APM&R
March 2018 Volume 99, Issue 3, Pages 574–583.e1
Victor Figueiredo Leite, MD
Abstract
Objective
To assess the efficacy of viscosupplementation (hyaluronic acid [HA]) on the pain and disability caused by hip osteoarthritis, and to determine the occurrence of adverse events.
Data Sources
PubMed, EMBASE, Cochrane Library, ClinicalTrials.gov database, and specific journals up to March 2017.
Study Selection
Randomized controlled trials (RCTs) comparing HA with any other intra-articular injection.
Data Extraction
Performed according to Cochrane/Grades of Recommendation, Assessment, Development, and Evaluation criteria. Two authors extracted data and assessed the risk of bias and quality of evidence. A random-effects meta-analysis was conducted.
Data Synthesis
Eight RCTs were retrieved (n=807): 4 comparing HA to placebo; 3 to platelet-rich plasma (PRP); 3 to methylprednisolone; and 1 to mepivacaine. Some RCTs had 3 arms. There is very low evidence that HA is not superior to placebo for pain at 3 months (standardized mean difference [SMD]=−.06; 95% CI, −.38 to .25; P=.69), and high evidence that it is not superior in adverse events (risk ratio [RR]=1.21; 95% CI, .79–1.86; P=.38). There is low evidence that HA is not superior to PRP for pain at 1 month. There is very low evidence that HA is not superior to PRP for pain at 6 and 12 months (mean difference in visual analog scale [in cm]: −.05 [95% CI, −.81 to .71], 1.0 [95% CI, −1.5 to 3.50], and .81 [95% CI, −1.11 to 2.73], respectively). There is high evidence that HA is no different from methylprednisolone for pain at 1 month (SMD=.02; 95% CI, −.18 to .22; P=.85). There is low evidence that HA is no different from methylprednisolone for Outcome Measures in Rheumatoid Arthritis Clinical Trials–Osteoarthritis Research Society International Responders Index at 1 month (RR=.44; 95% CI, .10–1.95; P=.28). There is high evidence that HA is no different from methylprednisolone for adverse events (RR=1.21; 95% CI, .79–1.87; P=.38).
Conclusions
We do not recommend viscosupplementation for hip osteoarthritis. Compared with placebo, data show scarce evidence of its efficacy up to 3 months, and suggest no difference at 6 months. However, future RCTs could present HA as an alternative to methylprednisolone for short-term symptom relief.