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Recent data on viscosupplements, analyzed by Dr. Yves Guglielmetti, from the symposium "hyaluronic acid in osteoarthritis: new horizons" Lille 2009.

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Raman Study R et al, The Knee 2008, 15: 1-9

independent, randomized single-center, single-blind, single injector with an independent assessor, comparing the Hylan GF 20 (Synvisc) 3 injections versus a sodium hyaluronate (Hyalgan®) 5injections. 392 gonarthroses evaluated at 3 months, 6 months and 12 months. The results showed clear superiority of Synvisc® both EVA as the WOMAC pain, WOMAC function, the Oxford Knee Scores and scale of quality of life.

Synvisc-One® Study

6 ml intra-articular in symptomatic knee osteoarthritis, led by Professor Xavier Chevalier de l'Hopital Henri Mondor in Cr├ęteil.
European multicenter, randomized, double-blind, placebo against (saline), including 253 patients evaluated 26 weeks on safety and efficacy. The results showed equivalent tolerability of Synvisc-one® to placebo and a few significant efficacy, 160 patients received a second injection at 26 weeks. Pending other more conclusive studies, evaluated over 12 months, I would reserve the mono-injection nomadic patients for whom three injections to 8 days apart is not adapted to their lifestyle.

hyaluronic acid and omo-brachial osteoarthritis (shoulder).

Very few studies have been conducted, only two were selected by Professor Ren├ę -Marc Flipo the University Hospital of Lille, not independent. The study Altman on Hyalgan┬« and the Franco-German study of Synvisc. In the latter, the best results were observed in the group with a single injection than in group 2 injections!

hyaluronic acid and tibiotalar osteoarthritis (ankle).

Very few studies have been conducted with small series and with multiple protocols. A study conducted with Synvisc®, of 55 included patients, with osteoarthritis stage 2 Kellgren Lawrence, has shown efficacy at 6 months in 70% of patients who received a single injection against an efficiency of only 30% of patients received a second injection of 1, 2 or month intervals if pain persists. In the current state of knowledge, an injection can be attempted, its repetition in the lack of results is questionable.

hyaluronic acid and osteoarthritis (hip).

Performed under fluoroscopy or under ultrasound, anterior or lateral approach, hip viscosupplementation was not part of the recommendations of the EULAR 2005 (European League Against Rheumatism) but appears in the recommendations of the OARSI (Osteoarthritis Research Society International). 16 studies were identified, to conclude a good safety and potential efficacy to be confirmed by further studies. A single injection may be sufficient, it could be a temporary solution to the implementation of PTH. The interest in osteoarthritis in young patients without malformation deserves to be studied.

Degradation of hyaluronic acid (HA) by an iodinated contrast agent (DG Mendoza et al., Spain).

iodinated contrast agents can chemically alter the HA molecule. It should be taken into account in clinical studies. Should HA injection is done under radiological identification with contrast or blind with a significant percentage of extra-articular injections? For the hip, echographic identification is it better to guide under fluoroscopy? Regarding the knee, the effectiveness is confirmed by clinical studies without radiological locating the injection site!

Doctor Yves GUGLIELMETTI. - 10 mai 2010.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.


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