Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis
In this article Danielle Steilen-Matias, MMS, PA-C discusses Hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis.
“My doctor says gel shots”
We get many emails asking about hip pain treatments. In people with osteoarthritis of the hip, the questions usually surround a treatment that will delay or prolong the need for hip replacement surgery. One such treatment is viscosupplementation, commonly referred to as hyaluronic acid injections or “gel shots.”
Gel shots are usually not the first, second, or even third line treatment for hip osteoarthritis. They are usually given when other treatments have failed to alleviate someone’s hip pain. These treatments include the typical conservative care of corticosteroid injections, pain medications and anti-inflammatory medications. In some instances, physical therapy and yoga are recommended for hip pain patients.
In theory, the idea of replacing or supplementing the protective and lubricating fluids of the hip sound like a good idea. So why is it not the first line of treatment for hip osteoarthritis and why do leading research centers suggest that the treatments do not work as well as hoped?
“We do not recommend viscosupplementation for hip osteoarthritis”
Researchers in Brazil publishing in the August 2017 edition of Archives of physical medicine and rehabilitation had this to say about using hyaluronic acid injections for hip osteoarthritis:
- “We do not recommend viscosupplementation for hip osteoarthritis. Compared to placebo, data shows scarce evidence of its efficacy up to 3 months, and suggests no difference at 6 months.”
- BUT, future random control studies could present hyaluronic acid injections as an alternative to methylprednisolone (steroid) for short-term symptom relief.(1)
That recommendation is because the steroid and viscosupplementation both showed the same small benefit of pain relief over the short-term. But if you don’t recommend viscosupplementation, how can you recommend viscosupplementation over steroid? Why not recommend the placebo?
One treatment we do recommend is Platelet Rich Plasma Therapy
- PRP treatment re-introduces your own concentrated blood platelets into your hip
- Your blood platelets contain growth and healing factors. When concentrated through simple centrifuging, your blood plasma becomes “rich” in healing factors, thus the name Platelet RICH plasma. Platelets play a central role in blood clotting and wound/injury healing.
The treatment itself is demonstrated in this video.
In this article, we will limit the discussion of PRP to a direct comparison to viscosupplementation.
Eleven studies compare PRP to hyaluronic acid viscosupplementation
A multi-national team of researchers from Israel, the United States, Italy, and Portugal published their findings in the medical journal Cartilage which suggested beneficial results for PRP Platelet Rich Plasma therapy in the treatment of hip osteoarthritis. In this research 29 medical studies were evaluated. In eleven of them, a comparison was made between PRP and hyaluronic acid injections. The doctors noted that patients treated with PRP showed significantly better results than hyaluronic acid groups.(2)
Doctors in Italy publishing in the American Journal of Sports Medicine also evaluated the effectiveness of intra-articular platelet-rich plasma injections versus hyaluronic acid injections for hip osteoarthritis.
A total of 111 patients were randomly assigned to 3 different study groups and each received 3 weekly injections of either
- PRP (44 patients),
- PRP + Hyaluronic Acid (31 patients),
- or Hyaluronic Acid alone(36 patients).
- At all follow-ups, the PRP group had the lowest pain assessment scores
- Significant improvements were achieved in reducing pain and improving quality of life and functional recovery.
“My doctor says he wants to give me both PRP and Hyaluronic Acid”
The idea is that while PRP rebuilds hip tissue, Hyaluronic Acid will act as a lubricant to help the PRP work better. As the research shows that did not happen.
The conclusion the doctors reached was that their results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip osteoarthritis without relevant side effects.
The benefit was significantly more stable up to 12 months as compared with the other tested treatments. The addition of PRP + Hyaluronic Acid did not lead to a significant improvement in pain symptoms.(3)
In another study in the medical journal Orthopedics, doctors said both PRP and Hyaluronic acid both worked well for patients with hip osteoarthritis, these researchers however offered a conflicting assessment.
Intra-articular injections of platelet-rich plasma and hyaluronic acid represent effective medical treatments for osteoarthritis. This study’s goals were to compare the clinical efficacy of platelet-rich plasma and hyaluronic acid at 12-month follow-up in hip osteoarthritis patients
One hundred patients with chronic hip were consecutively enrolled and randomly assigned to 1 of 2 groups:
- group A received PRP and
- group B received hyaluronic acid
- both administered via intra-articular ultrasound-guided injections.
- Patients were evaluated at baseline and after 1, 3, 6, and 12 months
- Despite a slightly progressive worsening between 6- and 12-month follow-up, the final clinical scores remained higher compared with baseline with no significant differences between PRP and hyaluronic acid. Regarding clinical temporal evolution, multivariate analysis showed that HHS was not influenced by the type of infiltration, patient age, sex, body mass index, or degree of OA, whereas a significant association was detected between
The conclusion these researchers reached was: Intra-articular injections of PRP are effective in terms of functional improvement and pain reduction but are not superior to hyaluronic acid in patients with symptomatic hip osteoarthritis at 12-month follow-up.(4)
While these studies show good results, we find more effective results can be achieved by treating the whole hip joint and surrounding ligaments and tendons to stabilize hip instability. Please read our article Treating Degenerative Hip Disease
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Do you have a question about hip osteoarthritis? Get help and information from our Caring Medical staff
1 Leite VF, Amadera JE, Buehler AM. Viscosupplementation for hip osteoarthritis: a systematic review and meta-analysis of the efficacy for pain, disability and adverse events. Archives of Physical Medicine and Rehabilitation. 2017 Aug 11. [Google Scholar]
2 Laver L, Marom N, Dnyanesh L, Mei-Dan O, Espregueira-Mendes J, Gobbi A. PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies. Cartilage. 2016 Sep 1:1947603516670709.[Google Scholar]
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4 Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics. 2013 Dec;36(12):e1501-8. [Google Scholar]