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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 10, 2017
Footnotes
International Prospective Register of Systematic Reviews (PROSPERO) Database Identification No.: CRD42015017312.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
