The Use of Intra-articular Platelet-Rich Plasma as a Therapeutic Intervention for Hip Osteoarthritis: A Systematic Review and Meta-analysis

Abstract

Background: There is a cohort of patients in whom hip preservation surgery is not indicated, because they have developed signs of early osteoarthritis (OA), and nor can they have a hip replacement, as they are too early in the disease process. Management of this cohort of patients is not standardised and both pharmacological and nonpharmacological measures are utilised to reduce pain. Interventions available for early OA include intra-articular injections of steroids, viscosupplementation and more recently platelet-rich plasma (PRP). However, the use of PRP in hip OA has not yet been studied systematically. Purpose: To assess intra-articular PRP as a therapeutic intervention for hip OA, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects. Study Design: A systematic review and meta-analysis; Level of evidence, 4. Methods: We performed literature searches on the MEDLINE, EMBASE, CINAHL, WEB OF SCIENCE, COCHRANE, and SCOPUS databases, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Data were pooled using random-effects meta-analysis. We assessed the quality of the included studies using the methodological index for non-randomized studies instrument, with an additional assessment for randomized controlled trials with the revised Cochrane risk of bias tool for randomized trials. This is the first study to concisely collate the available data on the use of PRP in hip OA. Results: Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared with the baseline at multiple time points, with the greatest effect at the 1- to 2-month follow-up, but PRP significantly improved function only at the 1- to 2-month follow-up. A significantly larger reduction in pain was achieved with a single injection of PRP compared with multiple injections, a total injected dose of PRP <15 mL compared with ≥15 mL, and use of a leukocyte-poor PRP preparation compared with leukocyte-rich PRP. There were no lasting adverse effects. Conclusion: Low- and moderate-quality evidence suggests that PRP reduces pain and improves function at the end-point follow-up of studies compared with the baseline. Moderate-quality evidence suggests that a larger reduction in pain is achieved with a single injection of PRP compared with multiple injections, and low-quality evidence attributes a larger reduction of pain with a total injected dose of PRP <15 mL compared with ≥15 mL and using leukocyte-poor PRP compared with leukocyte-rich PRP.

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

“… British Journal of Sports Medicine 2021 I Systematic review PRP for degenerative cartilage disease: A systematic review of clinical studies 10 Laver et al. Cartilage 2017 IV Systematic review The use of intra-articular platelet-rich plasma as a therapeutic intervention for hip osteoarthritis: A systematic review and meta-analysis 11 Lim et al. American Journal of Sports Medicine 2022 IV Systematic review Effectiveness of platelet-rich plasma in the management of hip osteoarthritis: A systematic review and meta-analysis 12 Medina-Porqueres 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.…”

“… 17 Moreover, existing trials typically compare PRP with hyaluronic acid (HA), itself an emerging injectable. 11 Studies additionally suffer from bias and heterogeneity, varying in PRP preparation (volume, leukocyte-rich vs -poor, etc. ), follow-up timeline, radiographic grade of osteoarthritis, and outcome measures.…”

Comparing Intra-articular Platelet-Rich Plasma With Hyaluronic Acid for the Treatment of Hip Osteoarthritis: A Systematic Review and Meta-Analysis

“…Intra-articular HA restores the viscoelastic properties of the synovial fluid, leading to a reduction of inflammation and functional improvement [ 30 ]. Intra-articular HA injection has emerged as a therapeutic option for HOA but hasn't been established as a gold standard for treatment [ 31 ]. Intra-articular injection of PRP, an autologous product rich in growth factors stored in platelet granules, stimulates chondrogenesis and reduces HOA catabolism and intra-articular inflammation [ 8 , 32 ].…”

Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell‐based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions—a systematic review

“…Furthermore, reviews that have investigated the usage of orthobiologics in hip disorders have more commonly been focused on hip OA, cartilage procedures, tendinopathies, or osteonecrosis of the femoral head, rather than FAIS in the pre-arthritic hip. [22,24,30,[48][49][50]. Due to the gap in literature regarding the use of orthobiologics in FAIS, an evaluation of their potential benefits can provide an additional treatment modality in managing FAIS.…”