Effect of Treatment by Hyaluronic Acid (HA) In Hip Osteoartrithis, Executed by Eco Tomografy Guide and Gait Analysis

Osteoarthritis is a multi-factorial factor disease, as obesity, age, genetic factors, metabolic or inflammation diseases. In Italy, five million of patients are suffering from symptomatic forms with pain and reduction of mobility. The treatment lead to pain reduction and in increasing of articular movement, with analgesic, steroidal and non-steroidal drugs, and physiotherapist treatments [1]. Hip osteoarthritis represents 7.7 per cent of OA localization, and is characterized by pain and impaired movement. Intra-articular joint infiltrations of hyaluronic acid (HA), using Eco tomography guide is new possible treatment [2]. The use of HA to restore the biologic properties sinovial fluid in the joint, is known. It was widely used in several forms of OA, as knee [3] or shoulder. In hip osteoarthritis an echographyguide is used to have an optimal control of the needle positioning in the joint [4]. In literature several studied investigate the effect of the treatment on hip OA, but few correlates to gait quality [5]. The Aim The aim of our study evaluated the effect of the treatment with Hyaluronic acid (HA), executed by Eco tomography guide, in patients with hip osteoartrithis, using functionals scale (vas, lequesne index), correlating to quality gait. Methods From January to May we have treated 13 patients with hip osteoarthritis by intra-articular joint infiltrations, of high molecular weight hyaluronic acid, executed by Eco tomography guide. 3 patients dropped out for bad compliance to treatment.


Introduction
Osteoarthritis is a multi-factorial factor disease, as obesity, age, genetic factors, metabolic or inflammation diseases. In Italy, five million of patients are suffering from symptomatic forms with pain and reduction of mobility. The treatment lead to pain reduction and in increasing of articular movement, with analgesic, steroidal and non-steroidal drugs, and physiotherapist treatments [1]. Hip osteoarthritis represents 7.7 per cent of OA localization, and is characterized by pain and impaired movement. Intra-articular joint infiltrations of hyaluronic acid (HA), using Eco tomography guide is new possible treatment [2]. The use of HA to restore the biologic properties sinovial fluid in the joint, is known. It was widely used in several forms of OA, as knee [3] or shoulder. In hip osteoarthritis an echographyguide is used to have an optimal control of the needle positioning in the joint [4]. In literature several studied investigate the effect of the treatment on hip OA, but few correlates to gait quality [5].

The Aim
The aim of our study evaluated the effect of the treatment with Hyaluronic acid (HA), executed by Eco tomography guide, in patients with hip osteoartrithis, using functionals scale (vas, lequesne index), correlating to quality gait.

Methods
From January to May we have treated 13 patients with hip osteoarthritis by intra-articular joint infiltrations, of high molecular weight hyaluronic acid, executed by Eco tomography guide. 3 patients dropped out for bad compliance to treatment.
The characteristics of patients were (   Polymers of hyaluronan can range in size from 5,000 to 20,000,000, for hip injections we used polymers at high molecular weight.
Moreover, in order to correlate the functional effect of treatment to treatment, we have used a gait analysis system called BTS. BTS G-WALK is a wireless system composed by triaxial accelerometer, a magnetic sensor, and a triaxial gyroscope. Positioned on L5 the system provides data of gait analysis as cadence, velocity, single support, and others.
In our study the parameters of gait considered are:  (Table 2), a useful and relatively straight forward grading system for X-rays of the arthritic hip. Their system considers:

Method of Infiltrations
Normally, the intra-articular infiltration is carried out by a blind technique. Hip is a depth joint, and the use of blind technique can present some difficulties. According to literature, we used ecotomografy guide using a linear probe of 7,5-10 Mhz, equipped by a guide support for spinal needle, and guide trace on echography screen, to have an optimal control of needle into the joint (8).

Statistical Analysis
All analyses were performed using statistical program. We used the paired t test in order to compare the data. We have studied the statistical difference at T0, T1 and T2, comparing the evolution of Lequesne Index, V.A.S. and the parameters of gait analysis considered.

Results
All results showed a statistical increase of parameters considered. Lequesne Index showed a mean variation from 7.41 to 2.75, p <0,01 (

Conclusion
Our study confirms the intra-articular joint infiltrations of hyaluronic acid, executed by Eco tomography guide, as a possible treatment to reduce the pain and increase the mobility in patients affected by hip osteoarthritis. Gait analysis can be a new method for evaluation of this patients.