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. 2020 Jan;11(1):47-59.
doi: 10.1177/1947603518783455. Epub 2018 Jun 21.

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

Thierry Conrozier  1 , Jordi Monfort  2 , Xavier Chevalier  3 , Raghu Raman  4 , Pascal Richette  5 , Demirhan Diraçoglù  6 , Hervé Bard  7 , Dominique Baron  8 , Jörg Jerosch  9 , Alberto Migliore  10 , Yves Henrotin  11
Affiliations

EUROVISCO Recommendations for Optimizing the Clinical Results of Viscosupplementation in Osteoarthritis

Thierry Conrozier et al. Cartilage. 2020 Jan.

Abstract

Objectives: The 3 aims of the work were to identify population subgroups that can benefit the most from viscosupplementation (VS), to provide recommendations on injection techniques, and to discuss VS appropriateness in clinical situations that are commonplace in daily practice.

Methods: The task force members voted on their degree of agreement on 27 statements, 36 recommendations, and 22 clinical scenarios using a 9-point scale. The strength of agreement/appropriateness/recommendation (SOA/SOR) was classified as strong if the median agreement score was ≥8. The level of consensus (LOC) was also obtained.

Results: Among the assumed predictors for VS failure, obesity, radiographic severity, large synovial fluid effusion, severe patellofemoral involvement, major malalignment, and gross joint instability received a large majority of agreements. The lateral mid-patellar approach was recommended for knee injection. Imaging guidance was unanimously recommended for hip and ankle. Agreement was achieved to strictly respect the dosing regimen proven by controlled trials. There was agreement for treating with VS patients with mild to moderate knee and hip OA, with normal weight or moderate overweight, insufficiently improved by first-line therapies, or who do not wish get oral treatment or who have contraindications to pain killers. The group considered the patient's wishes as a key element in therapeutic decision making.

Conclusion: Based on literature data and clinical experience, the EUROVISCO group proposed a set of recommendations for optimizing the results of VS, aimed to help practitioners, especially in some cases in which the patients' specificities make the therapeutic decision difficult.

Keywords: ankle; appropriateness; hip; hyaluronic acid; intraarticular injection; knee; osteoarthritis; recommendations; trapeziometacarpal; viscosupplementation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Yves Henrotin: Received honorarium from Menarini, Flexion Therapeutics, IBSA, BioIberica, Expansciences, Royal Canin, MagPharm, Pfizer, Fidia and LABRHA and Tilman SA for consultant services. Founder and shareholder of KIOmed pharma. Founder and shareholder of Artialis SA. Raghu Raman: Received honorarium from Sanofi and LABRHA for consultant services. Pascal Richette: Received fees from BioIbérica, Fidia, IBSA, Expanscience, Genévrier, Sanofi, Rottapharm, Servier, Flexion Therapics, and Ménarini. Hervé Bard: Received speaker and expert fees from Sanofi, Rottapharm-Madaus, Pfizer, Labrha, Expanscience, TRB Chemedica. Jörg Jerosch: Received honorarium from Sanofi for speaker services. Thierry Conrozier: Received honorarium from Genevrier, Sanofi, Aptissen Bioventus, and LABRHA for expert and consultant services. Xavier Chevalier: Received fees as a Genevrier Board member, Sanofi-Aventis expert, member of the IBSA foundation, speaker in IBSA meetings, Moebius and Flexion Therapics consultant. Alberto Migliore: Received consulting fees from Abbvie, BMS, MSD, Fidia, Sanofi, IBSA, Pfizer and LABRHA for national and international studies and courses. Jordy Monfort: Received consulting fees from Sanofi and Bioiberica. Dominique Baron: Received speaker fees from LCA and Expansciences.

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