State of art in intra-articular hip injections of different medications for osteoarthritis: a systematic review

Abstract

Background Intra-articular hip injections for osteoarthritis represent a useful instrument to reduce pain and disability in the common clinical practice. Several medications can be injected locally with different level of evidence-based efficacy. Objective The objective of this systematic review is to investigate the effectiveness of intra-articular injections of different medications or substances for the pain treatment and the management of disability in subjects affected by hip osteoarthritis. Methods Two reviewers selected independently randomised controlled trials published in the last 10 years, using PubMed and Scopus databases. The risk of bias was evaluated with Cochrane library assessment tool. Results 12 randomised controlled trials have been selected. We found 8 papers comparing hyaluronic acid with platelet rich plasma, with corticosteroids and with saline solution; 1 paper compares two types of hyaluronic acid with different molecular weights; 3 papers study the effects of corticosteroids alone or compared to ketorolac or saline solution. Conclusions The studies reviewed were heterogeneous regarding sample size, level of osteoarthritis, evaluated with Kellegren-Lawrence score, medications used and follow up timings. However, we have observed that intra-articular injections of platelet-rich plasma seem to decrease pain at short term and disability at long term, in patients affected by hip osteoarthritis better than hyaluronic acid. The association of hyaluronic acid and corticosteroids could give better results compared to hyaluronic acid alone, while the use of intra-articular ketorolac and saline solution requires more studies.

Double-blinded prospective randomized clinical trial in knee joint osteoarthritis treatment: safety assessment and performance of trehalose hyaluronic acid versus standard infiltrative therapy based on medium-weight sodium hyaluronate

“…Our clinical results corroborate those in the literature regarding the effectiveness of hyaluronic acid as a treatment for symptomatic knee OA, as both compounds of hyaluronic acid demonstrated a statistically significant improvement in pain and function from the basal time point 12,13 .…”

Reporting Bias is Highly Prevalent in Systematic Reviews and Meta-analyses of Platelet Rich Plasma Injections for Hip Osteoarthritis

“… Clinical Journal of Sports Medicine 2014 IV Systematic review The effects of platelet-rich plasma injection in knee and hip osteoarthritis: A meta-analysis of randomized controlled trials 6 Dong et al. Clinical Rheumatology 2021 I Systematic review State of art in intra-articular hip injections of different medications for osteoarthritis: A systematic review 7 Ferrara et al. BMC Musculoskeletal Disorders 2021 I Systematic review Preparation methods and clinical outcomes of platelet-rich plasma for intra-articular hip disorders: A systematic review and meta-analysis of randomized clinical trials 8 Garcia et al.…”

“…Intra-articular injection with platelet-rich plasma (PRP) is an emerging non-operative treatment option for hip osteoarthritis (OA), which is estimated to cause symptomatic disease in one in four people by age 85 years. 1 While there have been multiple studies examining the potential of PRP to improve hip pain and function, 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 it is difficult to make conclusions about its efficacy with the available evidence for several important reasons. Although comparisons of placebo (saline solution) with PRP have been made indirectly via network meta-analysis, 9 there are limitations to this type of study.…”

The safety of intraarticular injection prior to total hip arthroplasty: a review

“…7,11,12 A mixture of long-acting local anesthetics with corticosteroids is most commonly used in hip IAIs. [13][14][15][16][17][18][19][20] Triamcinolone acetonide has been reported to have more efficacy with regard to the duration of pain relief in some reports. 21 Some providers may also consider using viscosupplements for the IAI.…”