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| |  DG DISPATCH - AAOS: Visco-Supplementation May Be Used To Treat Hip Arthritis By Cameron Johnston Special to DG News
SAN FRANCISCO, CA -- March 5, 2001 -- Visco-supplementation, which is being used in some centres for the treatment of osteoarthritis of the knee, may eventually see its role expanded to include treating arthritis of the hip. At the annual meeting of the American Academy of Orthopedic Surgeons (AAOS) here, Dr. Vijay Vad, of the New York City Hospital for Special Services, presented findings from a small study on Hylan G-F 20 (Synvisc, Wyeth Ayerst Laboratories and Genzyme Biosurgery) used in treating arthritis of the hip. In Dr. Vad’s study, 25 patients, mean age 56.4 years, all with radiographically confirmed arthritis of the hip, were treated to saline hip lavage during the first week, followed by three injections of Hylan G-F 20 (2 cc each), one week apart. The patients were then enrolled in a rehabilitation program that included home exercises and aquatherapy. These patients had all failed other courses of therapy for their arthritis, including corticosteroid injections. Hylan G-F 20 is a viscous supplement that works by coating the intra-articular joint, protecting the chondyle and providing some measure of relief for the patient’s arthritis. To date, it has only been used to treat osteoarthritis of the knee, but in a number of clinical studies, has proven safe, efficacious and cost-effective. One course of three injections has been shown to produce a joint-protective benefit lasting up to six months. Dr. Vad reported that data showed an 84 percent rate of successful outcome after an average of 1.1 years of follow-up. Even for those who had grade 4 hip osteoarthritis, 50 percent reported a successful improvement. The success of the treatment was measured according to the AAOS Lower Limb Scale, and by a numerical pain scale which regards a 50 percent reduction in pain and patient satisfaction as an excellent or good outcome. At follow-up, the patients involved showed a mean improvement in lower limb scale from 44.2 points to 86.1 points (p=<0.05). Similarly, the mean numerical pain score improved from 8.7 points to 2.3 points (p=0.05) Despite the favorable results in this study, Dr. Vad cautioned that the treatment might not be beneficial for everybody. In the first place, it is not known how much of the benefit seen in this trial was a result of the intra-articular lavage. There is little question, however, that the patients would not have been able to participate in the home exercise or aquatherapy program with out the initial treatment. More concrete prognostic factors that would preclude somebody from having this treatment include grade 4 osteoarthritis, because not enough patients in this group showed a sufficient meaningful response rate. Hip flexor strength of less than three and presence of subchondral femoral head edema on magnetic resonance imagine should also be taken as contra-indications because there is little likelihood that the treatment would result in any kind of benefit, Dr. Vad said.
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