PMS48 HYALURONIC ACID MANAGEMENT OF KNEE OSTEOARTHRITIS: IMPACT ON PAIN

Abstract

Methods: It has been set a prospective study to assess control pain and functional performance in a group of patients affected by hip arthritis, before and after viscosupplementation. From May 2005 to September 2009 we performed an intra articular infiltration into the hip of 207 patients (108 male, 99 female), mean age 67,8 (range 40-83). Each patient received under fluoroscopic guidance one injection of highly purified sodium hyaluronate derived from bacterial fermentation, containing 75 mg of sodium hyaluronate per 3-ml syringe. The inclusion criteria were: hip pain, radiographic evidence of arthritis with the articular rima at least partly conserved, full range of motion of affected hip. All patients were evaluated using BPI score, VAS score and Harris Hip score, pre-infiltration, after three, six and twelve months after treatment. The categorical data were summarized in terms of frequency and percentage. Continuous data where analyzed in terms of mean, standard deviations, Student’s test. 150 patients out of 207 were studied at six months follow-up, 121 patients out of 207 were studied at one year follow-up. Results: Mean VAS scores before infiltration and at 1 year follow-up were 5.6 (range 10-6, SD 2,01) and 3.33 (range 10-3, SD 2.99) respectively (p<0,05). Mean HHS were 44.2 (range 24-66, SD 10.4) and 76.5 (range 32-81, SD 16.4) respectively (p<0,05). Mean BPI Interference score were 27,38± (range 16-53, SD 17,68) and 14,35 (range 8-34, SD 12,60) respectively (p<0,05). Fifty three patients (43%) reported at least 50% of pain relief of pain at 6 months follow-up. Each item of BPI showed a decrease of pain interference during daily activity. The decrease was statistically significant for all items (p<0,05). Particularly decreasing was observed for pain interference with sleep (from 4,09, SD 3,15 pre infiltration to 1,27, SD 1,36 at 1 year follow-up), mood (from 4,40, SD 3,17 pre infiltration to 2,04, SD 2,37 at 1 year follow-up), enjoy (from 3,21, SD 3,46 pre infiltration to 1,27, SD 2,10 at 1 year follow-up). No local side effects or systemic complications was observed in our series. Conclusions: Our data show that viscosupplementation is a promising approach for hip osteoarthritis, providing beneficial effects in a long-term follow up. The results demonstrated that it is possible to delay replacement of the arthritic hip, but above all that hip pain could be eliminated in patients clinically and radiographically at the limit of the indication for surgical treatment.