Ultrasound Guided Hip Injections comparing PRP and Hyaluronic Acid

By Phillip Steele, MD RMSK CAQ Sports Medicine
Performance Injury Care & Sports Medicine

Hip Osteoarthritis (OA) is a common and disabling disease in the United States. With improving care and treatment of chronic diseases and over all lower mortality from infectious diseases, the US population is aging, and older Americans are living with disabling arthritic conditions, including hip OA. The projected number of older adults with OA and other chronic joint disease is expected to nearly double, from 21.4 million in 2005 to 41.1 million by 2030.

The burden of hip OA is increasing due to the aging population and the obesity crisis in our country, as a result, the need for total hip replacement surgery (THA) is expected to grow by 174%, or 572,000 THA per year by 2030 in the United States alone. Although the number one most effective treatment for OA is weight loss, many of the aging active lifestyle patients that we care for here in Montana are struggling with hip pain. Recent advances in biological or regenerative approaches to OA continue to improve the quality of our active patients and we would like to share with you a recent study on hip OA published in one the orthopedic journals.

In a 2016 study published in the American Journal of Sports Medicine, researcher compared the effectiveness of platelet rich plasma (PRP) against hyaluronic acid.(HA) They compared these injection strategies for hip osteoarthritis(OA) in a randomized study of 111 individual with hip OA. They followed the patients for one year with 3, 6 and 12 month evaluations and found that PRP significantly improved pain. The six month follow-up was the most pronounced with an average pain score of 21 for the PRP group, 35 for combination therapy and 44 in the HA only group. The overall conclusion of this study was that intra-articular of PRP offered a significant clinical improvement in patients with hip OA with out relevant side effects. This benefit (PRP) was significantly more stable up to 12 months as compared to other treatments.

Although the use of viscosupplements (HA) for knee OA is common in the United States, the use of HA for hip OA is not covered by Medicare and therefore not widely available here. Although widely used throughout the world with moderate success in helping those with hip OA. HA or what many call rooster comb injections (synvisc, orthovisc, hyalgan) are typically injected once a week for three weeks and typically provide pain relief for around six months. PRP has been widely researched in the knee OA and similar to this study has been found to be superior to HA and corticosteroids. As the cost of PRP continues to decline with better techniques it is emerging as the best treatment strategies for OA. With other biologic or regenerative treatments such adipose derived stem cells, bone marrow concentrate and umbilical cord derived stem cells we are developing strategies to help prevent worsening OA and hopefully helping prevent the future need for total hip replacement. If you have questions about treatment to help prevent OA you should consider setting up an appointment to discuss strategies to keep you active.