Predictors of response to viscosupplementation in patients with hip osteoarthritis: results of a prospective, observational, multicentre, open-label, pilot study

Florent Eymard,Thierry Conrozier,Olivier Brocq,Bernard Maillet,Sylvie Mellac-Ducamp,Damien Loeuille,Xavier Chevalier,Henri Lellouche

doi:10.1186/s12891-016-1359-2

Abstract

BackgroundTo identify predictive factors of response to viscosupplementation (VS) in patients with hip osteoarthritis (HOA).MethodsProspective, multicentre, open-label trial, achieved in daily practice conditions. Patients with HOA were treated with a single intra-articular injection of a cross-linked hyaluronic acid combined with mannitol (HAnox-M-XL), using imaging guidance. WOMAC pain and function scores and patient global assessment (PGA) were assessed at baseline and day 90. Improvement, satisfaction and efficacy were self-assessed at day 90.Hip radiographs at baseline were scored using Kellgren-Lawrence grade and Osteoarthritis Research Society International (OARSI) score. Associations between clinical and radiological features and response to VS (pain improvement > 50% at day 90) were assessed in univariate analysis, and then using logistic regression, adjusted for confounding factors.ResultsThe intent-to-treat (ITT) population included 97 patients (57 females, mean age 63). Ninety completed the follow-up and 80 had full clinical and radiological data. Response to VS was achieved in 47.8% of patients. In univariate analysis, the only clinical outcome statistically and negatively related to response was PGA at baseline (p = 0.047). Radiologically, response to VS was negatively correlated with joint space narrowing (JSN) score (JSN < 2 vs. JSN ≥ 2, p = 0.01) and was related to the patterns of femoral head migration (p = 0.008). In multivariate analysis, only JSN grade (p = 0.03) remained significantly related to a poor response.ConclusionThis pilot study, which needs further confirmation by larger scale trials, suggests that radiological features might be of importance for the decision of VS in patients with HOA.Trial registration numberID RCB N°2013-A00165-40. Registered 31 January 2013.

Highlights

To identify predictive factors of response to viscosupplementation (VS) in patients with hip osteoarthritis (HOA)
This pilot study, which needs further confirmation by larger scale trials, suggests that radiological features might be of importance for the decision of VS in patients with HOA
The patient informed consent form and the protocol, which complied with the requirements of the International Conference on Harmonisation (ICH), were reviewed and approved by the French Comité consultatif sur le traitement de l’information en matière de recherche scientifique (CCTIRS)

Summary

Introduction

To identify predictive factors of response to viscosupplementation (VS) in patients with hip osteoarthritis (HOA). Hip OA (HOA) is one of the most frequent cause of lower limb OA and is responsible of a significant impact on multiple dimensions of quality of life, compared with healthy controls [2]. Total hip replacement, which is often the only one solution to alleviate pain in advanced stages of the disease, has been responsible of a dramatic increase of HOA related expenses during the last decade. In patients with mild to moderate HOA, and in those who do not accept or have contraindication to surgery, pain management includes analgesics, non steroidal anti-inflammatory drugs (NSAIDs), symptomatic slow acting drugs for OA (SYSADOAs), physiotherapy, rehabilitation, intra-articular (IA) steroid injections and viscosupplementation (VS)

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Discussion

Conclusion