STRONG RECOMMENDATION Five high quality studies (Nouri 2022, Brander 2019, Qvistgaard 2006, Richette 2009, Atchia 2011) compared intraarticular (IA) hyaluronic acid (HA) with placebo. All five showed no improvement in pain or function with IA hyaluronic acid compared to placebo. Specifically, Nouri (2022), Qvistgaard (2006), and Richette (2009) reported no difference in Western Ontario McMaster Arthritis Index (WOMAC) Total scores at follow up times leading up to and including six months. Pain outcomes reported via WOMAC Pain Scale, Visual Analogue Scale for Pain, and Lequesne Pain Scale showed no difference between HA and placebo at similar follow-up. Brander (2019) reported no significant differences between a variety of adverse event rates between HA and placebo.
Benefits/Harms of Implementation
There are no harms, known or anticipated, associated with implementing this recommendation.
Outcome Importance
Intra-articular injections of the hip may not only improve pain and function of the hip, but also may improve patient activity levels, patient satisfaction, and quality of life.
Cost Effectiveness/Resource Utilization
There is limited comparative data on the cost-effectiveness of intraarticular hyaluronic acid injections of the hip with other nonoperative treatments of osteoarthritis of the hip. Intraarticular injections of the hip are often performed with image guidance, such as ultrasound or fluoroscopy, which increase cost and resource utilization.
Acceptability
This recommendation should be readily implemented as it does not influence a major change in clinical practice. Intraarticular injections of the hip are commonly performed. It provides further evidence to support and guide this clinical practice.
Feasibility
These recommendations do not interfere with other interventions or clinical practice therefore it is deemed very feasible in patients with symptomatic osteoarthritis of the hip.
Future Research
Given the increased cost associated with their use, future cost-effectiveness research is warranted on the use of intraarticular hyaluronic acid injections. There is also a paucity of data on adverse events with their use. Future research would also be beneficial looking at different subgroups of patients based on patient related factors or disease related factors that may benefit from one nonoperative treatment over another.
- Richette, P., Ravaud, P., Conrozier, T., Euller-Ziegler, L., Mazières, B., Maugars, Y., Mulleman, D., Clerson, P., Chevalier, X.. (2009). Effect of hyaluronic acid in symptomatic hip osteoarthritis: a multicenter, randomized, placebo-controlled trial. Arthritis & Rheumatism, 60(3), 824-30.
- Qvistgaard, E., Christensen, R., Torp-Pedersen, S., Bliddal, H.. (2006). Intra-articular treatment of hip osteoarthritis: a randomized trial of hyaluronic acid, corticosteroid, and isotonic saline. Osteoarthritis & Cartilage, 14(2), 163-70.
- Atchia, I., Kane, D., Reed, M. R., Isaacs, J. D., Birrell, F.. (2011). Efficacy of a single ultrasound-guided injection for the treatment of hip osteoarthritis. Annals of the Rheumatic Diseases, 70(1), 110-6.
- Brander, V., Skrepnik, N., Petrella, R. J., Jiang, G. L., Accomando, B., Vardanyan, A.. (2019). Evaluating the use of intra-articular injections as a treatment for painful hip osteoarthritis: a randomized, double-blind, multicenter, parallel-group study comparing a single 6-mL injection of hylan G-F 20 with saline. Osteoarthritis & Cartilage, 27(1), 59-70.
- Nouri, F., Babaee, M., Peydayesh, P., Esmaily, H., Raeissadat, S. A.. (2022). Comparison between the effects of ultrasound guided intra-articular injections of platelet-rich plasma (PRP), high molecular weight hyaluronic acid, and their combination in hip osteoarthritis: a randomized clinical trial. BMC Musculoskeletal Disorders, 23(1), 856.