Intra-articular saline as good as other injectable options in hip osteoarthritis: Study

Osteoarthritis (OA) is a leading cause of disability worldwide, and its prevalence is on the rise globally.

Non-operative treatment for hip and knee OA consists of a stepwise approach, which in reality is generally deployed in a parallel and multimodal manner. Intra-articular (IA) injections represent a commonly used modality in the treatment of hip osteoarthritis (OA). Theoretically, a wide range of IA injection options exists, including local anesthetics, corticosteroids (CCS), hyaluronic acid (HA),platelet-rich plasma (PRP), and mesenchymal stem cells, though their clinical potential remains inconsistent till date.

Keeping this in mind, Aaron Gazendam and associates from the Department of Orthopedic Surgery, McMaster University, Canada undertook this network meta-analysis to compare the efficacy of the various IA injectable treatments in treating hip OA at up to 6 months of follow-up.

For the study, data sources from PubMed, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science, were taken from inception to October 2019. Participants with a diagnosis of primary hip OA and which compared at least two different IA injections were included if they reported at least one pain or functional outcome at up to 6 months of follow-up.

The outcome measures of interest were pain and function scores reported at baseline, 3 months, and 6 months.

On analysis, the following key facts emerged.

• Eleven randomized controlled trials comprising 1353 patients were included.
• For pain outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection.
• For functional outcomes at both 2–4 and 6 months, no intervention significantly outperformed placebo IA injection.
• Regarding the change from baseline at 2–4 months and 6 months, pooled data demonstrated that all interventions (including placebo), except HA+PRP, led to a clinically important improvement in both pains, exceeding the minimal clinically important difference.

The researchers concluded that the evidence suggests that Intra Articular hip saline injections performed as well as all other injectable options in the management of hip pain and functional outcomes.

However the current review demonstrated that no currently available intra-articular injections provide significant improvement in pain and function when compared with placebo at short-term follow-up.

"Limitations of this NMA include the relatively small sample sizes of the included RCTs, which should be considered when designing future trials." said the researchers.

Primary source: British Journal of Sports Medicine

For the full article click on the link : sci-hub.tw/10.1136/bjsports-2020-102179