Viscosupplementation with HANOX-M-XL (HAppyCross®) is effective in moderate hip osteoarthritis but is not an alternative to hip joint surgery in patients with severe disease. Results of a “real life” clinical survey in 191 patients. T.Conrozier; M. Bossert; A. Walliser-Lohse; M. Sondag; JC Balblanc. Eur J Musculoskeletal Dis. 2015; 2:49-55.

The aim of the large scale survey (191 patients), was to evaluate the efficacy of a single intra-articular injection of hyaluronic acid  in patients with hip osteoarthritis, carried out under fluoroscopy or ultrasonography in daily practice conditions, with particular focus on patients in whom viscosupplementation was seen as the last resort before total hip replacement.

The main lesson to be drawn from this survey is the very low rate of satisfaction in the group of patients in whom waiting for THR. In contrast, patients who do not consider surgery in the short term had a very high satisfaction rate.



Viscosupplementation with hyaluronic acid (HA) or its derivatives for the symptomatic relief of osteoarthritis (OA) of the hip joint have been studied in open-label and placebo-controlled trials with conflicting results. The objective of this survey was to obtain data from the daily practice on efficacy and safety of HANOX M-XL, a novel viscosupplement made of non-animal cross-linked HA and high concentration of mannitol (HAppyCross®) administered through a single injection regimen in patients suffering from hip OA.

Material and Methods:

Multicenter retrospective clinical survey using a standardized questionnaire in which one hundred ninety one consecutive patients treated with a single intra-articular injection of HANOX M-XL for symptomatic hip OA were included. Demographic data, imaging guidance, pain on a 10 point Likert scale (LS), patient’s self-evaluation of efficacy, satisfaction with the treatment and tolerability were obtained. According to the patient’s own decision, which was taken prior to the injection, patients were classified into two groups: those for which the viscosupplementation was the last resort before total hip arthroplasty (THA group) and those who would not consider surgery in the short term (Non Surgery- NS group).


Tolerability was very good/good in 165 patients (86.4%), moderate in 14 (7.3%) and poor in 12 (6.3%) cases. In the total population, the percentage of patients very satisfied/satisfied and not really satisfied/not satisfied with the treatment was 24.6%, 27.7% and 22.5% and 25.1% respectively. The efficacy was considered as very good/good in 51.8%, moderate in 23.6% and poor in 24.6% of the cases respectively. Efficacy was unrelated to gender, age, and guidance but was highly correlated with pain on LS (p<0.0001). Efficacy was unrelated to gender, age and guidance but was highly correlated with pain on LS (p<0.0001).  Efficacy was significantly different with regard to the clinical severity:  66.6% of the NS group patients were satisfied with the treatment versus only 25% of those belonging to the THA group (p<0.0001). In satisfied patients the decrease of analgesics/NSAIDs consumption was >75% in 60.5% of cases.


These data suggest that despite HANOX M-XL is a safe and efficient intra-articular treatment of hip OA, it is not a valuable alternative to surgery in advanced disease.


Read Full Text


This study was the subject of an oral communication at the 26th Congress of the French Society of Rheumatology in 2013 as well as at the ISIAT Congress in Barcelona in 2013. A poster was also displayed at the OARSI Congress in Paris in 2014.