Strong evidence does not support the use of intraarticular hyaluronic acid because it does not perform better than placebo for function, stiffness, and pain in patients with symptomatic osteoarthritis of the hip.

Rationale

Three high quality studies (Lambert et al, Atchia et al , Qvistgaard et al ) compared IA injection of corticosteroids with placebo and showed statistically significant improvement in pain and function scores. Significant benefits from IA corticosteroid injection were present 3 months (Lambert et al ) and 8 weeks (Atchia et al ) after treatment compared to placebo.

Atchia et al and Qvistgaard et al also compared IA injection of hyaluronic acid (HA) to corticosteroid and placebo in the same aforementioned studies. While these studies demonstrated improved pain and function with IA corticosteroid, they both failed to show significant difference between the performance of HA and placebo. In addition, single IA injection of HA for the treatment of symptomatic (VAS pain score >40mm) moderate hip OA (Kellgren Lawrence grades 2 and 3) failed to demonstrate significant improvement compared to placebo in another high quality study (Richette et al for function, stiffness and pain at 3 months. Other high quality studies investigating HA for the treatment of symptomatic hip OA discovered in this search compared the performance of IA injections of different formulations of HA (Bekerom 2008, Tikiz et al , IA injection of corticosteroids (Spitzer et al), and IA injection of anesthetic (Migliore et al), but did not test against a placebo.

No high quality randomized controlled trials were available comparing the performance of IA injection of stem cells or prolotherapy to placebo. Three studies (Battaglia et al , Dallari et al) compared IA injections of platelet-rich plasma (PRP) versus HA or a combination of PRP and HA. However, no high quality studies comparing PRP with placebo were available for inclusion in our analysis.

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