Abstract
Background: Obesity is the main risk factor for hip osteoarthritis, negatively affecting the outcome of the disease. We evaluated the effectiveness of viscosupplementation with hybrid hyaluronic acid compared to that with high molecular weight hyaluronic acid in overweight/obese patients with hip osteoarthritis (OA). Methods: 80 patients were divided into two groups: a treatment group received two ultrasound-guided intra-articular hip injections of hybrid HA 15 days apart; a control group received a single ultrasound-guided infiltration with medium-high molecular weight hyaluronic acid (1500–2000 kDa). We assessed the pain, functional and cardiovascular capacity of the patients at baseline, after 3 months, and after 6 months of the infiltrative sessions. Results: The treatment group showed greater improvements in the scores on the NRS scale (5.4 ± 0.8 vs. 6.3 ± 0.8; p < 0.05) and in the Lequesne index (11.4 ± 2.6 vs. 13.6 ± 2.7; p < 0.05) and in the distance traveled at 6MWT (238.1 ± 53.9 m vs. 210.7 ± 46.2 m; p = 0.02) both at 3 months (T1) and at 6 months (T2). Conclusions: This study underlines the importance of exploiting the anti-inflammatory, analgesic, and chondrogenic properties of hybrid HA for the treatment of hip OA in overweight/obese patients.
Highlights
Hip OA is a chronic musculoskeletal disease that is widespread and causes disability worldwide, with one in four people developing it by the age of 85 [1]
The purpose of the study was to evaluate the effectiveness of viscosupplementation with hybrid hyaluronic acid against viscosupplementation with high molecular weight hyaluronic acid in overweight/obese patients with II–III degree according to K–L hip osteoarthritis
hyaluronic acid (HA) infiltrative therapy is the best conservative therapy before surgery, as it acts on pain without modifying the anatomical structure of the hip, there are no guidelines on the ideal number of injections needed to achieve an optimal clinical response, which appears to be different [1,2,13,15,17,28] between products and dependent on molecular weight (MW) [8]
Summary
Hip OA is a chronic musculoskeletal disease that is widespread and causes disability worldwide, with one in four people developing it by the age of 85 [1]. Muscles are affected and atrophic muscle weakness in the lower limbs is likely to be the cause of the reported reduced physical function in these patients [3]. Among the risk factors for OA, a positive correlation between high body mass index (BMI) and hip OA is known [5,6]. This correlation is less strong than that with osteoarthritis of the knee, a recent meta-analysis found an 11% increase in the risk of hip OA per five-unit increase in BMI in both sexes [7]. Obesity affects the metabolic environment of the joint due to the pro-inflammatory systemic activation associated with obesity, increasing the risk of hip OA [9,10]
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