title: Efficacy and safety of hylan G-F 20 for symptomatic glenohumeral osteoarthritis: a prospective, pilot study.
abstract: OBJECTIVE
  To determine the safety and efficacy of 2 intra-articular, fluoroscopically guided hylan G-F 20 injections for painful glenohumeral osteoarthritis.
  
  
  METHODS
  This study was a prospective open-label pilot investigation with both U.S. Food and Drug Administration and institutional review board approval.
  
  
  METHODS
  Private, outpatient practice within a tertiary care, university medical school.
  
  
  METHODS
  Thirty-six subjects with moderate to severe glenohumeral osteoarthritis, with pain (visual analog scale [VAS] 40 mm or greater) despite following a 3-month standard, nonsurgical treatment program.
  
  
  METHODS
  Two injections of 2 mL hylan G-F 20, under fluoroscopic guidance confirmed by arthrography, 2 weeks apart. No new treatments were allowed during the course of the study. Analgesics were discontinued 24 hours before visits.
  
  
  METHODS
  Data collected were radiographs; rotator cuff integrity as determined with magnetic resonance imaging; VAS for pain at rest, at night, and with activity; and shoulder-related quality of life (Western Ontario Rotator Cuff Index [WORC]). Subjects were re-evaluated after each injection and at 6 weeks, 3 months, and 6 months. Changes from baseline for VAS and WORC were recorded in Excel and analyzed using SPSS. Intent-to-treat analysis was performed. The type and severity of adverse events were recorded.
  
  
  RESULTS
  Mean VAS at baseline was 63 mm (SD 14.5). Clinically (>or=20% improvement) and statistically significant improvements (P < .001) in VAS pain were seen at 6 weeks, 3 months, and 6 months. Mean improvement in WORC at 6 months was 16.5 (P < .01), with most gains in "lifestyle" and "emotion" questions. Age, gender, body mass index, and rotator cuff pathology did not correlate with response. Three subjects described heightened pain for a few days after injections. Three subjects reported greater pain at 6 months and were unsatisfied. Four experienced no effect of treatment. There were no inflammatory reactions.
  
  
  CONCLUSIONS
  Two hylan G-F 20 injections improved pain and function, and should be considered as part of a multimodal shoulder osteoarthritis treatment program.
authors.affiliation: Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Northwestern Orthopedic Institute,Chicago, IL 60611, USA. victoriabrander@aol.com
authors.forename: Victoria Anne
authors.initials: VA
authors.lastname: Brander
authors.forename: Ameer
authors.initials: A
authors.lastname: Gomberawalla
authors.forename: Michelle
authors.initials: M
authors.lastname: Chambers
authors.forename: Mark
authors.initials: M
authors.lastname: Bowen
authors.forename: Gordon
authors.initials: G
authors.lastname: Nuber
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D010865:Pilot Projects; D011446:Prospective Studies; D012785:Shoulder Joint; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C049816:hylan; D006820:Hyaluronic Acid