Viscosupplementation Is Effective for the Treatment of Osteoarthritis in the Hip: A Systematic Review.

To assess the efficacy of intra-articular viscosupplementation as a therapeutic intervention for hip osteoarthritis (OA), as well as to assess the duration of efficacy, effect of dose, composition and number of injections of the viscosupplement, and the incidence of adverse effects. We performed a systematic review using the literature search from the following databases: Embase, Medline, PubMed, Web of Science, and Scopus. Quality assessment of the included studies was performed using the Modified Newcastle-Ottawa Quality Assessment Scale. Random-effects meta-analysis and mixed-effects subgroup analysis were carried out, but due to the high heterogeneity, low level of evidence, and high risk of bias of the included studies after analyzing the data, weighted means and pooled estimates have not been provided. Instead, we have provided a subjective synthesis of the results. Forty studies were included in the analysis from an initial search of 3,265 studies, with data from a total of 3,350 patients. The level of available evidence was low with an overall high risk of bias. Nearly all studies showed a reduction in mean pain at 1 month, 3 months, and 6 months of follow-up, as well as at the end point, and an improvement in mean patient-reported function was also seen at these time points. However, heterogeneity was extremely high at all time points and remained despite attempts at removing outliers. Subgroup analyses looking at the effects of dose, volume, composition of viscosupplement, and number of injections were carried out, but substantial heterogeneity still remained. There were no lasting adverse effects. Weak evidence suggests that viscosupplementation improves patient-reported pain and function at end point compared to baseline, regardless of dose, volume, composition, and number of injections. However, due to the high heterogeneity, low level of evidence, and high risk of bias in the current available literature, the strength of our conclusions is limited. Level IV, systematic review of level I to IV studies.

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Disclosure The authors report the following potential conflicts of interest or sources of funding: V.K. received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Arthrex and Smith and Nephew; received support for attending meetings and/or travel from Smith and Nephew; has patents planned, issued, or pending for microfluidic force sensors; and has a leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid, for BHS, SICOT, ESSKA, and NAHR. A.W.M. received a grant from Versus Arthritis, received payment or honoraria for manuscript writing from CRC Press, and has patents planned, issued, or pending for Cell Guidance Systems. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.