (VAS) and Likert scales to evaluate interference of pain with daily activity, recovery from pain, and treatment satisfaction. A non-inferiority analysis was also performed. Results: Mean VAS score for pain significantly decreased comparing baseline with 1, 3 and 6 months in both treatment groups. VAS score for pain on palpation was also significantly lower than baseline in both arms. No significant differences were found between groups. Analysis of Likert scales at the sixth month didn’t detect statistically significant differences between treatment groups. The non-inferiority analysis showed that the treatment with HA was non-inferior to corticosteroids. No secondary adverse effects were found among the patients of both groups during the follow-up. Conclusions: The treatment with HA has demonstrated to be non-inferior to corticosteroids after 6 months of follow-up in patients with GTPS. Therefore, the treatment with HA may be considered an effective alternative therapeutic strategy to reduce pain in patients in whom the treatment with corticosteroids, or other therapies, have been unsuccessful or contraindicated.
Highlights
The greater trochanteric pain syndrome (GTPS) is a frequent condition characterized by the pain and reproducible tenderness at the greater trochanter region, buttock, and lateral thigh [1]
The total number of patients included in the study was 47, 22 from the group receiving corticosteroids and 25 from hyaluronic acid (HA)
No differences were found between treatment groups regarding Likert scale evaluating the interference of pain with daily activity, recovery from pain, and treatment satisfaction
Summary
The greater trochanteric pain syndrome (GTPS) is a frequent condition characterized by the pain and reproducible tenderness at the greater trochanter region, buttock, and lateral thigh [1]. A single corticosteroid injection has been shown to increase in 2.7-fold the number of patients being free of pain after 5 years since the injection [3] [6]. The beneficial effects of HA on the synovial fluid of joints and bursas derive from its high viscosity, its protective effects on articular cartilage and joints, by influencing the inflammatory process of the synovial tissue and promoting the healing and regeneration of the articular cartilage. In view of these effects for intra-articular injections, it seems reasonable to extrapolate the same effectiveness to intra-bursal injections for the treatment of GTPS.
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