Vladimir V. Senatorov, Ramon Cuevas-Trisan, Francisco J. Garcia, Gabriel P. Suciu, Robert H. Parkes and Alina M. Alonso
Objective: To evaluate the safety and efficacy of Hylan G-F 20 in recalcitrant shoulder and hip osteoarthritisrelated pain and function. Design: Retrospective review of patients undergoing fluoroscopically-guided intra-articular Hylan G-F 20 injections for management of shoulder and hip osteoarthritis-related intractable pain. Age, gender, body mass index, number of co-morbidities, use of opiates, severity, and location of osteoarthritis (OA) were assessed as possible contributing factors to the outcome. Months of pain relief and degree of symptomatic improvement were used to assess clinical outcome. Setting: Metropolitan area Veterans Affairs Medical Center Subjects: 26 adults (undergoing 53 consecutive injections, 31 of hip, 22 of shoulder, performed over a 4 year period) suffering from symptomatic OA who had previously failed conservative management measures, including prior corticosteroid injections. Methods/Results: Injections provided effective pain relief for up to 4 months in approximately half of the patients with a few patients experiencing pain relief during the whole analysis period of 24-30 months. No adverse events were reported. Higher body mass index had a statistically significant association with worse clinical outcome (shorter symptomatic relief and clinical improvement in both joints). Age, race, number of comorbidities, use of opiates, location (hip versus shoulder) and severity of joint disease showed no significant effects on clinical outcomes. Conclusions: In this retrospective review, intra-articular Hylan G-F 20 injections for the symptomatic management of hip and shoulder osteoarthritis-associated intractable pain appear to be safe; better efficacy was observed in lean individuals (particularly interesting for the non-weight-bearing shoulder joint) regardless of disease.