Effect of hyaluronic acid in symptomatic hip osteoarthritis: A multicenter, randomized, placebo‐controlled trial

Abstract

Objective. To evaluate the efficacy and tolerability of a single intraarticular (IA) injection of hyaluronic acid (HA) for the treatment of hip osteoarthritis (OA).Methods. A multicenter, randomized, parallelgroup, placebo-controlled trial was conducted over 3 months. Patients (older than 30 years) with symptomatic hip OA (pain score of >40 mm on a visual analog scale [VAS]) and a Kellgren/Lawrence grade of 2 or 3 were randomly assigned to receive 1 fluoroscopically guided IA injection of HA (2.5 ml) or placebo (2.5 ml). Patients were followed up for 3 months. The main outcome measure was pain score on a VAS (100 mm) at month 3 compared with baseline. Secondary outcome measures were the proportion of responders defined by Osteoarthritis Research Society International criteria; Western Ontario and McMaster Universities Osteoarthritis Index subscores for pain, stiffness, and disability; and patient and physician global assessment. Randomization was computer generated. HA and placebo preparations were placed in numbered identical containers, and syringes were covered with masking tape. Physicians assessing outcomes were blinded with regard to group assignment.Results. Eighty-five patients were randomized to the HA group (n ‫؍‬ 42) or placebo group (n ‫؍‬ 43). Baseline characteristics were similar between the 2 groups. At 3 months, the decrease in pain score did not differ between the HA and placebo groups in the intentto-treat analysis (mean ؎ SD decrease 7.8 ؎ 24.9 mm with HA versus 9.1 ؎ 27.4 mm with placebo; P ‫؍‬ 0.98). The responder rates were 33.3% and 32.6% in the HA and placebo groups, respectively (P ‫؍‬ 0.94). Other secondary end points did not differ between the groups, nor did use of rescue medication or frequency of adverse events.Conclusion. Our findings indicate that a single IA injection of HA is no more effective than placebo in treating the symptoms of hip OA.Osteoarthritis (OA) is the most common type of arthritis and the major cause of disability in elderly populations worldwide. Hip OA is the second most frequent form of OA affecting a large joint, and its prevalence ranges from 3% to 11% in populations older than 35 years (1-3).Current therapies for hip OA include a combination of nonpharmacologic and pharmacologic treatments (4-6). Viscosupplementation is an intraarticular (IA) therapeutic modality that is based on the physiologic importance of hyaluronic acid (HA) in synovial ClinicalTrials.gov identifier: NCT00330135.

The role of intra-articular hyaluronan (Sinovial®) in the treatment of osteoarthritis

“…One study showed no significant difference between HA (3 injections), saline and corticosteroid use at 3-month follow-up, despite some level of clinical benefit with corticosteroid and HA use [59]. Findings from an uncontrolled study by Conrozier et al [60] suggested that a single injection of HA was efficacious in hip OA; however, a recent, randomised, placebo-controlled trial in 85 patients showed no significant difference between placebo and a single intra-articular injection of HA for reduction in pain at 3-month follow-up [61]. Clearly, large well-controlled trials of HA in hip OA are warranted.…”

Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis

“…If compared to placebo, it is not clear whether HA is more effective in the treatment of hip OA. Richette et al 24 performed a single injection of HA or placebo. VAS and WOMAC were evaluated after 3 months and compared to baseline.…”

Interventional MSK procedures: the hip

“…Intra-articular injection of hyaluronic acid is still controversial in the management of hip osteoarthritis (OA), as its efficacy has not been clearly established. 3,[5][6][7][8][9] More recently, intra-articular injections of platelet-rich plasma (PRP) have been proposed but presently there is a paucity of data supporting its wide use in clinical practice.…”