The impact of treatment with hylan G-F 20 on progression to total hip arthroplasty in patients with symptomatic hip OA: a retrospective study

Abstract

Introduction:

There is scarce data available on intra-articular hyaluronan’s ability to modify the progression of osteoarthritis (OA).

Objective:

The purpose of this retrospective pilot study was to assess the impact of treatment with hylan G-F 20 on progression to total hip replacement (THR) in patients with symptomatic hip OA.

Research design and methods:

The records of patients presenting with symptomatic hip OA and treated with hylan G-F 20 were analysed. Endpoints were the number of THRs performed and the survival time (in months) between commencement of treatment and THR, if performed. Endpoints were evaluated for the entire study population and for those sub-groups of patients which were, or were not, defined as candidates for THR prior to intra-articular treatment. Predictive factors of progression to THR were also assessed.

Results:

A total of 850 patients’ records were evaluated and 224 patients’ data were included in the study and evaluated. Eighty-four patients (37.5%) progressed to THR, 206 patients (92.0%) achieved 12 months survival, 170 patients (75.9%) achieved 24 months survival, and 69 patients (30.8%) achieved 5 years survival. Mean survival time was 36 months. Classification as a THR candidate, Lequesne score, ultrasound pattern and the presence of diabetes were predictive factors for progression to THR.

Conclusions:

These results suggest that hylan G-F 20 could be included in the management of symptomatic hip OA before recommendation for THR, particularly in patients presenting with milder symptoms, or in patients where, due to comorbidities or personal choice, THR is not a feasible option. Limitations of this study include the retrospective study design and the lack of a control group to determine any placebo effect of hylan G-F 20. Further prospective studies are therefore needed to corroborate these results.

Keywords::

• hip osteoarthritis
• hip replacement arthroplasty
• hylan G-F 20

Transparency

Declaration of funding

The data analysis, reporting and writing of this study were supported by an unrestricted grant from Genzyme b.v.

Declaration of financial/other relationships

A.M. has received consulting fees, speaking fees, and/or honoraria from Abbot, Bristol-Myers Squibb, Servier, Roche, Fidia, Genzyme, Schering-Plough, Wyeth-Lederle and SPA. He is also the President of the National Foundation for Ultrasound-guided Intra-articular hip injection (A.N.T.I.A.G.E.). U.M. and E.B. have received consulting/speaking fees from Sanofi-Aventis and Wyeth-Lederle. P.P. has received funding for consulting/speaking from Sanofi-Aventis. A.B. has no financial or other relationships to declare. B.L. has received consulting fees, speaking fees, and/or honoraria from Bristol-Myers Squibb, Roche, Novartis and Wyeth-Lederle. S.T. has received consulting and speaking fees from Fidia and Genzyme. He is also the Vice President of A.N.T.I.A.G.E.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgements

The authors would like to thank Lacer Predalkaj, Roberto Taschini and Marco Mei for data collection; study nursing staff Eleonora Venier and Barbara Moriconi; Francesca Vacca MD, Maria Luisa Diaco MD, Cristiano Padalino MD and Marco Canzoni MD who assisted with the study follow-up.

Notes

* Synvisc is a registered trade name of Genzyme Corporation, Cambridge, MA, USA.