PRP injection for early hip OA reduced the risk of surgical intervention vs hyaluronic acid

Issue: August 2019

Matthew J. Kraeutler

Patients with early hip osteoarthritis underwent total hip arthroplasty or hip resurfacing at a significantly lower rate after treatment with platelet-rich plasma injections compared with hyaluronic acid, according to results presented at the Arthroscopy Association of North America Annual Meeting.

Perspective from Christopher M. Larson, MD

Matthew J. Kraeutler, MD, and colleagues randomly assigned 32 hips with early OA in 30 patients to receive treatment with either PRP or hyaluronic acid. Researchers collected WOMAC scores and assessed patient-reported outcomes and hip range of motion at baseline and at 6 weeks, 3 months and 6 months after injection.

“In terms of survivorship, significantly more patients who received hyaluronic acid injections withdrew to undergo either total hip arthroplasty or a hip resurfacing procedure compared to patients in the PRP group, 50% vs. 11%,” Kraeutler said in his presentation here.

He added that patients in the PRP group had significant improvements in WOMAC joint, function and overall scores from baseline to 6 weeks. WOMAC joint scores also significantly improved from baseline to 6 months in the PRP group, Kraeutler noted.

“Overall, the PRP [group] demonstrated greater improvement in most of these subscores, but this was not always statistically significant due to a relatively low sample size,” Kraeutler said.

He also noted there were no significant improvements in any of the subscores at any time point in the hyaluronic acid group.

“Finally, looking at range of motion in terms of hip internal rotation, the PRP group demonstrated significantly greater improvement from baseline to 6 months compared to the hyaluronic acid group,” Kraeutler said. “The [hyaluronic acid] HA group actually showed a decline in this outcome from baseline to 6 months.” – by Casey Tingle

Reference:

Kraeutler MJ, et al. A double-blind, randomized controlled trial comparing platelet-rich plasma vs. hyaluronic acid for early osteoarthritis of the hip joint. Presented at: Arthroscopy Association of North America Annual Meeting; May 2-4, 2019; Orlando.

Disclosure: Kraeutler reports no relevant financial disclosures.

Perspective

Christopher M. Larson, MD

Kraeutler and colleagues found better survivorship (50% vs. 11%) with PRP injections compared to HA injections in the setting of hip OA, a comparison that was studied in knee and hip OA with variable results and conclusions. A meta-analysis of randomized trials for knee OA showed better results with PRP vs. HA at 12-month follow-up. Limited studies regarding hip OA have reported conflicting results regarding PRP and HA. In the future, the authors might consider a crossover option to PRP after HA failure to see if PRP was more effective in these patients. It is important whether patients in the groups were well-matched regarding the degree of degenerative changes, as well as quality and severity of symptoms pre-injection. Although greater range of motion improvement occurred in the PRP group, the authors might identify whether range of motion was predictive of outcomes between and within groups. Ultimately, greater numbers, longer follow-up and determination of the optimal PRP and HA preparations are required to better define the efficacy for these injections in the setting of hip OA.

References:
Battaglia M, et al. Orthopedics. 2013;doi:10.3928/01477447-20131120-13.
Dallari D, et al. Am J Sports Med. 2016;doi:10.1177/0363546515620383.
Di Sante L, et al. Med Ultrason. 2016;doi:10.11152/mu-874.
Han Y, et al. Pain Med. 2019;doi:10.1093/pm/pnz011.

Christopher M. Larson, MD

Orthopedics Today Editorial Board Member

Disclosures: Larson reports no relevant financial disclosures.