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Viscosupplementation for Hip Osteoarthritis: A Systematic Review and Meta-Analysis of the Efficacy on Pain and Disability, and the Occurrence of Adverse Events

Published:August 10, 2017DOI:https://doi.org/10.1016/j.apmr.2017.07.010

      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.

      Keywords

      List of abbreviations:

      AE (adverse event), CI (confidence interval), HA (hyaluronic acid), KLG (Kellgren-Lawrence grade), OMERACT-OARSI (Outcome Measures in Rheumatoid Arthritis Clinical Trials–Osteoarthritis Research Society International), PRP (platelet-rich plasma), RCT (randomized controlled trial), RR (risk ratio), SMD (standardized mean difference), VAS (visual analog scale)
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