Osteoarthritis hip synvisc

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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Viscosupplementation is a term used to describe the injection of lubricants that are synthetic forms of synovial fluid into an arthritic joint.

Most of the data available has been published on the use of viscosupplements in knee osteoarthritis. Viscosupplements have also been used to treat osteoarthritis in the shoulder, hip, ankle, and base of the thumb.

There are a variety of viscosupplements available including Hyalgan, Synvisc, Supartz, Orthovisc, and Euflexxa

Clinical trials using these compounds have indicated that they may be helpful for some patients with osteoarthritis of the hip.

Viscosupplementation should be considered for the following patient types:

• Failed intraarticular glucocorticoid (cortisone) injection
• No contraindications to viscosupplements
• Surgery is either not an option or is an undesirable option
• Hip osteoarthritis is not end-stage

When injected into the hip, viscosupplements should be administered by a skilled physician using a spinal needle, local anesthesia, and either ultrasound or fluoroscopic guidance. Blind injection is not a good idea.

While it seems to work for some patients, the downside is that it is not yet indicated by the FDA for hip osteoarthritis and therefore, insurance companies will generally not pay for it.

Open pilot study of ultrasound-guided intra-articular injection of hylan G-F 20 (Synvisc) in the treatment of symptomatic hip osteoarthritis.

Migliore A, Tormenta S, Martin LS, Valente C, Massafra U, Granata M, Alimonti A.

Department of Internal Medicine, S.Pietro-Fatebenefratelli Hospital, via Cassia 600 Centro ricerche "S.Pietro" AFaR, 00195, Rome, Italy. alberto.migliore@tin.it

Patients suffering from hip osteoarthritis (OA) are frequently symptomatic, and the disease can result in significant limitation of patients' activity and high social costs. Hip OA is generally managed with systemic treatments such as nonsteroidal anti-inflammatory drugs (NSAIDs) and/or symptomatic slow acting drugs. Viscosupplementation with hyaluronan (HA) or its derivatives, which aims to restore the physiological and rheological features of the synovial fluid to improve symptoms, is now a routinely prescribed treatment for OA of the knee. However, few data exist in the literature regarding the use of viscosupplementation in the treatment of hip OA. The objective of this prospective, open, uncontrolled pilot study was to investigate the safety and effectiveness of intra-articular injection, under ultrasound control, of hylan G-F 20 for the treatment of OA of the hip. Twelve patients (> or =40 years old) with symptomatic hip OA were treated with one injection of 2 ml of hylan G-F 20 under ultrasound guidance. During the study, patients were evaluated for safety and efficacy using the Lequesne index, a visual analogue scale (VAS) measure of hip OA pain and analysis of NSAID consumption. Patients treated with hylan G-F 20 in this study showed clinically significant reductions in Lequesne and VAS scores and in the consumption of NSAIDs up to 3 months after the injection. In the 12 patients treated (total of 14 injections), no systemic adverse events were observed. Three patients reported mild, local pain post-injection. This study demonstrates the potential of ultrasound-guided intra-articular injections of a viscosupplement into the hip joint and gives positive preliminary information about the safety and efficacy of hylan G-F 20 for the treatment of symptomatic hip OA.

Clin Rheumatol. 2005 Jun;24(3):285-9. Epub 2004 Dec

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