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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2011 June;62(3):145-55
Presidio Sanitario Gradenigo, Torino, Italia
Hip osteoarthritis (OA) can be a major cause of disability. At present, with exception of surgery, all other treatments on the basis of clinical evidence do not change the course of the disease. Many of these treatments are able to relieve pain and increase function. Nonsteroidal anti-inflammatory drugs are used for early and late treatment of OA. Injectable medications are typically corticosteroid or hyaluronic acid (HA). In the absence of dependable and reproducible nonsurgical treatment alternatives, hyaluronic acid injections recently have been advocate as additional treatment option. Several different formulations of viscosupplements are now avaible, produced by different manufacturers and of widely different molecular weights. The origin of Hyaluronian molecula in each formulation divides preparations in two types: preparations with HA extracted from chiken combs, and preparations with biosintetic , non-animal derivated HA. Further difference in the active substance is presence of modification of HA molecula by cross-linking. Despite numerous reports about clinical efficacy of hyaluronian injection in the treatment of osteoarthritic knee, results of viscosupplementation in hip OA in literature are rare. The viscosupplementation appears as an effective treatment for OA of the hip with beneficial effects on pain, function and patient global assessment but there is no consensus on the number of injections, the dosage per injection, the most appropriate formulation of HA, and the optimal method for controlling the needle positioning in the hip joint. Fluoroscopic and ultrasound guidance are widely accepted as most safe approach to infiltration. Most important to optimize pain relief and patient satisfaction is the respect of inclusion criteria to hip viscosupplementation treatment: hip pain, radiographic evidence of OA with the articular joint at least partly conserved, full range of motion of affected hip. Viscosupplementation is a promising approach for hip OA, although further and wider studies are wanted to determine how long the beneficial effect lasts, and what is the optimal number of injections to administer.