Comparing Intra-articular Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Low-Molecular Weight Hyaluronic Acid for the Treatment of Symptomatic Osteoarthritis of the Hip: A Double-Blind, Randomized Pilot Study

Matthew J Kraeutler, Darby A Houck, Tigran Garabekyan, Shannon L Miller, Jason L Dragoo, Omer Mei-Dan, Matthew J Kraeutler, Darby A Houck, Tigran Garabekyan, Shannon L Miller, Jason L Dragoo, Omer Mei-Dan

Abstract

Background: Hyaluronic acid (HA) and leukocyte-poor platelet-rich plasma (LP-PRP) are 2 nonoperative treatment options that have been studied in patients with hip osteoarthritis (OA).

Purpose: To compare the efficacy of intra-articular injections of low-molecular weight (LMW) HA and LP-PRP in patients with hip OA.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 34 patients (36 hips) presenting with signs of hip OA were randomized to receive 3 blinded, weekly intra-articular injections of either LP-PRP or LMW-HA. Patients were prospectively evaluated before injections and at 6 weeks and then at 3, 6, 12, and 24 months. The primary outcome, conversion to total hip arthroplasty (THA) or a hip resurfacing procedure, was analyzed along with secondary outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and hip range of motion.

Results: The final analysis included 33 hips (mean Kellgren-Lawrence grade, 2.73) (LMW-HA: n = 14; LP-PRP: n = 19) in 31 patients (18 male; mean age, 53.8 years). Significantly more patients converted to THA or a hip resurfacing procedure in the LMW-HA group (7/14; 50.0%) (mean, 1.3 years after first injection) than the LP-PRP group (3/19; 15.8%) (mean, 0.73 years after first injection) (P = .035). There was no significant improvement or decline in any outcome scores within the LMW-HA group from before injections to 6 weeks or 3, 6, and 12 months. For the LP-PRP group, WOMAC overall (P = .032), joint (P = .030), and function scores (P = .025) significantly improved from before injections to 6 weeks, and WOMAC joint scores significantly improved from before injections to 6 months (P = .036). When comparing the difference between groups in internal rotation at 90° of hip flexion from before injections to 6 months, the LP-PRP group demonstrated a mean 5.0° improvement, while the LMW-HA group showed a mean 1.5° decrease (P = .028).

Conclusion: Intra-articular hip injections of LP-PRP in patients with hip OA resulted in an improvement in WOMAC scores and hip internal rotation at 6 months and delayed the need for THA or a hip resurfacing procedure compared with treatment with LMW-HA. A longer follow-up is necessary to further compare the effects of LP-PRP and LMW-HA injections in patients with hip OA.

Registration: NCT01920152 (ClinicalTrials.gov identifier).

Keywords: hip; hyaluronic acid; intra-articular injection; osteoarthritis; platelet-rich plasma.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by BTI Biotechnology Institute and Bioventus (distributor of Supartz); BTI Biotechnology Institute donated the platelet-rich plasma kits, and Bioventus donated hyaluronic acid for the study. T.G. has received consulting fees from Stryker and hospitality payments from Smith & Nephew. J.L.D. has received research support from Conmed Linvatec, Ossur, RTI Surgical, Terumo BCT, and Zimmer; consulting fees from Arthrex, Becton Dickinson, Biomet, Bioventus, Breg, Conmed Linvatec, DePuy, DJO, Exactech, Flexion Therapeutics, Genzyme, Harvest Technologies, Joint Restoration Foundation, KCRN Research, Moximed, Ossur, RTI Surgical, RNL Bio, Sideline Sports Doc, and Zimmer; speaking fees from Ossur; and other financial support from EmCyte and Harvest Technologies. O.M.-D. has received research support from Stryker, has received educational support from Arthrex, has received consulting fees from Smith & Nephew and Stryker, has received nonconsulting fees from Smith & Nephew, has received royalties from Stryker, and has stock/stock options in MITA. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. Sample sizes (n) refer to the number of hips included at each stage. HA, hyaluronic acid; NSAID, nonsteroidal anti-inflammatory drug; PRP, platelet-rich plasma; THA, total hip arthroplasty.
Figure 2.
Figure 2.
Survivorship of treatment groups. HA, hyaluronic acid; PRP, platelet-rich plasma.

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