Abstract
Shoulder osteoarthritis affect about 32% of patients over 60 years. Conservative treatment are recommended to restore shoulder function while shoulder arthroplasty remains the standard treatment for severe osteoarthritis. When conservative therapies fail and surgical approach is precluded, viscosupplementation with HA may be the treatment of choice. Currently, there is minimal information available comparing the results of Hylan G-F 20 and corticosteroid injections for the treatment of shoulder osteoarthritis. Therefore, the purpose of this study was to examine the results of these two treatments at specific time points with validated outcome measurements. Retrospective comparative cohort study. The study population included 84 patients, 51 of whom treated with Hylan G-F 20 and 33 with a corticosteroid. Gleno-humeral osteoarthritis was graded according to Samilson-Prieto classification and rotator cuff was assessed with MRI. Both groups received three injections 1 week apart and were evaluated using a Visual Analog Scale (VAS) for pain and satisfaction, the Shoulder Pain and Disability Index (SPADI) and the Constant-Murley scale. Outcomes were registered at 1, 3, and 6 months. The Hylan G-F 20 group showed a significant pain reduction (P < 0.05), improvement in the Constant-Murley, SPADI scores (P < 0.05), and satisfaction (P < 0.01) at all three follow-up times. Pain, clinical scores, and subjective satisfaction in the corticosteroid group improved in the first post treatment month only (P < 0.05) compared with the baseline. Overall, lower clinical advantages were found in patients with greater degree of osteoarthritis and rotator cuff tears. Intra-articular injections with Hylan G-F 20 are effective in reducing pain for up to 6 months in gleno-humeral osteoarthritis whereas corticosteroids injections resulte in improvement at 1 month only. In patients with severe osteoarthritis and/or full-thickness, RC tears results tended to be worse.
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Lo IKY, Litchfield RB, Griffin S, Faber K, Patterson SD, Kirkley A (2005) Quality-of-life outcome following hemiarthroplasty or total shoulder arthroplasty in patients with osteoarthritis. J Bone Joint Surg Am 87:2178–2185. doi:10.2106/JBJS.D.02198
Cofield RH (1990) Degenerative and arthritic problems of the joint. In: Wood CA Jr, Matsen FA III (eds) The gleno-humeral shoulder. WB Saunders, Philadelphia, pp 678–742
Cooke TD (1986) Immune pathology in polyarticular osteoarthritis. Clin Orthop 213:41–49
Edelson JG (1995) Patterns of degenerative change in the glenohumeral joint. J Bone Joint Surg Br 77-B:288–292
McCarty DJ, Halveron PB, Carrera GF, Brewer BJ, Kozin F (1981) Milwaukee shoulder: association of microspheroids containing hydroxyapatite crystals, active collagenase, and neutral protease with rotator cuff defects. Arthritis Rheum 24:464–491
Neer CS, Craig EV, Fukuda H (1983) Cuff-tear arthropathy. J Bone Joint Surg Am 65-A:1232–1244
Collins DN (1999) Pathophysiology, classification, and pathoanatomy of glenohumeral arthritis and related disorders. In: Iannotti JP, Williams GR Jr (eds) Disorders of the shoulder: diagnosis and management. Lippincott Williams and Wilkins, Philadelphia, pp 421–470
Misamore GW (1997) Management of osteoarthritis of the shoulder. In: Norris TR (ed) Orthopaedic knowledge update: shoulder and elbow. American Academy of Orthopaedic Surgeons, Rosemont, IL, pp 227–240
Williams A (1988) The importance of quality of life in policy decisions. In: Walker SR, Rosser RM (eds) Quality of life: assessment and application. MTP Press, Boston, pp 279–290
Copeland SA (2006) The continuing development of shoulder replacement: “reaching the surface”. J Bone Joint Surg Am 88:900–905. doi:10.2106/JBJS.F.00024
Deshmukh AV, Koris M, Zurakowski D, Thornhill TS (2005) Total shoulder arthroplasty: long-term survivorship, functional outcome, and quality of life. J Shoulder Elbow Surg 14:471–479. doi:10.1016/j.jse.2005.02.009
Merolla G, Paladini P, Campi F, Porcellini G (2008) Efficacy of anatomical prostheses in primary gleno-humeral osteoarthritis. Musculoskelet Surg 91:109–115. doi:10.1007/s12306-007-0019-y
Balasz EA, Denlinger JL (1993) Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol 20(S39):3–9
Altman RD, Moskowitz R (1998) Intraarticular sodium hyaluronate (Hyalgan) in the treatment of patients with osteoarthritis of the knee: a randomized clinical trial. Hyalgan Study Group. J Rheumatol 25:2203–2212
Bagga H, Burkhardt D, Sambrook P et al (2006) Long term effects of intraarticular hyaluronan on synovial fluid in osteoarthritis of the knee. J Rheumatol 33:946–950 PMID: 16652425
Dahlberg L, Lohmander LS, Ryd L (1994) Intraarticular injections of hyaluronan in patients with cartilage abnormalities and knee pain. A one-year double-blind, placebo-controlled study. Arthritis Rheum 37:521–528
George E (1998) Intra-articular hyaluronan treatment for osteoarthritis. Ann Rheum Dis 57:637–640
Huskisson EC and Donnelly S (1999) Hyaluronic acid in the treatment of the osteoarthritis of the knee. Rheumatology (Oxford) 38:602–607
