Viscosupplementation for Hip Osteoarthritis

Introduction to Hip Osteoarthritis Treatment

• The American Academy of Orthopaedic Surgeons provides a strong recommendation against hyaluronic acid injections for hip OA, citing high quality evidence and a strong strength of recommendation 1, 2
• The American College of Rheumatology strongly recommends against hyaluronic acid injections in hip OA, noting that best evidence fails to establish benefit when limited to low risk-of-bias trials 3

Evidence-Based Treatment Recommendations

• The American Academy of Orthopaedic Surgeons and the American College of Rheumatology recommend against viscosupplementation for hip OA, citing a lack of evidence for its efficacy 1, 2, 3
• The American College of Rheumatology/Arthritis Foundation guideline on optimal timing of arthroplasty conditionally recommends proceeding to surgery without delay over delaying for viscosupplementation, noting limited benefit on pain and function 4
• The American Academy of Orthopaedic Surgeons recommends intra-articular corticosteroid injection as a treatment option for symptomatic hip OA, with high quality evidence supporting its use 1, 2, 5

Treatment Algorithm for Moderate-Severe Hip OA

• For patients with moderate-severe hip OA, the treatment algorithm includes intra-articular corticosteroid injection, consideration of duloxetine as a pharmacologic adjunct, and proceeding toward total hip arthroplasty evaluation without further delay 1, 2, 4, 5
• The American Academy of Orthopaedic Surgeons recommends that patients who are otherwise total hip arthroplasty candidates should not be delayed for ineffective treatments, including viscosupplementation 4

Summary of Recommendation Strength

1, 2, 3, 4, 5