title: Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study.
abstract: BACKGROUND
  The effectiveness of intra-articular platelet-rich plasma (PRP) injections has been evaluated in knee chondroplasty and osteoarthritis (OA); however, little evidence of its efficacy in hip OA exists.
  
  
  OBJECTIVE
  To compare the therapeutic efficacy of autologous PRP, hyaluronic acid (HA), or a combination of both (PRP+HA) in hip OA.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 1.
  
  
  METHODS
  Patients aged between 18 and 65 years who were treated with outpatient surgery and who had hip OA and pain intensity at baseline of >20 on a 100-mm visual analog scale (VAS) were recruited for this study. Exclusion criteria were extensive surgery; presence of excessive deformities; or rheumatic, infective, cardiovascular, or immune system disorders. The primary outcome measure was a change in pain intensity as assessed by the VAS at 2, 6, and 12 months after treatment. Secondary outcome measures were the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and concentration of growth factors in PRP and their correlation with clinical outcomes. Clinical outcomes were evaluated by assessors and collectors blinded to the type of treatment administered.
  
  
  RESULTS
  A total of 111 patients were randomly assigned to 3 groups and received 3 weekly injections of either PRP (44 patients), PRP+HA (31 patients), or HA (36 patients). At all follow-ups, the PRP group had the lowest VAS scores. In particular, at 6-month follow-up, the mean VAS score was 21 (95% CI, 15-28) in the PRP group, 35 (95% CI, 26-45) in the PRP+HA group, and 44 (95% CI, 36-52) in the HA group (P < .0005 [PRP vs HA] and P = .007 [PRP vs PRP+HA]; F = 0.663). The WOMAC score of the PRP group was significantly better at 2-month follow-up (mean, 73; 95% CI, 68-78) and 6-month follow-up (mean, 72; 95% CI, 67-76) but not at 12-month follow-up. A significant, "moderate" correlation was found between interleukin-10 and variations of the VAS score (r = 0.392; P = .040). Significant improvements were achieved in reducing pain and ameliorating quality of life and functional recovery.
  
  
  CONCLUSIONS
  Results indicated that intra-articular PRP injections offer a significant clinical improvement in patients with hip OA 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+HA did not lead to a significant improvement in pain symptoms.
authors.affiliation: Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy dante.dallari@ior.it.
authors.forename: Dante
authors.initials: D
authors.lastname: Dallari
authors.affiliation: Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Stagni
authors.affiliation: Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Rani
authors.affiliation: Conservative Orthopedic Surgery and Innovative Techniques Ward, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Sabbioni
authors.affiliation: Radiology and Diagnostic Imaging Department, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pelotti
authors.affiliation: Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Torricelli
authors.affiliation: Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Tschon
authors.affiliation: Preclinical and Surgical Studies Laboratory, Rizzoli Orthopedic Institute, Bologna, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Giavaresi
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007270:Injections, Intra-Articular / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging* / Q000628:therapy*; D010147:Pain Measurement; D053657:Platelet-Rich Plasma; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid
keywords: hip; hyaluronic acid; intra-articular injection; osteoarthritis; platelet-rich plasma