Comparison of Clinical Efficiency and Safety Between Intra-Articular Injection of Platelet-Rich Plasma and Hyaluronic Acid for Hip Osteoarthritis: A Systematic Review and Meta-Analysis.

抄録

Purpose: The aim of this study is to compare the clinical efficacy and safety of platelet-rich plasma (PRP) and hyaluronic acid in the treatment of hip osteoarthritis.Methods: Data were collected from the PubMed, Embase, Cochrane Library, and Web of Science databases. The outcomes selected included the Visual Analog Scale (VAS) score, the Harris Hip Score (HHS), the Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) and its relevant subscores. A standardized mean difference (SMD) was used as the combined effect size, and a random-effects model was applied for analysis. The magnitude of the effect size was interpreted according to Jacob Cohen's criteria.Results: A total of seven studies involving 465 patients were included. The meta-analysis results indicated that in terms of pain relief, the PRP group showed a statistically significant advantage in VAS scores at 6 months (SMD = -0.38 and p = 0.01). Subgroup analysis revealed that LP-PRP yielded significant improvement (SMD = -0.32 and p = 0.02), whereas LR-PRP did not (SMD = -0.46 and p = 0.18). Similarly, multiple injections (SMD = -0.43 and p = 0.02) demonstrated superiority compared to a single injection (SMD = -0.12 and p = 0.63).Regarding WOMAC-pain scores, the PRP group exhibited statistical differences at 6 months (SMD = -0.45 and p = 0.0006) and 12 months (SMD = -0.36 and p = 0.03). In terms of functional impairment, no significant differences were found in the HHS (SMD = 0.13 and p = 0.64) or WOMAC subscores (WOMAC-stiffness: SMD = 0.01 and p = 0.97 and WOMAC-function: SMD = -0.24 and p = 0.06) at any follow-up time point. However, the WOMAC total score indicated that the overall health status of patients in the PRP group was superior to that in the HA group after treatment (SMD = -0.42 and p = 0.009).Discussion: The findings of this study indicate that compared with HA, PRP demonstrates a statistically significant advantage in alleviating pain (VAS and WOMAC-pain) and improving overall symptoms (WOMAC total score) in patients with hip osteoarthritis (HOA) although the effect size was found to be moderate. However, regarding the improvement of joint function (HHS and WOMAC-function), no significant differences were observed between the two groups. In summary, while PRP presents a statistical benefit over HA in the treatment of HOA, the effect size is limited; therefore, further high-quality studies are warranted to definitively confirm its clinical superiority.