Abstract
BackgroundOsteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. Intra-articular hyaluronic acid (HA) injection may be of benefit but quality evidence for HA use in hip OA is lacking. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA.MethodsThis single site study is an analysis of prospectively collected outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA. Inclusion criteria were male or female patients over 18-years of age with mild to moderate hip OA on x-ray. Patients with severe hip OA were excluded. The primary outcome measure was a modified Harris Hip Score (mHHS) questionnaire at baseline and 6-weeks with a minimal clinically important difference (MCID) of 10 points. All adverse events were recorded and assessed.ResultsData from 87 patients, 49 women and 38 men with mean age of 54 (SD = 10.8) were analysed. At baseline, mean mHHS was 58.47 (SD 14.31). At the 6 week follow up, mean mHHS improved to 71.30 (SD 16.46), a difference of 12.83 (p < 0.01). This was greater than the MCID of 10. No significant adverse events were encountered. Five patients reported short-lived injection site pain.ConclusionA single injection of HA (NASHA) in the setting of hip joint OA was both safe and efficacious in this 87 patient cohort. Improvement in pain and function as measured with mHHS was statistically significant and reached the MCID of 10.Trial registrationThe study was retrospectively registered on the 1st of February 2021 in the Australian New Zealand Clinical Trials Registry with registry number ACTRN12621000098831. All research was performed in accordance with the Declaration of Helsinki.
Highlights
Osteoarthritis (OA) is the most prevalent form of joint disease and a significant cause of morbidity worldwide [23, 37] It is characterised by progressive degradation of cartilage, remodelling of bone, pain and progressive loss of range of motion and function [40]
The purpose of this study was to assess the safety and efficacy of hyaluronic acid (HA) (Durolane) in reducing pain and improving function in hip OA in the clinical setting. Trial design This single site study is a prospective analysis of outcome data for 87 consecutive patients over a 2-year period who received a single HA (Durolane) injection for symptomatic hip OA
No patients in this study reported any of the previously described adverse events associated with HA injection including bleeding, local or systemic allergic response, septic arthritis or so-called “pseudoseptic arthritis”
Summary
Osteoarthritis (OA) is the most prevalent form of joint disease and a significant cause of morbidity worldwide [23, 37] It is characterised by progressive degradation of cartilage, remodelling of bone, pain and progressive loss of range of motion and function [40]. The socioeconomic costs of hip OA have increased by 80% in the past ten years [37, 41]. In Australia alone the estimated total cost of OA is $5.5 billion [15]. The majority of these costs are due to joint replacement surgery for end stage disease and premature exit from the workplace [15]. In 2018 49,972 hip replacements were performed, a 125% increase since 2003 [3]. Osteoarthritis (OA) is the most prevalent form of joint disease and commonly affects the hip. Hip OA is associated with a high socioeconomic burden. The purpose of this study was to assess the safety and efficacy of ultrasound guided injection of a high molecular weight, non-animal derived, stabilised HA (NASHA) in patients with mild to moderate hip OA
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