Estudio comparativo entre la infiltración con ácido hialurónico y corticosteroides en la trocanteritis

espanolExisten pocos estudios sobre la eficacia de las inyecciones de acido hialuronico (HA) en la bursitis trocanterica (BP). Objetivo: Comparar la eficacia y seguridad del HA con las inyecciones de corticosteroides para el tratamiento de la BP. Metodos: Este ensayo prospectivo, aleatorizadoy de dos brazos involucro a 47 pacientes con BP unilateral o bilateral. Los pacientes recibieron una inyeccion intrabursal de 40 mg de acetonido de triamcinolona mas 1 ml de lidocaina (grupo 1), o de 60 mg de HA (grupo 2). Los pacientes completaron escalas visuales analogicas (EVA) y escalas tipo Likert para evaluar la interferencia del dolor con la actividad diaria, la recuperacion del dolor y la satisfaccion del tratamiento. Tambien se realizo un analisis de no inferioridad. Resultados: La puntuacion media de la EVA para el dolor disminuyo significativamente comparando los resultados basales con los de 1, 3 y 6 meses despues del tratamiento, en ambos grupos. La puntuacion de la EVA para el dolor a la palpacion tambien disminuyo significativamente en ambos grupos. No se encontraron diferencias significativas en la eficacia entre los grupos. El analisis de las escalas tipo Likert al sexto mes no detecto tampoco diferencias significativas entre los grupos. El analisis de no inferioridad mostro que el tratamiento con HA no era inferior a los corticosteroides. No se describieron efectos adversos. Conclusiones: El tratamiento con HA demuestra ser no inferior a los corticosteroides despues de 6 meses de seguimiento en pacientes con BP. EnglishObjective: To date, there are no studies addressing the efficacy of hyaluronic acid (HA) injections at the trochanteric bursa in patients with greater trochanteric pain syndrome (GTPS). The objective of the study was to compare the efficacy and safety of HA to corticosteroid injections for the treatment of the GTPS. Methods: This prospective, randomized, two-arm trial involved 47 patients with unilateral or bilateral GTPS. Patients received an intra-bursal injection of 40 mg triamcinolone acetonide plus 1mL lidocaine, or of 60 mg HA. Patients completed visual analog scales (VAS) and Likert scales to evaluate interference of pain with daily activity, recovery from pain, and treatment satisfaction. A non-inferiority analysis was also performed. Results: Mean VAS score for pain significantly decreased comparing baseline with 1, 3 and 6 months in both treatment groups. VAS score for pain on palpation was also significantly lower than baseline in both arms. No significant differences were found between groups. Analysis of Likert scales at the sixth month didn’t detect statistically significant differences between treatment groups. The non-inferiority analysis showed that the treatment with HA was non-inferior to corticosteroids. No secondary adverse effects were found among the patients of both groups during the follow-up. Conclusions: The treatment with HA has demonstrated to be non-inferior to corticosteroids after 6 months of follow-up in patients with GTPS. Therefore, the treatment with HA may be considered an effective alternative therapeutic strategy to reduce pain in patients in whom the treatment with corticosteroids, or other therapies, have been unsuccessful or contraindicated.