Lohmander LS, Dalen N, Englund G, Hamalainen M, Jensen EM, Karlsson K, Odensten M, Ryd L, Sernbo I, Suomalainen O, Tegnander A (1996) Intra-articular hyaluronan injections in the treatment of osteoarthritis of the knee: a randomised, double-blind, placebo controlled multicentre trial. Hyaluronan Multicentre Trial Group. Ann Rheum Dis 55:424–431
Moreland LW, Arnold WJ, Saway A, Savory C, Sikes D (1993) Efficacy and safety of intraarticular Hylan G-F 20 (Synvisc), a viscoelastic derivative of hyaluronan, in patients with osteoarthritis of the knee. Arthritis Rheum 36:B143
Watterson JR, Esdaile JM (2000) Viscosupplementation: therapeutic mechanisms and clinical potential in osteoarthritis of the knee. J Am Acad Orthop Surg 8:277–284
Wobig M, Dickhut A, Maier R, Vetter G (1998) Viscosupplementation with hylan G-F 20: a 26-week controlled trial of efficacy and safety in the osteoarthritic knee. Clin Ther 20:410–423
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG et al (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352
Smith AM, Barnes SA, Sperling JW, Farrell CM, Cummings JD, Cofield RH (2006) Patient and physician-assessed shoulder function after arthroplasty. J Bone Joint Surg Am 88:508–513. doi:10.2106/JBJS.E.00132
Roach KE, Budiman-Mak E, Songsiridej N, Lertrantanakul Y (1991) Development of a shoulder and pain disability index. Arthritis Care Res 4:143–149
Constant C, Murley A (1987) A clinical method of functional assessment of the shoulder. Clin Orthop 214:160–164
Samilson R, Prieto V (1983) Dislocation arthropathy of the shoulder. J Bone Joint Surg Am 65:456–460
Balich SM, Sheley RC, Brown TR, Sauser DD, Quinn SF (1997) MR imaging of the rotator cuff tendon: interobserver agreement and analysis of interpretive errors. Radiology 204:191–194
Robertson PL, Schweitzer ME, Mitchell DG, Schlesinger F, Epstein RE, Frieman BG et al (1995) Rotator cuff disorders: interobserver and intraobserver variation in diagnosis with MR imaging. Radiology 194:831–835
Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psycol Meas 20:37–46
Ludbrook J (2002) Statistical techniques for comparing measures and methods of measurement: A critical review. Clin Exp Pharmacol Physiol 29:527–536. doi:10.1046/j.1440-1681.2002.03686.x
Noel E, Hardy P, Hagen FW, Laprelle E, Goebel F, Faure C, Favard L, Gaudin P, Christ R, Baudot C, Dieti J, Goupille P (2009) Efficacy and safety of Hylan G-F 20 in shoulder osteoarthritis with an intact rotator cuff. Open-label prospective multicenter study. Joint Bone Spine 76:670–673. doi:10.1016/j.jbspin.2009.10.008
Brander VA, Gomberawalla A, Chambers M, Bowen M, Nuber G (2010) Efficacy and safety of hylan G-F 20 for symptomatic glenohumeral osteoarthritis: a prospective pylot study. PMR 2:259–267
Blaine T, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, Daley M, Altman R (2008) Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, control trial. J Bone Joint Surg Am 90:970–979. doi:10.2106/JBJS.F.01116
Silverstein E, Leger R, Shea KP (2007) The use of intra-articular Hylan G-F 20 in the treatment of symptomatic osteoarthritis of the shoulder: a preliminary study. Am J Sports Med 35:979–985. doi:10.1177/0363546507300256
Itokazu M, Matsunaga T (1995) Clinical evaluation of high-molecular weight sodium hyaluronate for the treatment of patients with periarthritis of the shoulder. Clin Ther 17:946–955
Rovetta G, Monteforte P (1998) Intra-articular injection of sodium hyaluronate plus steroid versus steroid in adhesive capsulitis of the shoulder. Int J Tissue React 20:125–130
Tamai K, Mashitori H, Ohno W, Hamada J, Sakai H, Saotome K (2004) Synovial response to intra-articular injections of hyaluronate in frozen shoulder: a quantitative assessment with dynamic magnetic resonance imaging. J Orthop Sci 9:230–234. doi:10.1007/s00776-004-0766-7
Leardini G, Perbelli A, Franceschini M et al (1988) Intra-articular injections of hylauronic acid in the treatment of the painful shoulder. Clin Ther 10:521–526
Hollander JL, Brown EM Jr, Jessar RA, Udell L, Smukler N, Bowie MA (1954) local anti-rheumatic effectiveness of higher esters and analogues of hydrocortisone. Ann Rheum Dis 13:297–301
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Giovanni Merolla certify that some of the authors received grants by Genzyme Biosurgery srl (Modena, Italy) in support of their research for the preparation of this manuscript.
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IRB (COMETICO Area Vasta Romagna e IRST, Italy) approved the data collection according to AIFA determination (Agenzia Italiana del Farmaco, GU Repubblica Italiana, n.76, 20 marzo 2008) for observational studies. IRB approval was registered with prot. n° 0056704 (582575), 15/10/2009.
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Merolla, G., Sperling, J.W., Paladini, P. et al. Efficacy of Hylan G-F 20 versus 6-methylprednisolone acetate in painful shoulder osteoarthritis: a retrospective controlled trial. Musculoskelet Surg 95, 215–224 (2011). https://doi.org/10.1007/s12306-011-0138-3
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DOI: https://doi.org/10.1007/s12306-011-0138-3