Hip osteoarthritis (OA) is a progressive joint disease that affects millions of people worldwide, causing pain, stiffness, and reduced mobility. As treatment options continue to evolve, viscosupplementation injections, or hyaluronic acid (HA) injections, into the joint—have gained attention as a potential therapy. But what does the evidence say about their effectiveness for hip OA?
What are Viscosupplementation Injections?
Viscosupplementation involves injecting hyaluronic acid, a naturally occurring component of joint fluid, directly into the affected joint. Hyaluronic acid acts as a lubricant and shock absorber, with the goal of improving joint function and reducing pain. This approach is more commonly used in knee OA, but its use in hip OA has been explored as well.
The Evidence: Do Hyaluronic Acid Injections Help with Hip OA?
Research on viscosupplementation for hip OA has produced mixed results. While some studies suggest a potential benefit, others indicate minimal or no significant improvement compared to placebo or other treatments.
- Potential Benefits: Some clinical trials and observational studies report that hyaluronic acid injections can provide modest pain relief and functional improvement, particularly in patients with mild to moderate hip OA.
- What does the literature on hyaluronic acid injections for hip osteoarthritis show?
- The clinical trial data on viscosupplementation for hip osteoarthritis presents a mixed picture.
- Negative Studies:
- A systematic review and meta-analysis by Leite et al. (2018) concluded that there is very low evidence that hyaluronic acid (HA) is not
superior to placebo for pain relief at 3 months and high evidence that it is not superior in terms of adverse events. This study included eight randomized controlled trials (RCTs) with 807 participants and found no significant difference between hyaluronic acid and placebo, platelet-rich plasma (PRP), or methylprednisolone in terms of pain relief and adverse events [Leite et al, 2018].
- Similarly, Liao et al. (2019) performed a meta-analysis of five high-quality RCTs with 591 patients and found that intra-articular viscosupplementation did not significantly reduce pain or improve function better than placebo at any time point [Liao et al, 2019].
- Branderet al. (2019) in a large multicenter RCT found no significant difference between a single 6-mL injection of hylan G-F 20 and saline in terms of pain and function improvement over 26 weeks [Branderet al, 2019].
- Positive Studies:
- Zhu et al. (2024) conducted a systematic review and found weak evidence suggesting that viscosupplementation improves patient-reported pain and function at various time points compared to baseline. However, the high heterogeneity and low level of evidence limit the strength of these conclusions [Zhu et al, 2024].
- Wu et al. (2017) also conducted a meta-analysis and found that while intra-articular HA can significantly reduce pain and improve functional
recovery compared to baseline, there was no significant difference between HA and saline or other treatments [Wu et al, 2017].
- In
a real-world setting, De Lucia et al. observed that repeated courses of
viscosupplementation provided significant pain relief and functional
improvement over 12 and 24 months, suggesting an additive effect with
repeated administrations [De Lucia et al, 2019].
- Comparisons to Other Treatments: Some studies have compared hyaluronic acid injections to corticosteroids, a more commonly used intra-articular injection for OA. Research suggests that corticosteroids may provide quicker, but shorter-lived pain relief, whereas hyaluronic acid injections may offer more prolonged effects in some patients.
- Studies comparing platelet-rich plasma (PRP) and viscosupplementation (hyaluronic acid, HA) for hip osteoarthritis (OA) have shown mixed results, with some evidence suggesting that PRP may offer superior or comparable benefits to hyaluronic acid in the management of hip OA, particularly in terms of longer-lasting pain relief and functional improvement.
- A randomized clinical trial by Nouri et al. found that both PRP and hyaluronic acid improved pain and function in patients with hip OA, but the effects of PRP and the combination of PRP+HA lasted longer and were superior to HA alone at 6 months [Nouri et al, 2022].
- Similarly, Dallari et al. reported that PRP provided significant clinical improvement in pain and function up to 12 months, outperforming hyaluronic acid and the combination of PRP+HA at various follow-up points [Dallari et al, 2016].
- A systematic review and meta-analysis by Belk et al. concluded that PRP and HA yielded similarly beneficial short-term clinical outcomes, with
no significant short-term differences in pain and function scores between the two treatments [Belk et al, 2022].
- Another meta-analysis by Ye et al. indicated that PRP was associated with a significant reduction in pain at 2 months compared to HA, but no significant differences were observed at 6 and 12 months [Ye et al, 2018].
What do society guidelines recommend?
Despite studies indicate potential short-term benefit with viscosupplementation injections, society guidelines emphasize that the lack of efficacy and recommendation against the use of hyaluronic acid injections for hip OA.
- The
American Academy of Orthopaedic Surgeons (AAOS) recommends
against the use of intra-articular hyaluronic acid injections for the
treatment of symptomatic osteoarthritis (OA) of the hip.
This recommendation is based on evidence indicating that these
injections do not improve function or reduce pain better than placebo [Hannon et al, 2024].
- Similarly,
the American College of Rheumatology (ACR) and the Arthritis Foundation
also strongly recommend against the use of hyaluronic acid injections
for hip OA.
Their guideline highlights that the best available evidence fails to
demonstrate a benefit of these injections over placebo, and there may be
associated harms [Kolasinski et al, 2020].
Considerations and Limitations
- Technique Challenges: Hip injections should be performed using image guidance. The hip joint is deep and harder to access, requiring ultrasound or fluoroscopy image guidance for accurate injection placement.
- Cost and Accessibility: HA injections for hip osteoarthritis is not covered by insurance. Given the inconsistent evidence, some practitioners hesitate to recommend them routinely.
- Variability in Response: Some patients experience significant relief, while others notice little to no improvement. Factors such as disease severity, individual joint mechanics, and response to previous treatments may play a role in the efficacy of hyaluronic acid injection.
Should You Consider Hyaluronic Acid Injections for Hip OA?
While hyaluronic acid injections are generally safe and may offer pain relief for some individuals, they are not a guaranteed solution. Patients should weigh the potential benefits against the cost and available alternatives. Non-invasive approaches like physical therapy, weight management, and pain medications should be prioritized, with injections considered as an adjunct therapy.
Conclusion
The evidence for viscosupplementation in hip osteoarthritis remains inconclusive. Some patients may experience benefits, but the overall effectiveness appears limited compared to other treatment modalities. Those considering hyaluronic acid injections should discuss the potential risks and benefits with their healthcare provider to determine the best course of action for their specific condition.
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