ANTIAGE

Our innovative technique allows us to perform in the hip the same therapies carried out in the rheumatic diseases of the knee where steroids and hyaluronic acids are used. Hyaluronic acid is a viscous elastic substance which has the capacity of softening shocks to the joints, nourishing cartilage and preventing friction between articular surfaces.

When speaking with patients we compare the action of hyaluronic acid to the grease action of oil inside a car engine. This technique is often used in the knee but seldom in the hip because of the difficulty of reaching this joint with precision without the help of an imaging guide. Before the ultrasound guided “Migliore-Tormenta” technique it was only possible to inject the hip using TC or fluoroscopic guidance but these techniques were more complicated to apply and exposed patients to radiation. On the contrary, with this technique the intra-articular injection is now easier to perform, is safer, costs less and does not expose patients to radiation.

Ultrasound guided intra-articular hip injection are performed with a different technique in a few other European Centres (prof Bliddal and co. in Copenaghen use an anterior-inferior approach and Dr. Gerber in Zuric who applies the technique without a biopsy device). In France, USA and Mexico there are few teams which continue injecting using a fluoroscopic guidance.

This technique is useful in the initial and intermediate stage of hip osteoarthritis. In later stages a surgical intervention is necessary.

In our experience we noticed a reduction of pain and an improvement of motor and articular function. Patients improved in performing common daily activities, such as standing up, getting in and out of a car, standing, cutting toenails, putting on one’s socks and walking. There was an important reduction in the use of the anti-inflammatory drugs generally used to reduce pain, with a subsequent reduction in side effects and health care spending.

We performed 1500 intra-articular hip injections on 900 patients with good results which are being published in several scientific journals and presented during national and international scientific meetings. Our case record is one of the larger ones in the world.

What are the costs for the patient?

None; the technique is usually performed under a day hospital arrangement, however patients living outside Rome are given the opportunity of staying in hospital overnight. At the beginning the patient is examined in an outpatients’ clinic to evaluate his/her symptoms and hip x-rays.

Generally one or two intra-articular injections are performed every six months and sometimes the improvement lasts for eight to twelve months. Unfortunately 10% of the patients don’t respond to the treatment and we are studying the causes of these unusual occurrences.

Patients report no pain during injections so we do not use local anaesthetic. We have never observed significant side effects. A Doppler device is included in the ultrasound guidance to avoid injecting into blood vessels. With the appropriate disinfection measures we have never had infections. The rare transient haematomas in the injection sites never had long-term sequels. 10% of the patients reported a feeling of heaviness in the injected joint which lasted a few days. This sensation is normal and depends on the time the acid, tick and viscous, takes to spread into the joint after the injection. Therefore the only two contraindications for this treatment are infections in the site of the injection or the risk of haemorrhage in patients being treated with anticoagulants like dicumarols.

In conclusion an easy, safe, economic treatment which doesn’t interfere with the possibility of eventual surgical procedures.

Information for Patients