Session Type: Abstract Submissions (ACR)
Background/Purpose: Painful syndrome of the mayor trochanter(MTPS).The treatment includes intra-bursal injections with corticosteroids.Steroids.Estimate the efficacy of the treatment with hyaluronic acid injections in comparison to injections with triamcinolone acetonide in a follow up time of 1,3 and 6 months.
Methods: Random double blind clinical study. The patients were recruited of the consult injection clinic of the rheumatic diseases.Inclusion:MTPS confirmed by physical exam/ Pain that persist at least 1 month in spite of treatment/Fulfillment of the informed content. Exclusion: coxo-femoral intra-articular pathology. The more symptomatic side was evaluated. First group intrabursal injection 40 mg of triamcinolone acetonide.Second group intra-bursal injection 60 mg of hyaluronic acid depot.Technique: spinal syringe 22 g in a maximal pain point.Non steroidal anti-inflammatory was not permitted and paracetamol was permitted.Variables: Analog visual scale espontaneous pain and pain upon palpation at baseline,1,3 and 6 months. Likert scale of interference of pain in activities at baseline, Likert scale of pain resolution and treatment satisfaction at baseline, 1, 3 and 6 months. Statistical Analysis age, pain VAS palpation: average and standard deviation. Sex and Likert scales: frequency and percentage.Chi-square/fisher exact test: category variables.T student test for independent data.To analyze the progression in the VAS:ANOVA. A non-inferiority analysis:treatment with hyaluronic acid is non inferior that the treatment with triamcinolone acetonide. SPSS 18
Results: 52 patients, 2 arms: 4 lost in the triamcinolone acetonide group. 1 lost in the group with hyaluronic acid.Final sample 22pts triamcinolone acetonide group, 25 hyaluronic acid group. F/M:87.2 /12.8%. VAS on palpation (was less than one point and considered irrelevant) in any case better results (barely) in the group with hyaluronic acid than in the group with triamcinolone acetonide. No statistically significant differences in the interference of pain in the activities at baseline. Analysis of the variance: the progression of spontaneous pain VAS 1, 3 and 6 for the group effect P=0,756,The interaction effect P=0,433.Time effect P<0,001( both therapies reduce pain). Analysis of the progression of pain to VAS palpation.The group effect P=0,241.The interaction effect P=0,639.Time effect P<0,001(Both therapies reduce pain).Non-inferiority analysis: The treatment with hyaluronic acid is non inferior to the treatment with triamcinolone acetonide. No secondary adverse effect.
Conclusion: MTPS treatment with hyaluronic acid injections is not inferior to the treatment with triamcinolone acetonide injections at 6 month.In specific cases like in diabetic patients or where corticosteroid have been unsuccessful or are contraindicated, hyaluronic acid injections is a therapeutic alternative .
A. Acosta Sr.,
A. Rodriguez de la Serna,
G. Sterba Sr.,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mayor-trocanter-painful-syndrome-treatment-with-hyaluronic-acid-versus-triamcinolone-acetonide-injections-a-comparative-study/