Intra-articular saline as good as other injectable options in hip osteoarthritis
Intraarticular (IA) hip
saline injections performed as well as all other injectable options in
the management of hip pain and functional outcomes, suggests a recent
study which has been published in the British Journal of Sports
Medicine.
Intra-articular (IA) injections represent a commonly used modality in
the treatment of hip osteoarthritis (OA). Commonly used injections
include corticosteroids (CCS), hyaluronic acid (HA) and platelet-rich
plasma (PRP). The researchers conducted network meta-analysis that
allows for comparison among more than two treatment arms and uses both
direct and indirect comparisons between interventions.
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