Is Hyaluronic Acid Injected Into Arthritic Hips?

An X-ray showing hip arthritis.
An X-ray showing hip arthritis. ZEPHYR/Getty Images

Question: Is Hyaluronic Acid Injected Into Arthritic Hips?

Intraarticular hyaluronic acid injections are one of the treatment options for knee osteoarthritis. What do we know about the effectiveness of hyaluronic acid for the hip? Have hyaluronic acid injections been studied for other joints or is it primarily used to treat knee osteoarthritis?

Hyaluronic Acid Injections Are FDA-Approved for Knee Osteoarthritis but Not for Hips

Hyaluronic acid injections have been FDA approved for many years as a treatment for knee osteoarthritis.

But hyaluronic acid has not been approved for hips or other joints. Nevertheless, some doctors have been using it off-label for hip injections for their patients. For example, Blue Cross/Blue Shield medical insurance considers intra-articular injections of it in any joint other than the knee to be investigational and not medically necessary. Researchers have studied the effectiveness of hyaluronic acid injections for the hip and the results were unimpressive. The American College of Rheumatology does not recommend using it for hip osteoarthritis.

Injectable Hyaluronic Acid Drugs

There are several brands of injectable hyaluronic acid, with Synvisc being the one that was first approved. Euflexxa, Orthovisc, Hyalgan, and Supartz are others. Synvisc-One was approved on February 26, 2009 as a single injection formulation of Synvisc, which requires a series of three injections.

Hyaluronic Acid Ineffective for Hip Osteoarthritis

Hyaluronic acid aims to restore the normal properties of synovial fluid.

It has also been suggested that hyaluronic acid may have a protective effect on cartilage, and may reduce the production and activity of chemicals involved in inflammation (such as proinflammatory mediators, matrix metalloproteinases).

According to one study, a single injection of hyaluronic acid is not effective for hip osteoarthritis -- actually, no more effective than placebo. Because hyaluronic acid is rapidly cleared from joints, more than one injection could be needed to provide benefit. Rapid clearance of hyaluronic acid is just one theory of why multiple injections may produce a better result.

Studies that looked at the effectiveness of hyaluronic acid for hip osteoarthritis have been small and scarce. More studies are needed to determine if hyaluronic acid is a suitable treatment option for joints other than the knee.

Hyaluronic Acid Injections Also Falling Out of Favor for Knee Osteoarthritis

A Cochrane review of 76 studies, published in 2006, concluded that hyaluronic acid was no more effective overall for knee osteoarthritis than NSAIDs.

It reduced pain levels, but no more than that standard treatment, and takes five weeks to produce full effects. The advantage was that the effects can be longer lasting. Based on a review of 15 studies, the American Academy of Orthopedic Surgeons (AAOS) issued new recommendations in June, 2013 saying hyaluronic acid doesn't meet minimum clinically important improvement measures. This may lead to fewer and fewer doctors using these injections for knee osteoarthritis.

Sources:

Effect of hyaluronic acid in symptomatic hip osteoarthritis: A multicenter, randomized, placebo-controlled trial. Arthritis & Rheumatism. March 2009. Richette P et al.

Hyaluronic Acid Injections for Osteoarthritis, Timothy Gower, Arthritis Foundation, accessed 1/5/16.

Bellamy N, et. al. "Viscosupplementation for the treatment of osteoarthritis of the knee." Cochrane, 19 April 2006.

Hochberg MC, Altman RD, April KT, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res (Hoboken). 2012; 64(4):465-474.

Treatment of Osteoarthritis of the Knee Evidence-Based Guideline 2nd Edition. American Academy of Orthopaedic Surgeons Board of Directors May 18, 2013.

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